Breast Magnetic Resonance Imaging Examinations - Assignment Example

Question Breast Magnetic Resonance Imaging (MRI) examinations have been timed carefully to avoid wrong results from the hormonal influences during the normal menstrual cycle. According to Ellis (2009), cyclical hormonal changes are usually manifested in a normally menstruating woman. The breast epithelium is usually influenced by changes in oestrogen and progesterone levels in the body during the normal menstrual cycle (Partridge, 2001). Ellis (2009) states that one main limitation for breast MRIs are the hormonal fluctuations manifested through oestrogen and progesterone. According to Sharma et al (2009), breast tissue assessment during the menstrual cycle depends on the size of breast lobules. During the menstrual cycle, the common characteristics of breast tissue include the weakening of the myoepithelium, inflammation, and strengthening of intralobular stroma. In this period, one of the phases includes the half part of proliferation where stromal edemas are witnessed. These phases are some of the causes of tissue changes in the breast that occur because of oestrogen and progesterone production. One of the effects of these hormonal influences on breast tissue during the menstrual cycle is that gadolinium intake is increased in normal breast tissue during the hormonal cycle (Ellis, 2009). This occurs during the follicular phase of the menstrual cycle, and from a review of literature it appears that this increase causes false-positive findings during a breast MRI. Another effect that is seen in the menstrual period is an increase in size of normal glandular tissue due to a manifestation of hormones. This occurs during the luteal phase of the menstrual circle, with the additional effect of multiple enhancing foci in the breasts. As already stated, these effects are caused by an increase in hormonal fluctuations in the female body. According to Ellis (2009), screening breast MRI has increased substantially after guidelines were published by the American Cancer Association. This means that the uses of MRI will increase to encompass breast examinations. However, it is important for radiologists to consider the effects of the hormonal changes mentioned above during the normal menstrual cycle. The two phenomena mentioned above are factors caused by the hormonal changes discussed, which. in turn, cause variations in the breasts. As already stated, the hormonal fluctuations during the hormonal cycle cause an increase in gadolinium intake, which, in turn, can cause false-positive findings from the breast MRI. The effect of breast tissue enhancement seen during the luteal phase also causes false-negative findings that affect the MRI. The other factor that radiologists should consider is that the MRIs should be timed to coincide with the time when hormonal influences are least felt (Ellis, 2009). The effects stated above can be eliminated when conducting breast MRIs by rescanning the patients after the results (Ellis, 2009). If the results display abnormal tissue enhancement as a result of the hormonal influences, it is advisable for the radiologists to reschedule the scans and find optimal solutions (Ellis, 2009). The doctors can also use the menstrual history of the patient to find the optimal period of women with normal menses to avoid the influence of hormonal fluctuations on the MRI. Question 2 In the human body, there is a group of genes referred to as tumor suppressor genes, which assist in preventing cells in the body from growing too fast (Plaut, 2011). Two of these tumor suppressor genes are the BRCA1 and BRCA2 genes, with BRCA referring to Breast Cancer. These two genes are part of a set of tumor suppressor genes called RING-type Zinc Fingers (Plaut, 2011). The main distinction between these two genes is that BRCA1 genes are used by the body to provide instructions for the creation of proteins that repair DNA in the body (Plaut, 2011). The BRCA genes coordinate with other genes in the cell to mend broken DNA strands, which are damaged when the chromosomes link their genetic nuclei before cell division. Research indicates that despite the usefulness of BRCA1 and BRCA2 genes, mutations in these genes increase susceptibility to cancer (Plaut, 2011). In women, there is an increased susceptibility to breast cancer due to the influence of mutated BRCA1 and BRCA2 genes. Studies have identified more than 100 mutations linked to these genes, which cause a shortening of the BRCA1 and BRCA 2 genes (Plaut, 2011). These mutations prevent the genes from producing copies of the proteins from single copies of the gene, or change some amino acids in the proteins (Plaut, 2011). The overall effect of these mutations is that the BRCA genes are unable to repair damaged DNA strands in the cell and body, which, in turn, leads to increased risk of cancer. This increased risk is because the failure to repair the genes leads to rapid growth of cells, which leads to formation of tumors in the body (Plaut, 2011). Some of the strains of cancer associated with this abnormality include ovarian cancer, fallopian cancer and different forms of breast cancer in both men and women, though women are more likely to develop breast cancer (Plaut, 2011). This is because the mutations cause a change in the amino acids that are used to develop the BRCA genes, which, in turn, means that the genes are not able to develop their normal functions. This abnormality is usually inherited by the affected individual; Plaut (2011) states that the lifetime risks are increased if the individual inherits the mutated gene. These individuals, mostly women, are at increased risk of developing breast or ovarian cancer, which is also supported by the fact that close family members are also diagnosed with the disease. The distinction is that BRCA1 genes are closely associated with causing breast, ovarian or fallopian cancer in women, but BRCA2 genes are more associated with causing cancers in male individuals. Some of the cancers associated with the BRCA2 gene include pancreatic, testicular and prostate cancer. Many women diagnosed with breast cancer are tested with BRCA mutations, but not all with the history of the cancer have the same or are even connected to the damaging mutations in the genes (Kuhl et al., 2000). There are women who are defined as not being in high risk as far as breast cancer is concerned, because they do not have harmful mutations in BRCA1 or BRCA2. High risk women are those with harmful BRCA gene mutation which is hereditary, which makes it probable to pass on to other female offspring, especially if one or more members of the family have the two primary cancers. Such mutations occur in specific ethnic groups where tumors develop in different parts of the body. However, not every female with the harmful BRCA1 and BRCA2 mutation will develop ovarian and breast cancer, but the majority of them eventually get one or both cancers. Regardless of the type of cancer that a high risk or low risk individual has, they all need to be managed at some point (Plaut, 2011). Chemoprevention, surveillance and prophylactic surgery are some of the accepted options for controlling and managing identified mutation carriers. There are advantages of early surgery and surveillance for women with BRCA gene mutation. Surgical mastectomy should be able to eliminate all the cancerous cells while removal of tamoxifen should try to reduce the chances of getting breast cancer. Based on the family testing, aggressive strategies of managing the cancer should be used, for example, the MRI screening for high risk women (Williams-Jones & Burgess, 2004). Though cancer preventions strategies differ among mutation carriers from one country to another, there are benefits of every person who has general signs of having cancer to seek clinical or medical attention. This especially applies to families who have ancestors with the history of having breast and other primary cancers. Women with increased chances of getting breast cancer should undergo prophylactic mastectomy, and those who are unaware of the importance of their baseline should be trained to acquire the useful information regarding managing cancer (Plaut, 2011). The other detail that people should be aware of is the difference between getting cancer or the development of the same and the risk of dying from cancer. A large percentile of stage 1 and stage 2 cancers can be treated with breast covering method other than going through the mastectomy. Though it is important to go through surveillance program, it does not guarantee perfect detection of the cancer, especially at its early stages, as statistics show that less than 30% of cancers were detected at stage 1. Chemoprevention has been the most effective way of managing cancer patients with most of them surviving the first 20 to 30 years after being detected and diagnosed (Lin et al., 2010). The method has added years of survival to women at their most productive and active years. Clinical follow-up for patients with cancer is very important as it improves the outcome of women with breast cancer by ensuring they get sufficient psychological treatment to minimize stresses that come with the cancer. Question 3 Breast reconstruction techniques for breast cancer patients are sometimes followed by complications after the reconstruction (Brown, Silverman & Berg, 1997). The complications can be detected in a number of ways including the use of mammography and Magnetic Resonance Imaging Brown, Silverman & Berg, 1997). However, MRI has been known to be the most effective methods for discovering the complications. According to Benedetto et al. (2008), patients who have ruptured implants from reconstruction usually suffer from intracapsular or extracaspular rupture, with intracapsular rupture being the most common. The intra capsular is the most common implant ruptures where after the saline or the silicone implantation, a fibrous mark forms around the implant shell. The silicone shell implanted is disrupted and disintegrates into gel, where it appears in MRI images to be hypo intense, and is also referred to as an intracapsular defect (Benedetto et al., 2008). The main difference between these two kinds of complications is based on the agent that migrates through the capsule into the breast tissue (Benedetto et al., 2008). In this case, intracapsular rupture is seen when silicon and fluid migrates through the tissue in the capsule surrounding the implant. All implants that rupture are usually intracapsular ruptures, and if not detected, develop to become extracaspular ruptures (Benedetto et al., 2008). When reconstruction surgery is being conducted, the capsule used is formed from collagen, fibroblast and the blood vessels of the patient (Brown, Silverman & Berg, 1997). When the saline implants rupture, fluid is retained in the lymphatic vessels, a process referred to as extracaspular rupture (Brown, Silverman & Berg, 1997). In contrast, intracapsular rupture is usually associated with silicone gel additions, and when the rupture is not treated early, the gel will get out of the capsule and form an extracaspular rupture (Brown, Silverman & Berg, 1997). This means that the gel will spread through the lymphatic vessels in the affected individual and spread through the whole body (Brown, Silverman, & Berg, 1997). Both of these ruptures are shown in the images below, which were obtained through MR imaging. This means that MRI can be used to detect both intracapsular and extracaspular ruptures in an affected individual (Brown, Silverman, & Berg, 1997). The use of Magnetic Resonance Imaging is the best way of determining the ruptured vessels in a patient’s body. In addition, Brown, Silverman and Berg (1997) state that simple saline capsular deflations are usually evidenced by re-absorption of the fluids in the lymphatic vessels, which prevents the contraction of scar tissue around the implant. The main symptoms of intracapsular rupture for patients with silicon mastitis are that they will have calcified granulomas, while patients with extracaspular rupture will have capsular contractions. As already stated, extracaspular rupture usually develops from intracapsular rupture; however, the time limit for this transition usually depends on the patients. Extracaspular rupture can easily be seen on clinical examination or the mammography as it leads to alteration in the implant outline (Brown, Silverman, & Berg, 1997). This rupture can happen even after intracapsular rupture and has only been accounted for only 5 to 10 percent of implant failures as they tend to occur after a period of implantation time. Most extra capsular ruptures appear in the shape of a snow storm after breast ultra sound. It can, at times, come into view as a stepladder mark of an intracapsular rupture. This kind of rupture is clear as free silicone does separate from the implant which, at times, extends past the implant capsule into the breast. Figure 1: Intracaspular Rupture (Juanpere et al., 2011, p. 656) Figure 2: Extracaspular Rupture (Juanpere et al., 2011, p. 657) References Benedetto, GD, Cecchini, S, Grassetti, L, Baldassarre, S, Valeri, G, Leva, L, Giuseppetti, GM & Bertani, A 2008, ‘Comparative study of breast implant rupture using mammography, sonography, and magnetic resonance imaging: correlation with surgical findings,’ The Breast Journal, vol. 14, no. 6, pp. 532–537. Brown, SL, Silverman, BG & Berg, WA 1997, ‘Rupture of silicone-gel breast implants: causes, sequelae, and diagnosis,’ The Lancet, vol. 350, pp. 1531–1537. Elliss, R 2009, ‘Optimal Timing of Breast MRI Examinations for Premenopausal Women Who Do Not Have a Normal Menstrual Cycle,’ AJR, vol. 193, pp. 1738–1740. 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Partridge, S, McKinnon, G, Henry, R & Hylton, N 2001, ‘Menstrual cycle variation of apparent diffusion coefficients measured in the normal breast using MRI,’ Journal of Magnetic Resonance Imaging, vol. 14, pp. 433–438. Plaut, D 2011, ‘BRCA1 and BRCA2,’ Continuing Education Topic and Issues, Article 379. Sharma, U, Kumar, M, Sah, R. G & Jagannathan, N 2009, ‘Study of normal breast tissue by in vivo volume localized proton Mr. Spectroscopy: variation of Water–Fat ratio in relation to the heterogeneity of the breast and the menstrual cycle,’ Magnetic Resonance Imaging, vol. 27, pp 785–791. Williams-Jones, B & Burgess, MM 2004, ‘Social contract theory and just decision making: lessons from genetic testing for the BRCA mutations,’ Kennedy Institute of Ethics Journal, vol. 14, no. 2, p. 115. Read More