Interdisciplinary Conference on the Diagnosis and Treatment of Early Stage Breast Cancer

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1 The Vásárhely Health Program is pleased to present: 3D image of the breast tissue on the Diagnosis and Treatment of Early Stage Breast Cancer in Hódmezővásárhely Bessenyei F Community Center Dr. Rapcsák András u 7 Jan 24-26, 2013 Galactography of a lobe Designed for: Radiologists Surgeons Pathologists Gynecologists Radiology Technologists 2013 BREAST SEMINAR SERIES LÁSZLÓ TABÁR, M.D.,F.A.C.R (Hon) Professor emeritus of Radiology and TIBOR TOT, M.D.,Ph.D. Chairman, Department of Clinical Pathology, Falun, Sweden Jan 24-26, 2013 This course provides extensive knowledge about diagnostic breast imaging correlated to modern large thin and thick section histology, differential diagnosis of breast diseases, implications for management and newest diagnostic technologies

2 FACULTY Radiologist László Tabár, M.D., F.A.C.R. (Hon). Professor emeritus of Radiology Uppsala School of Medicine Department of Mammography Falun, Sweden Pathologist Tibor Tot, M.D., Ph.D. Associate Professor of Pathology Uppsala School of Medicine Chairman Department of Clinical Pathology & Cytology Falun Central Hospital Falun, Sweden. II

3 Vásárhely Health Program (EVP), launched in January 2008, is the 10-year public health program of Hódmezővásárhely. It has been developed by the Municipality of Hódmezővásárhely and the city hospital (EKRI). Implementation of EVP is based on effective teamwork of stakeholders including the Municipality, the hospital, GPs, social welfare institutions, social workers, the education system, the Police, the local media, private companies, sport clubs, different facilities and NGOs. Among the key priorities of EVP are mammography screening, fight against cardiovascular diseases, supporting improvement of children's health, etc., but since breast cancer is one of the major causes of cancer death in the EU and also in the region of Hódmezővásárhely, we emphasize the need for efficient work against it. Our mammography screening results are exceptional: attendance of yr old women in mammography screening has increased from 40-45% to close to 70% during the past 5 years. This makes early detection and appropiate treatement of breast cancer possible, and as a result, we reduce the rate of advanced cancers as well as death from breast cancer. CREDITS We would like to thank Árpád Kallai MD., Radiologist, General Director, Erzsébet Hospital and Medical Center, Hódmezővásárhely, for initiating and supporting this medical educational event. NOTE Images from the non-profit Tabar Foundation for Research and Education for Breast Cancer III

4 rect terminology, 2013 BREAST SEMINAR SERIES of 1st day Morning lectures between 8:30 AM and 12:00 8:30 INTRODUCTION - Arpad Kallai, M.D., A NEW ERA in the DIAGNOSIS and TREATMENT of BREAST CANCER. L Tabár New Era pathology techniques: Large section histology - T Tot THE BASIS FOR EFFICIENT INTERPRETATION OF THE MAMMOGRAPHIC IMAGE Correlative 3-dimensional, subgross anatomy and mammography of the normal breast The problem: The variable appearance of the normal mammogram. The solution: classification into structural subtypes, mammographic parenchymal patterns, based on 3D/subgross histologic-mammographic correlation. Result: Increased confidence in reading a mammogram and finding subtle perceptual abnormalities The dynamic change of mammographic patterns and its application in clinical practice Breaks at 10:00 and at 11:00 AM MAMMOGRAPHIC PARENCHYMAL PATTERNS Practical implication, problems and solutions. Mammographic patterns and the risk of developing breast cancer. Understanding the mammograms of dense breasts. I II III IV V 12:00-1:00 L u n c h IV

5 2013 BREAST SEMINAR SERIES of 1st day Afternoon lectures between 1:00 PM and 4:30 PM 1:00 THE DIDACTIC LECTURE SERIES WILL COVER THE FOLLOWING TOPICS: ALGORITHM FOR CLASSIFYING BREAST DISEASES ACCORDING TO THEIR SITE OF ORIGIN: NEW ASPECTS, SUGGESTION FOR NEW TERMINOLOGY. IN SITU CARCINOMA SUBTYPES.. Breast diseases originating in the major ducts Benign type calcifications originating in the major ducts a) Secretory disease type calcifications Malignant type calcifications originating in the major ducts L Tabár, T Tot Secretory disease type calfications a) Fragmented casting type calcifications b) Dotted casting type calcifications c) Skipping stone-like calcifications 4:30 End of Day 1 * Four different malignant type calcifications developing in the major ducts: a) fragmented casting type b) dotted casting type c) skipping stone-like d) pearl necklace-like. * The concept of neoductgenesis. Long-term follow-up results. New aspects, correct terminology. * Th erole of breast MRI examination in demonstrating the extent of Gr 3 in situ carcinoma. * Mammographic/3D histologic correlation helping to explain the underlying pathophysiology and outcome. d) Pearl necklace-like calcifications V

6 2nd DAY Morning lectures between 8:00 AM - 12:00 8:00 ASYMMETRIC DENSITIES ON THE MAMMOGRAM - L Tabár, T Tot Didactic workup of non-specific asymmetric densities without architectural distortion ANALYSIS of BENIGN RADIATING STRUCTURES on the mammogram, originating in the ducts - Radial scar. A suggested algorithm for the workup of stellate lesions - Indications and contraindications of using minimally invasive preoperative diagnostic techniques. Breaks at 10:00 AM and at 11:00 AM Radial scar ANALYSIS of MALIGNANT LESIONS PRESENTED as RADIATING STRUCTUREs on the mammogram. Clinical presentation, mammographic appearance and outcome: - L Tabár, T. Tot - Invasive lobular carcinoma: the most deceptive and frequently missed cancer of the breast. The value of ultrasound and MRI in finding and diagnosis invasive lobular cancer subtypes. Case demonstrations - Neoductgenesis cases presenting on the mammogram as architectural distortion - A suggested algorithm for the workup of lesions with architectural distortion - Indications and contraindications of using minimally invasive preoperative diagnostic techniques. Essential pathology diagnosis of mammographically detected 1-14 mm invasive breast cancer - T Tot 12:00-1:00 L u n c h VI Multimodality workup of a huge invasive lobular carcinoma

7 2nd DAY Afternoon lectures between 1:00 PM - 4:30 PM 1:00 THE DIDACTIC LECTURE SERIES WILL COVER THE FOLLOWING TOPICS: ALGORITHM FOR CLASSIFYING BREAST DISEASES ACCORDING TO THEIR SITE OF ORIGIN Didactic workup of asymmetric densities caused by: Benign breast diseases originating in the TDLU - L Tabár, T. Tot - - Fibrocystic change. Fibroadenoma. Different types of adenosis.understanding pathophysiology leading to calcified and non-calcified hyperplastic breast changes. - Detailed analysis of calcifications associated with hyperplastic breast changes Weddellites, powdery calcifications, pleomorphic calcifications on the mammogram. Malignant breast diseases originating in the TDLU: - L Tabár, T. Tot 1) Grade 1 in situ carcinoma: Mammographic / 3-D histologic / MRI correlation of cases with powdery calcifications on the mammogram Breaks at 2:30 PM and at 3:30 PM 2) Grade 2 cancer in situ: Mammographic / 3-D histologic / MRI correlation of cases with crushed stone-like/pleomorphic calcifications on the mammogram. 3) The issue of uni-and multifocality of breast cancer - T. Tot 4:30 End of Day 2 VII

8 3rd DAY Morning lectures between 8:00 AM - 12:00 8:00 HOW TO FIND THE INVASIVE BREAST CANCER WHEN IT IS STILL SMALL. SCREENING COMBINED WITH AN ANALYTICAL APPROACH FOR THE DIFFERENTIAL DIAGNOSIS OF STELLATE/SPICULATED LESIONS - L Tabár Breaks at 10:00 AM and at 11:00 AM A systematic method for viewing mammograms. Areas on the mammogram where most breast cancers will be found Viewing dense breasts Viewing relatively easy-to-read breasts PRACTICE IN PERCEPTION OF SUBTLE, NON-CALCIFIED CANCERS The role of hand-held ultrasound / 3D automated ultrasound / MRI in the detection and workup of the findings. The multimodality approach Malignant stellate lesions: clinical presentation, histology, mammographic/ MRI/ ultrasound appearance and outcome: - L Tabár, T. Tot - invasive breast carcinoma, not otherwise specified (NOS): the most frequently occurring carcinoma. Multimodality case demonstrations - tubular carcinoma: the stellate tumor with the best outcome - sonographic and MRI correlation with the mammogram Multifocal invasive and in situ carcinoma on an area measuring 180X60 mm pn 4/9 12:00 - End of course VIII

9 EXAMPLES: HOW TO FIND THE INVASIVE BREAST CANCER WHEN IT IS STILL SMALL. SCREENING COMBINED WITH AN ANALYTICAL APPROACH FOR THE DIFFERENTIAL DIAGNOSIS OF STELLATE/SPICULATED LESIONS, cont. Mammograms and MRI images of a diffuse cancer case Subtle mammography finding / MRI shows that the entire lobe is filled with a diffuse breast cancer, confirmed at histology IX

10 For registration and information, contact: EVP Office Fax: or Register Online at: The schedule is subject to change without notice and does not represent a commitment on the part of EVP All rights reserved including the right of reproduction in whole or in part of any form. Visit us on the Internet: Copyright Computer simulation images of the development of Grade 2 in situ carcinoma within the TDLU. The lobule becomes gradually distended and deformed. Calcifications are formed within the necrotic debris and are seen on the mammogram as crushed stone-like calcifications. X

11 2013 BREAST SEMINAR SERIES of Teaching Atlas of Mammography László Tabár Peter B. Dean With the contribution of Tibor Tot 4th edition

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