Breast & Gynecological Diseases Role of Imaging in the Management

Foreword
Foreword
Preface
Contents
Contributors
1: Imaging the Symptomatic Breast in the Pediatric, Young, Pregnant, Lactating, and Transgender Patient
	Imaging of the Breast During Pregnancy and Lactation
	Imaging of the Breast in the Teenage and Transgender Population
	Breast Cancer in Young Women
		Case 1
		Case 2
		Case 3
	Bibliography
2: Imaging of the Symptomatic Breast
	Palpable Abnormalities of the Breast
	Nipple Discharge
	Symptoms Related to Nipple Areola Complex
	Breast Pain
	Inflammatory Breast Carcinoma (IBC)
	Symptoms Associated with Breast Implant Complications
	Axilla
		Non-tumorous Axillary Masses
	Bibliography
3: Imaging of the Symptomatic Male Breast
	Introduction
	Embryology and Anatomy of the Male Breast
	Imaging the Male Breast
		Mammography
		Ultrasound
		Breast Magnetic Resonance Imaging
	Breast Interventional Procedures
	Benign Diagnoses
		Gynecomastia
		Pseudogynecomastia
		Lipoma
		Intramammary Lymph Node
		Pseudoangiomatous Stromal Hyperplasia
		Epidermal Inclusion Cyst
		Granulomatous Mastitis
		Subareolar Abscess
		Myofibroblastoma
		Nodular Fasciitis
		Granular Cell Tumor
		Hemangioma
	Male Breast Cancer
		Invasive Ductal Carcinoma
		Papillary Carcinoma
		Invasive Lobular Carcinoma
		Summary
	References
4: Management of a Woman at Elevated Risk for Breast Cancer
	Introduction
	Identification of the High-Risk Patient
		Hereditary Cancer
			Review
		Under-recognition: The Scope of the Problem
		Benign Atypical Lesions
			ADH/ALH/LCIS and FEA
		Breast Density
		Therapeutic Irradiation
	Risk Modeling
	Gail Model
	Tyrer-Cuzick Model
	Barlow/Breast Cancer Surveillance Consortium
	Claus
	BRCAPRO
	BOADICEA/CanRisk
	Discussion and Clinical Implementation
	Polygenic Risk Score
	Risk Management
	Imaging in High-Risk Patients
		Screening Mammography: Special Challenges
		Choosing the Modality: Digital Mammography Versus Digital Breast Tomosynthesis
		NCCN Criteria for Screening MRI
		ACR Criteria for Screening MRI in Breast Cancer Survivors
		FAST/Abbreviated MRI
		Other Modalities: Ultrasound, Contrast Enhanced Mammography, BSGI, and MBI
		Future Directions in Breast Imaging
	Interesting Cases
		Case 1
		Case 2
		Case 3
	Chemoprevention
		Tamoxifen and Raloxifene
		NSABP P-1 Study: The Breast Cancer Prevention Trial
		STAR Trial
		Low-Dose Tamoxifen
		Exemestane
		Anastrozole
		Risk-Reducing Surgery
		Breast Reconstruction
	Psychological Assessment and Counseling
	Lifestyle Modifications
		Modifiable Risk Factors
			BMI/Exercise
			Alcohol
			Breastfeeding
			Menopausal Hormone Therapy
			What About Contraception?
	Conclusion
	References
5: The Multidisciplinary Approach to Breast Cancer Management
	Introduction
	General Considerations
		Preoperative Multidisciplinary Management
		Intraoperative Multidisciplinary Management
		Postoperative Multidisciplinary Management
	Management of Ductal Carcinoma In Situ
		Key Clinical Trials
			Ongoing Trials
		Selection of Surgical Therapy
			Breast-Conserving Surgery or Mastectomy
			Axillary Staging
		Surgical Technique
			Breast-Conserving Surgery
			Mastectomy
		Radiation Therapy
		Adjuvant Tamoxifen
	Management of Early-Stage Breast Cancer
		Key Clinical Trials
			Trials Comparing BCT and Mastectomy
			Axillary Staging
		Selection of Surgical Therapy of the Primary Tumor
			BCT or Mastectomy
			Breast Reconstruction After Mastectomy
			Management of the Regional Lymph Nodes
		Surgical Techniques
			Breast-Conserving Surgery
			Mastectomy
			Axillary Lymph Node Surgery
		Radiation Therapy
		Systemic Therapy
	Management of Locally Advanced Breast Cancer
		Selection of Surgical Therapy
		Surgical Techniques
			Breast-Conserving Surgery
			Mastectomy
			Axillary Lymph Node Dissection
			Targeted Axillary Lymph Node Dissection
		Radiation Therapy
		Systemic Therapy
	Surveillance for Breast Cancer Patients Who Have Completed Curative Treatment
		Guidelines for Follow-Up After Breast Cancer Treatment
		Actual Practice Patterns
		NCCN Guidelines for Breast Cancer Survivors
	References
6: Screening for Breast Cancer
	Early Detection of Breast Cancer with Mammography: Benefits and Harms
	Mammographic Signs of Breast Cancer
		Uncommon Mammographic Signs of Breast Cancer
	Optimizing Mammographic Interpretation
		Mammography Quality Standards Act (MQSA) Mandated Mammography Audit
	Screening Mammography Guidelines for Women at an Average Risk for Breast Cancer
		Digital Breast Tomosynthesis (DBT)
	Bibliography
7: Emerging Technologies in Breast Cancer Screening and Diagnosis
	Supplemental Screening
	Personalized Risk-Based Screening
	Functional Imaging: CE-MRI, CE-Mammography (CEM), and CE-CBCT
		Contrast-Enhanced MRI (CE-MRI)
		Contrast-Enhanced Mammography (CEM)
		Contrast-Enhanced Cone-beam Breast CT (CE-CBCT)
	Artificial Intelligence
	References
8: Pelvic Pain: Role of Imaging in the Diagnosis and Management
	Acute Pelvic Pain
		Imaging Techniques in the Evaluation of a Patient with Acute Pelvic Pain
		Computed Tomography (CT)
	Gynecological Causes of Acute Pelvic Pain
		Adnexal Causes of Acute Pelvic Pain
			Simple Ovarian Cysts
			Hemorrhagic Ovarian Cyst
			Imaging in Ovarian Torsion
			Pelvic Inflammatory Disease (PID)
			Ovarian Venous Thrombosis
		Uterine Causes of Acute Pelvic Pain
			Hematometra
			IUD Complications
			Fibroids
			Spontaneous Abortion (SAB)
	Non-gynecological Causes of Acute Pelvic Pain
	Gastrointestinal Causes of Acute Pelvic Pain
		Anatomy and Technical Aspects of Ultrasound Assessment of the Bowel
		Acute Appendicitis
		Secondary Appendicitis
		Acute Diverticulitis
		Omental Infarction
		Epiploic Appendagitis
		Small Bowel Ischemia and Hemorrhage
		Groin Hernias
	Genitourinary Causes of Acute Pelvic Pain
		Distal Ureteral Calculus
		Cystitis
		Ectopic Pregnancy
		Ultrasound Imaging in Ectopic Pregnancy
		Differential Diagnosis
		Uncommon Location of Ectopic Pregnancies
			Interstitial Ectopic Pregnancy
			Cervical Pregnancy
			Intramural Pregnancy
			Heterotopic Pregnancy
			Ovarian Ectopic Pregnancy
			Cesarean Scar Pregnancy
			Role of MRI in Ectopic Pregnancy
			Posttreatment Imaging
	Chronic Pelvic Pain
		Chronic PID
	Endometriosis
		Introduction
		Diagnosis and Imaging in Endometriosis
		Ultrasonography
		Magnetic Resonance Imaging (MRI)
			MR Imaging Features
			Endometriosis of the Ovaries
			Extraovarian Endometriosis
			Deep Invasive Endometriosis (DIE)
			Endometriosis and Malignancy
			Abdominal Scar Endometriosis
			Conclusion
	References
9: Imaging of Abnormal Uterine Bleeding and Menstrual Disorders
	Introduction
	The Menstrual Cycle
		The Hypothalamic-Pituitary-Ovarian Axis
		The Ovary: Follicular Phase and Luteinizing Phase
		The Endometrium: Proliferative Phase and Secretory Phase
	Imaging Modalities
		Ultrasound
		MRI
		Hysteroscopy
	Pregnancy
		Miscarriage
		Ectopic Pregnancy
		Molar Pregnancy
	Polyps
		Imaging Modalities
		Transvaginal Ultrasonography
		Color Flow Doppler
		Saline Infusion Sonography
		Hysteroscopy, Biopsy, and Endometrial Polypectomy
	Adenomyosis
		Imaging Modalities
		Ultrasonography
		Magnetic Resonance Imaging
		Management
	Leiomyoma
		Imaging Modalities
		Ultrasonography
		Hysteroscopy
		Magnetic Resonance Imaging
		Management
		Myomectomy
		Uterine Artery Embolization
	Malignancy and Hyperplasia
		Endometrial Cancer
		Ultrasound
		MRI
		Cervical Cancer
	Coagulopathies
		Von Willebrand Disease
		Acquired Coagulopathies
	Ovulatory Dysfunction
		Hyperprolactinemia
		Hypothalamic Dysfunction
		Hypothyroidism
		Imaging
	Endometrial
		Diagnosis
		Ultrasound
		MRI
		Management
	Iatrogenic
		IUD
		Chemotherapy Agents and Steroid Hormones
	Not Yet Classified
		Pelvic Inflammatory Disease
		Imaging
		Ultrasound
		Magnetic Resonance Imaging
		Laparoscopy
		Vaginal Trauma
		Foreign Bodies
	Conclusion
	References
10: Non-obstetric Complications in Pregnancy: Role of Imaging
	Radiation Risk Considerations from the Use of Diagnostic Imaging in Pregnancy
	Pathogenesis of the Diagnostic Radiation Exposure Risks to the Fetus
		Pathological Effects of Exposure of the Human Embryo to Ionizing Radiation
			All or None Phenomenon
			Congenital Malformation and Growth Retardation
			Neurobehavioral Effects
			Effects of Protraction and Fractionation
			Indirect Exposure to Radiation
			Increased Risk of Leukemia and Other Malignancies
			Maternal Risk from Radiographic Examination
		Counseling a Pregnant Patient Regarding Risk of Being Exposed to Diagnostic Radiation
			Screening for Pregnancy Prior to Radiological Examinations
			Pregnancy Consent Policy
			Methods to Reduce Radiation Dose
			Management of the Patient Not Known to Be Pregnant During the Examination
			Ultrasonography Imaging in Pregnancy
			Computed Tomography in Pregnancy
			Magnetic Resonance Imaging in Pregnancy
	Imaging in the Evaluation of Non-obstetrical Complications in Pregnancy
		Common Indications
		Evaluation of a Pelvic Mass in Pregnancy
			Ultrasound in the Assessment of a Pelvic Mass
			MRI Evaluation of an Adnexal Mass
			MRI Differential Diagnosis of Adnexal Masses
			Malignancies in Pregnancy
		Imaging a Pregnant Patient with Abdominal Pain
		Imaging of Renal Colic in Pregnancy
			Imaging Algorithm in a Patient with Renal Colic
		Imaging of Trauma during Pregnancy
			Radiography
			Ultrasonography
			Computed Tomography (CT)
			Magnetic Resonance Imaging (MRI)
	References
		Suggested Reading
11: Pelvic Mass: Role of Imaging in the Diagnosis and Management
	Uterine Masses
		Leiomyomas
			Clinical Considerations
			Imaging Features of a Fibroid
			Differential Diagnosis in Patients with an Enlarged Uterus in a Nonpregnant Setting
			Smooth Tumors of Unknown Malignant Potential (STUMP)
	Adnexal Masses
		Ovarian Tumor Lexicon
		Cystic Tumors of the Ovary
		Solid Tumors of the Ovary
	Morphological Patterns of Ovarian Tumors
		Unilocular Cyst
		Unilocular Cyst with Solid Components
		Multilocular Cyst
		Multilocular Cyst with Solid Components
		Solid Ovarian Tumors
	Imaging Pathological Correlation of Ovarian Cancers
		Borderline Tumors of the Ovary (BOT)
		Solid Ovarian Cancers
		Cystic Ovarian Cancers
		Hormonally Active Ovarian Tumors
		Doppler Ultrasound Characteristics of Ovarian Tumors
	Ovarian Tumors: Malignancy Risk Stratification
		Pattern Recognition Approach
		IOTA Logistical Regression Models
		Simple Ultrasound-Based Rules for the Diagnosis of Ovarian Cancer
		IOTA-ADNEX Model for the Characterization of Different Types of Ovarian Cancers
		Risk of Malignancy Index
		Adnexal Tumors Difficult to Classify
	Non-ovarian Pelvic Mass
		Cystic Extraovarian Mass
			Cystic Extraovarian Masses
		Fallopian Tube Pathology Mimicking Ovarian Tumors
			Primary Fallopian Tube Carcinoma (PFTC)
			Imaging Features of PFTC
			Hematosalpinx
			Chronic Tubal Pregnancy
			Chronic Tuboovarian Abscess
			Extraovarian Endometrioma
			Peritoneal Inclusion Cysts
			Paraovarian Cysts
			Mucocele of the Appendix
			Rectal Duplication Cyst
			Spinal Meningeal Cyst
			Lymphocele
	Solid Extraovarian Mass
		Parasitic Fibroid and Broad Ligament Fibroid
			Extraovarian Fibrothecomas
			Chronic Pelvic Hematoma
			Gastrointestinal Stromal Tumors
			Pelvic Metastasis
		Supplemental Role of CT and MRI in the Evaluation of Pelvic Masses and in the Staging of Gynecological Malignancies (Saleh, M and Vikram, R, MDACC)
	Masses Arising from the Uterus
		Masses Arising from the Uterine Cervix
			Cervical Carcinoma
			Adenoma Malignum
	Masses from the Uterine Corpus
		Endometrial Carcinoma
		Ovarian Masses
	Solid
		Simple Cystic Ovarian Masses
		Serous Cystadenoma
		Complex Cystic Ovarian Masses
		Teratoma
		Endometrioma
		Hemorrhagic Cyst
	Mixed
		Adenocarcinoma
		Clear Cell Carcinoma
		Endometrioid Carcinoma
		Metastasis
	References
		Suggested Reading
12: Postmenopausal Bleeding: Role of Imaging in the Diagnosis and Management
	Etiology of Postmenopausal Bleeding
		Medications That Can Cause Postmenopausal Bleeding
	Evaluation of Postmenopausal Bleeding (Table 12.3)
	Imaging of Endometrial Cancer
		Carcinosarcomas or Malignant Mixed Mullerian Tumors (MMMT) of the Uterus
	Bibliography
13: Pelvic Floor Dysfunction: Role of Imaging in Diagnosis and Management
	Transperineal Ultrasonography: Method and Clinical Application
		Introduction
		Equipment and Technique
		Anterior Compartment Pathology
			Residual Urine and Detrusor Wall Thickness
			Stress Urinary Incontinence
		Pelvic Organ Prolapse
		Anterior Compartment
		Central Compartment
		Posterior Compartment
		The Anal Sphincter
	Synthetic Implants
		Slings
		Prolapse Mesh
		The Levator Ani
	Conclusions
	Take-Home Messages
	Bibliography
14: Role of Imaging in the Management of Female Infertility
	Introduction
	Imaging Modalities for Diagnosis of Infertility
		Ultrasound
			Uterine Evaluation
			Evaluation of Adnexa and Ovaries
		Saline Infusion Sonography and Sonohysterosalpingography
		Hysterosalpingography
		Magnetic Resonance Imaging
		Hysteroscopy
		Computed Tomography
		Conclusion of Use of Imaging in Infertility Workup
	Management of Infertility Using Imaging
		Monitoring for IVF and Embryo Transfer
		Retrieval
		Transfer
		Hysteroscopy for the Treatment of Intrauterine Lesions
		Conclusion of Use of Imaging in Infertility Management
	References
15: Urinary Tract Infections: Role of Imaging in the Management
	Introduction
	Terminology
		Location
			Lower Tract
			Upper Tract
	Complicated Versus Uncomplicated UTIs
	Time Course
	Diagnostic Evaluation
		Laboratory Evaluation
		Imaging Evaluation
			Cystourethroscopy
			Ultrasound
			X-Ray
			Tc-99m DMSA Renal Cortical Scintigraphy
			CT Imaging
			MR Imaging
	Conclusion
	References
16: Health Economics in Women’s Imaging
	Radiology-Related Healthcare Policy
	Different Payors and Payment Systems
		Current State of the Affairs and Challenges in Healthcare Delivery and Management in the United States
			Myths and Realities of the US Healthcare System
			What Is Being Done Today?
		A Primer for Setting Up an Outpatient Women’s Imaging Center
	Bibliography
Index