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Radiological-pathological correlation in breast lesions:

A short course with emphasis on core needle biopsies

Faculty

Course schedule

First session: Introduction to Breast Imaging and to Breast Pathology

Second Session

Radiological-pathological correlation in breast lesions:

A short course with emphasis on core needle biopsies

Faculty

The current availability of mammographic screening has necessitated the development of novel methods to evaluate non-palpable abnormalities of the breast. These techniques, mammographically, sonographically or MRI directed core biopsy, yield specimens whose pathologic interpretation can be extremely challenging.

 At the completion of this course, the participants will recognize the utility and, indeed, the necessity of correlation of pathologic appearance with radiologic imaging findings. Participants will understand the increased diagnostic specificity yielded by this technique as well as the limitations of core biopsy and when surgical biopsy should be recommended. The course will also examine proper specimen handling, complications of core biopsy, and histologic appearance of post core biopsy specimens.

After brief overviews of breast imaging and breast pathology, the majority of the course will consist of topics introduced by exemplary cases. Each case's imaging findings will be presented by a diagnostic radiologist specializing in breast imaging and will be followed by an evaluation of the pathologic findings and discussion concentrating on their correlation and impact on clinical management. The importance of communication between the pathologist and radiologist will be stressed throughout.

The course is intended for residents and attending surgeons, pathologists, radiologists and oncologists, which have special interest in diseases of the breast. An electronic detailed syllabus will be distributed at the course.

First session: Introduction to Breast Imaging and to Breast Pathology

Breast imaging update from mammography to MRI – Miri Sklair-Levy, MD

The lecture reviews the development in breast imaging for the early detection of breast carcinoma.

• Mammography , Digital mammography , CAD, Tomosynthesis, Contrast enhanced mammography
• Breast Ultrasound, recent advances - Elastography , Automated 3D breast Ultrasound
• Breast MRI, BIRADS classification , MR Spectroscopy
• Molecular breast imaging - Dedicated gama camera, PET mammography5/ Image guided breast biopsies - from FNA to core needle biopsy , US guided , stereotactic vacuum assisted biopsy , and MRI guided breast biopsies. Preoperative needle localization, indications for clip mark placement

Breast Pathology outlines and core needle interpretation – Ady Yosepovich, MD

• General consideration – clinician-pathologist communication 
• Understanding the pathological report - Macroscopic and microscopic considerations 
• Second opinion in breast pathology, the tumor board concept 
• Basic breast histopathology, immunohistochemistry, pitfalls in breast pathology – DCIS, LCIS, over diagnosis and under diagnosis of invasive tumor, mimickers of breast cancer 
• Preneoplasia of breast cancer, usual ductal hyperplasia, ADH, flat epithelial atypia 
• Pathological prognostic and predictive factors of breast cancer 
• Concepts in core needle biopsy interpretation – the importance of radiological- pathological correlative approach 

Second Session: Case Discussions : a Radiological- Pathological Correlative Approach

Miri Sklair-Levy, MD and Ady Yosepovich, MD

• Well circumscribed solid lesions 
• Cystic lesions 
• Well circumscribed malignant appearing lesions 
• Stellate architectural distortion
• Other architectural distortions
• Micro-calcifications