E1655. Imaging Appearance and Treatment Goals for Early Stage, Locally Advanced, and Metastatic Breast Cancer
  1. Hana Haver; University of Maryland Medical Center
  2. Nikki Tirada; University of Maryland Medical Center
Breast cancer is the most common malignancy in women. Fortunately, given routine screening, the majority of newly diagnosed breast cancers are nonmetastatic, including early stage or stage I to IIB (T2N1) and locally advanced or stage IIB (T3N0) to stage IIIC breast cancer. Patients with de novo stage IV breast cancer are seen in approximately 6% of women with a new diagnosis. Imaging plays a crucial role in initial staging, including determining the size of the cancer, identifying suspicious axillary and internal mammary chain lymph nodes, and recognizing metastatic disease. Caring for patients with breast cancer requires a multidisciplinary approach and here we aim to review the imaging appearance of breast cancers at an early stage, locally advanced breast cancer (LABC) and metastatic breast cancer (MBC). We will discuss the recommended imaging modalities, mammography, CT, MRI and PET, and touch on the latest advances in specific breast cancer radiotracers. Treatment goals for each stage will be discussed, including how to determine if a patient is eligible for neoadjuvant chemotherapy, and when to consider breast conservation therapy. In conjunction with the treatment for the physical aspects of breast cancer, we will discuss the role of supportive and palliative care to provide psychosocial support for patients and their families.

Educational Goals / Teaching Points
This exhibit aims to use a series of cases to work through a step-wise approach to staging of breast cancer, patient-centered treatment plans and review their respective treatment goals. The intersection of palliative care and breast cancer care will be discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multimodality examples of early stage breast cancer, locally advanced breast cancer (LABC) and metastatic breast cancer (MBC) will be shown and imaging features will be discussed. Multidisciplinary treatment tools for each patient stratification will be reviewed, including those that address the patient’s physical health, such as neoadjuvant chemotherapy, radiation and surgery. With a discussion of psychosocial health, including supportive and palliative care, we will bring the radiologist up to date with the current recommendation to recommend utilizing these services for patients with new cancer diagnoses, which may serve as an additional tool during these patient interactions. By increasing the radiologist’s familiarity with identifying breast cancer stages and understanding the associated treatment options, we hope this facilitates efficient communication with both the patient and interdisciplinary breast care colleagues.

In this exhibit, we ask learners to build on their knowledge of imaging advanced breast cancer and incorporate an understanding of treatment goals, supporting the physical and psychosocial wellbeing of the patient, to enhance the experience of both the patient and the radiologist.