E5193. Be the Best at Breast: Imaging Findings that Change Clinical Management
  1. Daniella Boros; University of California - Los Angeles
  2. Olivia Linden; University of California - Los Angeles
  3. Bo Li; University of California - Los Angeles
Diagnostic imaging of breast cancer helps guide clinical and surgical management. Therefore, it is important for radiologists to understand how specific imaging findings may affect treatment. The purpose of this education exhibit is to: review breast cancer staging, summarize indications for different types of breast cancer treatment (including surgery, radiation, and systemic therapy), and provide a pictorial review of pertinent imaging findings. Representative cases will be included to highlight the relevance of such findings in clinical management. Image-guided localizations will also be discussed.

Educational Goals / Teaching Points
Key imaging findings that impact clinical and surgical management in breast cancer include multifocal and multicentric disease, nipple and skin involvement, lymphadenopathy, chest wall involvement, and the presence of metastatic disease. These findings impact surgical planning and can determine eligibility for breast conserving surgery. For example, patients with multicentric disease may not be eligible for breast conserving surgery, instead requiring mastectomy. Nipple or skin involvement is important when considering nipple or skin sparing mastectomy. For metastatic disease, neoadjuvant chemotherapy is often indicated with restaging prior to surgical intervention.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A representative case includes: An 89-year-old woman presented with a palpable left breast mass. Diagnostic mammography demonstrated an irregular 19-mm mass with spiculated margins and associated calcifications in the left breast at 11 o’clock, with a second satellite 5-mm mass at 12 o’clock. Ultrasound confirmed these findings. Ultrasound-guided biopsy of the dominant mass was performed, with grade 3 ER/PR/HER2+ invasive ductal carcinoma (IDC) on pathology. The above findings, including two masses located in the same breast quadrant, are consistent with multifocal disease (stage cT1c [multifocal], cN0). The patient qualified for breast conservation therapy. The patient was treated with wire-localized lumpectomy with satellite lesion included in the resection, followed by systemic chemotherapy.

At the conclusion of this presentation, the reader will be able to recognize and comment on important imaging findings that impact clinical and surgical management of breast cancer.