Download Maryam Rahmani MD

‫به نام او‬
Role of imaging in
LABC management
Maryam Rahmani MD
Associate professor
Tehran university of Medical Science
Radiology Department
Imam Khomeini Hospital
Imaging & LABC
 Diagnosis and staging
 Metastatic work up
 Response to therapy
Definition
 T3, T4
 N2
 Inflammatory carcinoma
 Patients with LABC have a high risk of both
LR and DM.
 Proper initial imaging of the breast and
nodal beds is essential for staging,
determining response to neoadjuvant
therapy, and RT planning.
 Breast conservation can be achieved in a
select population of patients who have
noninflammatory LABC and a good
response to neoadjuvant chemotherapy.
Role of imaging
 Local staging;
mammography
US
MRI
 Metastatic work up
 Response to neoadjuant therapy;MRI
Case 1 & 2
 CNB proved IDC
 Dense breast in mammography
 Multiple masses in US
 Metastatic work up ;negative
 MRI performed for initial local staging
Case 1
 Bulky tumor
 Skin;nl
 Nipple;nl
 Pectoralis muscle;nl
 LN;N1
 Maybe a good candidate for breast
conserving surgery
 Marker replacement before NAC
 The consensus reached at the Canadian
Consortium for Locally Advanced Breast
Cancer (COLAB) in 2011 was that clips
should be inserted at the time of diagnosis
to mark tumor location and that should be
considered the standard of care.
Ontario
 Use of clips allows for more accurate
identification of the original tumor site
(especially if there is complete
response), resection of all (previously)
cancerous tissue with adequate
margins, pathologic interpretation of
the most appropriate area of
specimens, and greater accuracy of
molecular analyses.
Case 2
 Multifocal lage masses
 Close contact with chest wall
 Probable nipple involvement
 Skin;nl
 LN;N2
 BCS is not an appropriate suggestion
Response to treatment
 MR imaging findings are a stronger predictor
of pathologic response to NACT than clinical
assessment
 It is more accurate in HER 2 + tumors and
triple –
 But it’s not optimal
Why ?
 Since MR imaging relies on contrast enhancement
to depict residual disease, it may not depict small
foci or scattered cancer cells or clusters that need
little vascular supply to survive.
 Mixed fibrosis and scattered cancer cells are
problem
The limitation of MRI
 Depicting scattered residual disease is the
major reason for the false-negative
diagnoses.

Also, this limitation is the source of high
discrepancy in the tumor size measured at
MR imaging and that measured at
pathologic examination.
 Enhancing DCIS plus invasive tumor
Better results
 The more aggressive tumors are known to
have a better response to chemotherapy,
and that would minimize the possibility of a
false-negative diagnosis made at MR
imaging.
Diagnostic results of MR imaging should be
used with caution in surgical planning:
 HER2-negative
 Hormone receptor–positive cancers
 Non masslike enhancement
 As they are more likely to show residual
disease as small foci or scattered cells after
NAC, leading to underestimation of residual
disease extent at MR imaging
Case 3
Case 4
Thanks for your attention