No in stage I, II or operable III - - false positive Less sensitive for ILC Early cancer - - sensitivity to detect axillary adenopathy 20-50%

Breast Cancer NM Flashcards by Vita Kan

Breast cancer T

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Breast cancer N

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Breast cancer M

Bone
Lung
Brain (ER-, HR-)
Liver
Leptomeninges, brain, gyn, GIT (ILC)

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Luminal A 50-55%

ER+
PR+
HER2-
Ki67-
Best prognosis
Hormone therapy - - aromatase inhibitor, tamoxifen

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Luminal B 15%

ER+
PR+
HER2 +-(30%)
Ki67+
Hormone therapy

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HER2 15%

ER-
PR-
HER2+
Trastuzumab, pertuzumab
Cardiotoxic - - MUGA

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Basal-like type 10-20%

Triple negative
Cytotoxic therapy

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ER+

75% of cases

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Breast cancer US

More sensitive than mammography in IDC
US vs MRI to assess largest diameter
LN MTS - - focal cortical thickening >3mm, round (not reni form), no fatty hilum

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Breast cancer MRI

High risk screening
Extent of disease
Recurrence vs scar
Perform in days 7-10 of cycle
Not accurate to assess cortical thickening of LN

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Breast cancer FDG

No in stage I, II or operable III - - false positive
Less sensitive for <1 cm, ILC, grade 1, well diff
Stage III+, locally advanced, inflammatory, recurrent, metastatic - - not replace SLNB - - limited in LN <8 mm
IDC>ILC
Early cancer - - sensitivity to detect axillary adenopathy 20-50%

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Breast cancer FDG
Response to treatment

Complete response - - complete resolution of lesions
Partial response - - reduction >15% SUV after 1 cycle, >25% after >2 cycles
PERCIST - - partial response - - reduction >30% SUL (SUV for lean body mass)
Complete response - - uptake of target lesions <liver

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Breast cancer F-FLT (thymidine)

Good correlation with Ki67, but signal <FDG - - false negative
Phosphorylated by thymidine kinase

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Breast cancer C-Methionine (amino acid)

Correlated with cells in S phase
T1/2 20 min - - cyclotron

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F-fluciclovine
F-FACBC

Also prostate cancer

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O15-labeled water

T1/2 2 min - - cyclotron
Combi with FDG
Tumor blood flow

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F-FES
F-fluoroestradiol

ER expression
Patients who can not be biopsied
Sensitivity 70-100%, specificity 80-100%

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F-FDHT
F-fluorodihydrotestosterone

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AR expression

F-FFNP

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PR specific tracer
Efficacy of antiestrogen therapy

In111-trastuzumab SPECT

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Replaced by
Zn89 - - PET - - T1/2 78.4h - - cross BBB
Cu64 - - PET - - T1/2 12.7h - - less radiation exposure

Breast cancer Bone scan

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Stage I-IIIC - - CT and bone scan
Stage IV - - 70% bone MTS - - CT, bone scan, MRI
FDG - - optional for high risk
Bone scan sensitivity 88%
Response to treatment - - 6 months
Lytic bone MTS with soft tissue mass >10 mm are measurable

Scintimammography

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MBI = molecular breast imaging
Modern BSGI = breast specific gamma imaging
Sestamibi 20-30 mCi - - planar 5-10 min after IV - - lateral and oblique prone with hanging breasts - - anterior, oblique and SPECT supine
Radiation dose 0.07 mSv vs 0.44 mSv mammography

MIBI interpretation

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Accumulates within mitochondria
P-glycoprotein - - multidrug resistant gene - - efficacy of anti cancer drug
Non specific - - false positive - - surgery, fibroadenoma, atypical hyperplasia
Small non palpable - - early disease - - scan negative - - observation
>2 cm - - 100% sensitivity

MIBI indication

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Nipple discharge
Lesions BIRADS-3
Identified lesions
Multiple masses
Architectural distortion
Not possible MRI

MIBI and diagnosed cancer

Extent Multicentric vs multifocal vs bilateral Response to neoadjuvant chemo

Axillary MTS Treatment

Adjuvant systemic therapy if LN>1 cm Postmastectomy radio

Contra to breast conserving therapy

Positive resection margins Multicentric disease (>2 tumors in separate quadrants) Prior radio Pregnancy

SLNB location

Majority to subareolar Sappey plexus 3% internal mammary chain

SLNB injection

Intratumoral - - high activity up to 10 mCi, large volume up to 4 ml - - shine through Peritumoral (deep) - - 2-4 aliquotes on each side 125-250 microCi 0.5-1.0 ml = gold standard - - 20-30% internal mammary Intra/subdermal - - 0.1 ml - - small wheal Periareolar (superficial) - - 2-4 injections 0.1 ml

SLNB indication and Contra

Indication - T1, T2, DCIS>2.5 cm (+mastectomy), before neoadjuvant, male, old, obese without proven axillary LN MTS!! Offer - multicentric, previous surgery or neoadjuvant Contra - T3, T4, inflammatory, DCIS without mastectomy, pregnant

SLNB interpretation

No SLN - - old, obese, tumor not in upper outer quadrant - - no ALND, but if not found during surgery - - maybe ALND 1-2 SLN - - no ALND - - breast conserving surgery + RADIO of whole breast Positive - - mastectomy + ALND

ROLL Radioguided occult lesion localisation

Tc-MAA 2-15 MBq size 10-150 microm Intratumoral Add contrast to radioactive preparation - - mammogram to check correct position Early stage non palpable breast cancer during breast conserving surgery

ROLL with seeds

Similar to Brachytherapy in prostate cancer 4.5*0.8 mm titanium capsule with 1-10 MBq I125 T1/2 59.4 dayst Low energy gamma 27 keV In center of non palpable breast lesion few days before surgery Excision guided by gamma probe

SNOLL Sentinel node and occult lesion localisation

TC-MAA intratumoral for ROLL + Tc-nanocolloid subdermal/intratumoral for SLNB Only a minor fraction migrated through lymphatic channels - - most retained at injection site If use Seeds for ROLL - - energy window of gamma probe between 27 keV of I125 and 140 keV of Tc - - discriminate gamma ray emission