Devita, Hellman, and Rosenberg's Cancer

LWBK1006-15 LWW-Govindan-Review December 7, 2011 19:5

Chapter 15•Advances in Diagnostics and Intervention 179

biopsied to prevent false overstaging. Routine imaging of the brain, liver,

and bone is not warranted in patients with lung cancer unless suspected

metastasis has a clinical basis because likelihood of disease is low.

Answer 15.28. The answer is C.

Lymphoma is a fairly common neoplasm that has seen dramatic change

in its imaging in the era of cross-sectional imaging. In the past, lymphan-

giography was used for evaluation of paraaortic lymphadenopathy, but

its role in lymphoma imaging has been replaced by CT, MRI, and PET. CT

is an efficient way to evaluate nodal and solid-organ involvement by lym-

phoma but is limited in the evaluation of bone marrow involvement. MRI

is equally as effective as CT in the evaluation of nodal and solid-organ

involvement. MRI tends to take longer, is more expensive, and often is

performed in patients unable to undergo CT or who cannot receive intra-

venous iodinated contrast. MRI is also useful in depicting bone marrow

involvement. PET is highly accurate in the staging of lymphoma and with

CT fusion is better than gallium scintigraphy for the staging of lymphoma.

PET is limited in evaluating bone marrow involvement by lymphoma

because increased uptake can be seen diffusely in reactive bone marrow,

especially after chemotherapy and marrow-stimulating drugs.

Answer 15.29. The answer is D.

Mammography remains the standard of care for breast cancer screen-

ing. Annual screening is recommended beginning at 40 years. High-risk

patients (those with personal or strong family history of breast cancer)

should consult their physician regarding initiation of screening at an

earlier age. In these patients, there may be a role for screening sonog-

raphy or MRI. On mammography, screening is based on the detection

of a spiculated mass, architectural distortion, or microcalcifications that

may be indicative of in situ carcinoma. Each mammogram has a final

assessment category defined by the American College of Radiology breast

imaging reporting and data system lexicon based on the likelihood of

malignancy (1=normal; 5=highly suggestive of malignancy). This

standardized reporting format has gained wide acceptance and serves as a

model for other screening imaging modalities. Imaging can provide guid-

ance for biopsy of any suspicious lesion (by ultrasound, mammography,

and, most recently, MRI). Unlike with ovarian cancer, there is no fear of

seeding the needle tract. Percutaneous needle biopsy is faster, safer, and

less expensive than surgical biopsy. Patients undergoing percutaneous nee-

dle biopsy are more likely to be treated with a single, definitive surgery

than patients undergoing surgical biopsy.

Answer 15.30. The answer is B.

Breast sonography is an important adjunct to mammography in the detec-

tion of breast cancer. It is especially useful in patients with dense breasts

but is not standard of care in breast cancer screening. It is a great first-line

tool in the evaluation of a mass to determine whether it is cystic or solid