MULTIMODALITY APPROACH TO THE DETECTION AND DIAGNOSIS OF OCCULT BREAST CANCER

16 CME credits (2 1/2 day courses) - 26 CME credits (3 1/2 and 4 1/2 day courses)

Brief overview of course content and methodology with a few image examples:

• The mammographic, ultrasound, MRI, and histologic images of a wide range of breast diseases will be explained using the latest presentation technology tools (click here) in a multiple-screen presentation format.

• Unique thick-section histologic images graphically illustrate (click here) the normal breast structure and its alterations with disease. This type of presentation will help the attendees understand the underlying pathophysiology, explaining the mammographic and ultrasound appearance of the alterations.

• Didactic correlation between the clinical picture, mammograms, galactogram, and thick section / 3D histology is an approach which can be readily understood and applied in practice. Example:

• Illustration of the entire spectrum of breast pathology using:
  • large histology sections (10 x 8 cm)
  • thick section / 3D pathology
  • the corresponding mammography images

• Breast ultrasound lecture by Ward Parsons, M.D., R.T., RDMS at the 3 1/2 and
  4 1/2 day courses only.

• Film reading session: normal mammograms mixed with early breast cancer cases displayed on motorized multiviewers. Immediate feedback following reading.

Example from the "test yourself" cases:

• Hands-on positioning workshop with live models for technicians only.
  Instructors: Joan Berry, R.T. and Sandy Reynaga, R.T.

• Interactive lecture by radiologist and surgeon regarding the diagnosis and treatment of DCIS subtypes and invasive breast cancers.
  

Faculty:

Program Objectives:

Having participated in this course, the physician should:

• Be familiar with the varying appearance of a normal mammogram.
• Understand the subgroups of in situ and invasive breast cancer.
• Have competence in the differential diagnosis of breast diseases.
• Be able to guide the diagnostic workup using mammography, ultrasound and perform needle biopsy.
• Be able to analyze the mammographic and ultrasound image and determine which adjunctive methods will be most appropriate for each of the subgroups of breast diseases.
• Appreciate the importance of weekly tumor board meetings and cooperation among radiologists, surgeons and pathologists.
• Understand the value and relationship of the main prognostic factors in order to predict the outcome of the disease.
• The technologists having attended the course should be proficient in mammographic technique and understand the rationale of mammographic workup in order to be a valuable member of the diagnostic team. This course is particularly recommended for technologists already familiar with mammography.

Topics Covered:

• Normal breast - mammographic appearance; variations, impact of HRT.

• DCIS and its subtypes -a special challenge.

• The many histologic subgroups of invasive breast cancer and their varying
  mammographic appearance.

• Description of the natural history of breast cancer subtypes.

• Mammographic differential diagnosis in depth :
  • calcifications
  • stellate lesions
  • circular / oval shaped lesions
  • lymphedema of the breast
• Mammographic-pathologic correlation with long term follow up data from a mammography screening trial.

• Therapeutic implications: How can good, correlative mammography and pathology assist the surgeon in decision making?
• Description of the sentinel node technique .
• New insights into the natural history of breast cancer. Who should be screened and how often?

DCIS and nonpalpable invasive breast cancer:

• diagnostic criteria and new classifications

• thorough mammographic/histologic correlation of breast cancer subtypes

• tips for finding breast cancer at its earliest detectable stages
• interventional diagnostic procedures: indications and contraindications for many new needle biopsy options and/or surgical biopsy

New therapeutic options in early stage breast cancer: smaller cancer - lesser treatment?

Axillary dissection: re-evaluation of its role. Sentinel node technique.

• The role of local and systemic treatment in the management of mammographically detected breast cancer.
  
• Description of indications and contraindications of interventional diagnostic procedures while solving diagnostically challenging cases.