N DUCHESNE 02-2017
publicité
LE CANCER DU SEIN: CANCER LE PLUS FRÉQUENT AU MONDE POUR LA PLUPART DES PAYS DU MONDE: DEMEURE UN PROBLÈME DE SANTÉ PUBLIQUE CERVICAL CANCER BREAST CANCER 7 Nature MedicineISSN: 1078-8956EISSN: 1546-170X A B C 8 D LA SENSIBILITÉ DE LA MAMMOGRAPHIE DÉPEND DE LA DENSITÉ MAMMAIRE OVERALL 85% D E N S E PA R E N C H Y M A ( D ) : 4 5 % IN USA ACR “C” OR “D”: 50% OF <50 YO 33% OF > 50 YO I N U S A : 2 8 - 3 0 % B R E A S T C A A S S O C I AT E D W I T H D E N S I T Y 5 - 1 0 % A S S O C I AT E D W I T H B R C A 1 & 2 BERG ET AL 2015;274:663-673 S E I N S D E N S E S : E X C È S D E S TA G E A V A N C É S ( I I & I I I ) B R E A S T D E N S I T Y A N D L E G I S L AT I O N Connecticut X 2009 LOI SUR LA DENSITÉ MAMMAIRE SCREENING MAMMO NORMAL ABNORMAL WORK-UP BREAST DENSITY EVALUATION & RISK ASSESSMENT ACR C OR D OR RISK 15-20% ACR A OR B OR RISK <15% ROUTINE SCREENING BUS? ABUS? TOMOSYNTHESIS? NORMAL LESIONS SUPERIMPOSED IN 2D MAMMOGRAPHIE 3D/ TOMOSYNTHÈSE 2D FFDM 1 SLICE DBT TOMOSYNTHÈSE MOINS DE RAPPELS MAMMOGRAPHIE DE CONTRASTE MAMMOGRAPHIE DE CONTRASTE Images courtesy of Institut Gustave Roussy, Villejuif, France MAMMOGRAPHIE DE CONTRASTE Histology : IDC Images courtesy of Institut Gustave Roussy, Villejuif, France R E V I E W O F T H E L I T T E R AT U R E MEAN SIZE < 1CM >85% INV AND LN BREM R ET AL. AJR 2015; 2044:234-240 É C H O G R A P H I E A U T O M AT I S É E - A W B U S O R A B U S SPECIFIC PROBES ROBOTIC ARM ABUS- STATIC IMAGES TECHNIQUE 21 22 BREM R ET AL. RADIOLOGY 2015; 274:663-673 US TOPS TOMO IN DENSE BREASTS OR NOT? A S T O U N D S T U D Y: A D J U N C T S C R E E N I N G W I T H T O M O S Y N T H E S I S O R U LT R A S O U N D I N M A M M O G R A P H Y- N E G AT I V E D E N S E B R E A S T T R I A L HOUSSAMI N ET AL. J CLIN ONC 2016 (MARCH) HIGH RISK BREAST CANCER SCREENING RISK AGES SURVEILLANCE PROTOCOL 20-29 30-39 40-49 50+ n/a MRI MRI+ Mammo Mammo +/- MRI FREQUENCY NOTES n/a Annual Annual Annual Review MRI annually on basis of background density MRI MRI MRI+ Mammo Mammo +/- MRI Annual Annual Annual Annual Review MRI annually on basis of background density 30-39 40-49 50+ MRI MRI+ Mammo Mammo +/- MRI Annual Annual Annual A-T Homozygote 25+ MRI Annual A-T Heterozygote 40-49 50+ Mammo Mammo 18 monthly Routine Screening BRCA 1 BRCA 2 Not tested,equivalent risk TP53 ( Li-Fraumeni) Supra-diaphragmatic radiotherapy-irradiated below age 30 0r 8yrs after first irradiation 20-29 30-39 40-49 50+ Review MRI annually on basis of background density No mammo Routine screening from 50 [1] NHS Cancer Screening Programmes. Protocols for Surveillance of Women a Higher Risk of Developing Breast Cancer. NHSPSP publication 2013; no 74 MP MR -DIFFUSION-WEIGHTED MDI -SPECTROSCOPY -MP MRI Pinker K et al. Invest Radiol 2014;49:421-430
