breast cancer surgery & treatment

7/31/2019 Breast Cancer Surgery & Treatment

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Digital Mammography andComputer-Aided Diagnosis

Email: enquiry@medicyatra

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http://www.medicyatra.com/


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Breast Cancer

One out of every seven womenwas diagnosed with breastcancer in 2007

Fortunately, radical mastectomy(surgical removal) is rarelyneeded today with bettertreatment options

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Breast cancer is second only to lung cancer asa cause of cancer deaths in American women

Email: [email protected]



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Outline

Female Breast Anatomy

Breast CancerMammography

Computer-Aided Diagnosis of BreastCancer

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Muscles

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Breast hasno

muscle tissue

Musclesunderneaththe breasts

separating themfrom the ribs




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Female Breast Anatomy

Breasts consistmainly of fatty tissue

interspersed withconnective tissue

There are also less

conspicuous partslobesductslymph nodes

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Breast Gland

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Each breast has 15 to 20sections ( lobes) arrangedlike the petals of daisy

Inside each lobe are manysmaller structures calledlobules

At the end of each lobuleare tiny sacs ( bulbs) thatcan produce milk




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Ducts

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Areola

Lobes, lobules,and bulbs are

Linked by anetwork of thintubes (ducts)

Ducts carrymilk from bulbs

toward dark areaof skin in thecenter of the

breast (areola)

Ducts join togetherinto larger ducts ending

at the nipple, wheremilk is delivered




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Blood Vessels

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Oxygen, nutrients, and otherlife-sustaining nourishmentare delivered to breast tissueby the blood in the arteries and capillaries .




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Lymphatic System

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Lymph ducts : Drain fluidthat carries white bloodcells (that fight disease)from the breast tissuesinto lymph nodes underthe armpit and behindthe breastbone

Lymph nodes : Filterharmful bacteria andplay a key role infighting off infectionA network of vessels

Lymph ductLymph node




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Three Types of Vessels

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BacteriaBlood

VesselsCell life

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LymphNodes

LymphVessels

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MilkLobules Ducts Nipple1




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Signs and Symptoms

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Most common :lump orthickening inbreast. Oftenpainless

Change in coloror appearanceof areola

Redness or pitting

of skin over thebreast, like theskin of an orange

Dischargeorbleeding

Change in sizeor contours of breast




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Noncancerous Conditions (1)Fibrocystic changes : Lumpiness, thickening andswelling, often associated with a womans period Cysts : Fluid-filled lumps can range from very tiny

to about the size of an eggFibroadenomas : A solid, round, rubbery lump thatmoves under skin when touched, occuring most in

young women

Infections : The breast will likely be red, warm,tender and lumpyTrauma : a blow to the breast or a bruise can causea lump

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Noncancerous Conditions (2)

Microcalcifications : Tiny deposits of calciumcan appear anywhere in a breast and oftenshow up on a mammogram

Most women have one or more areas ofmicrocalcifications of various sizes

Majority of calcium deposits are harmlessA small percentage may be precancerous or cancer(biopsy is sometimes recommended)

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Causes

Some of the cells begin growing abnormallyThese cells divide more rapidly than healthycells do and may spread through the breast,to the lymph or to other parts of the body(metastasize)

The most common type of breast cancerbegins in the milk-production ducts, butcancer may also occur in the lobules or inother breast tissue

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Normal Breast

Breast profile

A ducts

B lobules

C dilated section of duct to hold milkD nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

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Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Illustration Mary K. Bryson


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Ductal Carcinoma in situ(DCIS)

16Illustration Mary K. Bryson

Ductalcancercells

Normalductalcell

Carcinoma refers to anycancer that begins in theskin or other tissues thatcover internal organs




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Invasive Ductal C arcinoma(IDC 80% of breast cancer )

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The cancer has spread to thesurrounding tissues

Illustration Mary K. Bryson

Ductal cancercells breakingthrough thewall


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Range ofDuctal Carcinoma in situ

18 I l l u s

t r a

t i o n

M a r y

K .

B r y s o n


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Invasive Lobular Carcinoma(ILC)


Lobular cancercells breaking

through the wall




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Cancer Can also InvadeLymph or Blood Vessels


Cancer cellsinvade

lymph duct

Cancer cellsinvadebloodvessel




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Mammography Use a low-dose x-ray system to examinebreastsDigital mammography replaces x-ray

film by solid-state detectors thatconvert x-rays into electrical signals.These signals are used to produce imagesthat can be displayed on a computerscreen (similar to digital cameras)Mammography can show changes in thebreast up to two years before aphysician can feel them

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Computer-Aided Diagnosis

Mammography allows for efficientdiagnosis of breast cancers at an

earlier stageRadiologists misdiagnose 10-30%of the malignant cases

Of the cases sent for surgicalbiopsy, only 10-20% areactually malignant

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National Cancer Institute

CAD systemscan assist

radiologists toReduce these

problems




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What Mammograms Show

Two of the most important mammographicindicators of breat cancers

MassesMicrocalcifications : Tiny flecks of calcium likegrains of salt in the soft tissue of the breastthat can sometimes indicate an early cancer.

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Detection of Malignant Masses

Malignant masses have a more spiculated

appearance

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malignant

benign




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Mammogram Difficult Case

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Heterogeneously dense breastCancer can be difficult todetect with this type of

breast tissueThe fibroglandular tissue(white areas) may hide thetumor

The breasts of youngerwomen contain more glandsand ligaments resulting indense breast tissue




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Mammogram Easier Case

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With age, breast tissue

becomes fattier and hasfewer glandsCancer is relatively easyto detect in this type ofbreast tissue




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Different Views

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Top-to-Bottom

Side-to-SideMRI - Cancer can have a uniqueappearance many small irregular

white areas that turned out to becancer (used for diagnosis)




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Scalar Field

A scalar field is a n-dimensional spacewith a scalar value attached to each

point in the space (e.g., a gray-scaleimage)

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Scalar Field and Gradient

A scalar field is a n-dimensional spacewith a scalar value attached to each

point in the space (e.g., a gray-scaleimage)The derivative of a scalar field resultsin a vector field called the gradient

i.e., the gradient is a vector fieldwhich points in the direction of the greatestrate of increase of the scalar field, andwhose magnitude is the greatest rate of change

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Black representingHigher values




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Gradient The derivative of a scalar fieldresults in a vector field calledthe gradient

i.e., the gradient is a vectorfield

which points in the direction ofthe greatest rate of increaseof the scalar field, andwhose magnitude is thegreatest rate of change

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Black representingHigher values




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Cartesian Gradient For an image functionI(P) where P is a pixel,the Cartesian gradient at

P is:

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y

P I x

P I

Pg )(

)(

)(

x

P I yP I

P )(

)(

arctan)(

Orientation:

yP I

xP I Pm )()()(

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Magnitude:

)(P

)(Pg

P

( ) I P

y

( ) I P

x

( )

tan( )

I P y

I P x




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Radial Gradient

The radial gradientvector has the samemagnitude as theCartesian gradientvector, but

the orientation is givenas:

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)(P

)(Pg

P

)()()( PPPr

)(Pr

)(P

Radial gradient




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Feature: Spiculation [Huo et al.]Extract the mass using aregion-growing techniqueThe maximum gradient and

its angle relative to theradial direction arecomputedCalculate the full-width at

half-maximum (FWHM)from the cumulativegradient orientationhistogram

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Feature: Spiculation [Chan et al.]Determine the outline ofthe segmented massObtain the rubber-band-

straightening-transformedimageThe spicules becomeapproximately aligned in asimilar direction

The rectangular region canthen be subjected totexture analysis

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Breast Calcifications

Calcifications show up aswhite spots on a mammogram

Round well-defined, largercalcifications (left column)are more likely benign

Tight cluster of tiny,irregularly shapedcalcifications (right column)may indicate cancer

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Calcification FeaturesThe morphology of individualcalcification, e.g., shape, area,and brightness

The heterogeneity of individualfeatures characterized by themean, the standard deviation,and the maximum value for each

feature.Cluster features such as totalarea, compactness

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Database Approach toComputer-Aided Diagnosis

The database consists of a largenumber of images with verifiedpathology results

Diagnosis is done by submittingthe suspected mass region as aquery to retrieve similar casesfrom the database

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Content-based image retrieval techniques canprovide radiologists visual aids to increaseconfidence in their diagnosis




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A Mammography CAD System[Giger et al.]

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Probability ofmalignancy

Similar images ofknown diagnosis

Indicates the unknownlesion relative to alllesions in the database


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