NCoBC 2014 March 15-19 Las Vegas

New Insights for the Diagnosis of Benign Breast Disease

Tuesday, March 18 at 2:10pm during the Clinical Track Breakout

Steven E. Harms, MD, FACR
Clinical Professor of Radiology, University of Arkansas for Medical Sciences
Director, The Breast Center of Northwest Arkansas, Fayetteville, AR

Breast MR is well established for the screening of high-risk patients and for pre-treatment staging of breast cancer; but MR also has significant value in the diagnostic evaluation of patients with inconclusive clinical examinations and mammograms. This presentation will provide some examples of how breast MR can be used to diagnose a variety of common clinical presentations for benign diseases of the breast.

A wealth of diagnostic information lies beyond the bright objects seen on a subtracted MR image. Diagnostic breast MR should include methods for making fluid weighted images and dynamic contrast-enhanced images. Visualization of these data combined with high resolution images can be used to extract histologic detail to accurately characterize a variety of breast diseases.

The most common symptom seen in patients presenting for mammography is breast pain, yet most diagnostic work-ups for pain are negative. Some of these patients may have thrombophlebitis of the breast (Mondor’s disease). The most common presenting symptom of Mondor’s disease is breast pain. An accurate MR method for venous imaging integrated with routine breast MR facilitates the diagnosis of venous thrombosis of the breast. The reported incidence of Mondor’s disease is only 0.5-0.8%, but it is clearly under-diagnosed by conventional imaging. In our practice, the incidence of Mondor’s disease as diagnosed by MR is about 1%. Not only can Mondor’s disease be a diagnostic cause of breast pain, but it is important because of its high association with malignancy (Trousseau’s sign).

Masses that occur due to infection may simulate malignancy and vice-versa. The presence of a high fluid content on MR may be used to distinguish abscess from tumor necrosis. This appearance can also be distinguished from lakes of mucin seen with mucinous carcinoma.

MRI is indicated in a patient presenting with spontaneous, unilateral bloody or serous nipple discharge with inconclusive mammography and/or ultrasound. It is recognized that MR may identify an occult malignancy that may not be seen with conventional imaging. However, intraductal papilloma (61%) is a far more common etiology for this condition than is malignancy (13%). Intraductal papilloma is difficult to identify on most MR images. A MR method for accurately identifying intraductal papillomas that are missed with ultrasound or galactography is presented. This method is integrated into routine breast MR examinations. Minimally invasive management can be used to avoid the cost and morbidity of surgical treatment.

One of the most important issues in improving the specificity of breast MR is the accurate distinction of benign proliferative disease from ductal carcinoma in situ (DCIS). Both are seen as non-mass enhancement on breast MR. Improvements in image contrast and resolution can be used to exploit features that make this characterization much more straightforward. Following these guidelines can help reduce false positive breast MR examinations and unnecessary benign biopsies.

Breast MR can accurately diagnose benign lesions of the breast and be integrated into the diagnostic imaging work-up for a number of common presentations. Knowledge of the appearances of benign and malignant conditions may be used to avoid unnecessary biopsies and surgery for benign conditions.

Models of Navigation

Saturday March 15 at 8:45am during the Navigation Course

Karyl Blaseg, RN, MSN, OCN
Cancer Administration, Billings Clinic

Over the past several years, the traditional navigation role has expanded to support a broad range of roles in a variety of settings. This session will provide an overview of the historical development of navigation programs before highlighting different models of navigation, including lay navigation, site-specific navigation, and setting-specific navigation. Case scenarios will be utilized to depict key navigator roles and responsibilities within each model, such as providing education, resources, coordination of care and support for patient and family.

Attendees of this session will be better able to assess the best model for their breast center environment as there is no single patient navigation model. Navigation is a dynamic process making it possible and necessary that the program at each site meets the needs of the patients and services available for that site. Attendees will have a clear understanding of the complex issues involved as well as the roles and responsibilities of each model.

Quality Improvement Initiatives

Saturday March 15 at 3:15pm during the Navigation Course

Karyl Blaseg, RN, MSN, OCN
Cancer Administration, Billings Clinic

Identifying areas which could benefit from process improvement initiatives is key to the success of any navigation program. This session will discuss opportunities for navigators to utilize in further enhancing their own programs and demonstrate the overall impact navigation-led quality initiatives can have on improved patient outcomes. Practical examples of tools and strategies will be provided for participants to consider utilizing in their own setting.

In addition, the attendees will learn how to assess system barriers and program gaps as well as identify internal champions - all of which are critical to understand before moving forward with a definitive navigation program. Among the tools to be discussed are needs assessments, satisfaction surveys, chart audits, national benchmarks, process flow mapping and fishbone diagrams. Likewise, establishing priorities and setting goals for quality improvement activities will be discussed so that attendees can return to their breast centers with specific initiatives in mind.