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Review
. 2017 Feb;208(2):248-255.
doi: 10.2214/AJR.16.17130. Epub 2016 Dec 8.

Paradigm Shifts in Breast Care Delivery: Impact of Imaging in a Multidisciplinary Environment

Savitri Krishnamurthy  1 , Therese Bevers  2 , Henry M Kuerer  3 , Benjamin Smith  4 , Wei Tse Yang  5
Affiliations
Review

Paradigm Shifts in Breast Care Delivery: Impact of Imaging in a Multidisciplinary Environment

Savitri Krishnamurthy et al. AJR Am J Roentgenol. 2017 Feb.

Abstract

Objective: The practice of breast imaging in a collaborative multidisciplinary environment adds significant value to outcomes in women's health care. In this article, we describe multidisciplinary considerations in breast cancer screening and early detection, the impact of imaging and histopathologic findings in the diagnostic evaluation and management of breast abnormalities, and the contribution of imaging to surgical and radiation therapy planning for the breast cancer patient.

Conclusion: The multidisciplinary delivery of breast care for women that incorporates screening, diagnosis of borderline and high-risk lesions, and management of the breast cancer patient adds considerable value to outcomes in health care.

Keywords: atypia; biopsy; breast cancer; lobular neoplasia; nodal metastases; ultrasound.

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Figures

Fig. 1
Fig. 1
27-year-old woman with biopsy-proven invasive ductal right breast cancer metastatic to right axilla. A. Baseline ultrasound right axilla demonstrates markedly hypoechoic node (arrow) with clip in situ (short arrow) that was placed at time of needle biopsy. B. Follow-up ultrasound right axilla 6 months later after completion of neoadjuvant chemotherapy shows interval decrease in size of hypoechoic node (arrow), and clip (short arrow). C. Ultrasound right axilla during I125 radioactive seed placement shows radioactive seed within node (arrow), and shaft of introducer (short arrow). D. Right MLO mammogram demonstrates radioactive seed (long arrow) and marker clip (short arrow). E. Specimen radiography of right axillary content at surgery confirms removal of seed (long arrow) and clip (short arrow).
Fig. 1
Fig. 1
27-year-old woman with biopsy-proven invasive ductal right breast cancer metastatic to right axilla. A. Baseline ultrasound right axilla demonstrates markedly hypoechoic node (arrow) with clip in situ (short arrow) that was placed at time of needle biopsy. B. Follow-up ultrasound right axilla 6 months later after completion of neoadjuvant chemotherapy shows interval decrease in size of hypoechoic node (arrow), and clip (short arrow). C. Ultrasound right axilla during I125 radioactive seed placement shows radioactive seed within node (arrow), and shaft of introducer (short arrow). D. Right MLO mammogram demonstrates radioactive seed (long arrow) and marker clip (short arrow). E. Specimen radiography of right axillary content at surgery confirms removal of seed (long arrow) and clip (short arrow).
Fig. 1
Fig. 1
27-year-old woman with biopsy-proven invasive ductal right breast cancer metastatic to right axilla. A. Baseline ultrasound right axilla demonstrates markedly hypoechoic node (arrow) with clip in situ (short arrow) that was placed at time of needle biopsy. B. Follow-up ultrasound right axilla 6 months later after completion of neoadjuvant chemotherapy shows interval decrease in size of hypoechoic node (arrow), and clip (short arrow). C. Ultrasound right axilla during I125 radioactive seed placement shows radioactive seed within node (arrow), and shaft of introducer (short arrow). D. Right MLO mammogram demonstrates radioactive seed (long arrow) and marker clip (short arrow). E. Specimen radiography of right axillary content at surgery confirms removal of seed (long arrow) and clip (short arrow).
Fig. 2
Fig. 2
64-year-old woman diagnosed with grade 3 invasive mammary (ductal and lobular features) carcinoma. A. Ultrasound of left axilla shows 2 contiguous markedly hypoechoic left axillary nodes (arrows), suspicious for metastases. B. Ultrasound left supraclavicular nodal region demonstrates multiple small hypoechoic nodes (arrows). Ultrasound-guided needle biopsy confirmed metastatic carcinoma. Radiation therapy was administered to left breast via medial and lateral approach; left supraclavicular fossa and axillary apex were treated via AP oblique photon field.
Fig. 2
Fig. 2
64-year-old woman diagnosed with grade 3 invasive mammary (ductal and lobular features) carcinoma. A. Ultrasound of left axilla shows 2 contiguous markedly hypoechoic left axillary nodes (arrows), suspicious for metastases. B. Ultrasound left supraclavicular nodal region demonstrates multiple small hypoechoic nodes (arrows). Ultrasound-guided needle biopsy confirmed metastatic carcinoma. Radiation therapy was administered to left breast via medial and lateral approach; left supraclavicular fossa and axillary apex were treated via AP oblique photon field.
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References

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