Mammography Education, Inc. Multimodality approach to screening, diagnosis and differential diagnosis of breast diseases

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TABÁR, MD, FACR (Hon) Multimodality approach to screening, diagnosis and

Aug 30-Sept 11, 2015 Designed for: Buda by night viewed from Pest All members of

extensive knowledge about diagnostic breast imaging, differential diagnosis of

1 Mammography Education, Inc BREAST SEMINAR SERIES The Parliament building in Pest viewed from Buda LÁSZLÓ TABÁR, MD, FACR (Hon) Multimodality approach to screening, diagnosis and differential diagnosis of breast diseases BUDAPEST, Hungary Hotel Intercontinental Aug 30-Sept 11, 2015 Designed for: Buda by night viewed from Pest All members of the diagnostic and therapeutic breast team This international course provides extensive knowledge about diagnostic breast imaging, differential diagnosis of breast diseases, implications for management and newest diagnostic technologies The Chain-bridge connecting Buda and Pest 22 hours of Category I CME credits

2 FACULTY., University of Uppsala School of Medicine, Department of Mammography, Sweden Images from the non-profit Tabar Foundation for Research and Education for Breast Cancer II

Mammography Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. Mammography Education, Inc.

3 Mammography Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. Mammography Education, Inc. designed these medical education activities for a maximum of 22 credit hours in Category I of the Physicians' Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he / she actually spent in the educational activity. River Duna (Danube) with numerous bridges connecting the two cities, Buda and Pest. The name Budapest came after the first bridge was built in the second half of the 1800s. The Parliament House is seen on the right side of the photograph. III

The day of arrival Aug 30th Pickup at the airport: upon arrival our guides are going to wait for you at the airport. Please look for the sign with your name on it.

4 The day of arrival Aug 30th Pickup at the airport: upon arrival our guides are going to wait for you at the airport. Please look for the sign with your name on it. Transport to Hotel Intercontinental will be taken care of by our guides. The hotel is a fivestar hotel on the Pest side of the Duna river, opposite the Royal Castle in Buda. River-view hotel rooms have been booked for everybody, so we should be able to enjoy the view of the Royal Castle in Buda, the opposite side of the river (see the photograph below). The view through your hotel-room window: the Royal Castle on the opposite side of river Welcome party at 7:00 PM. An opportunity to get together with old-time friends and make new friends. IV

Check-in to our deluxe five-star hotel: * We are going to stay in Hotel Intercontinental during the first and

* Having spent four nights in the hotel, we need to check out since we are going to spend four nights at other

Then we will check-in again to Hotel Intercontinental for the last four nights - once again in river-view rooms.

5 Check-in to our deluxe five-star hotel: * We are going to stay in Hotel Intercontinental during the first and last four nights. In between, excursions to other parts of the country and stay in other hotels. * Having spent four nights in the hotel, we need to check out since we are going to spend four nights at other hotels countryside. Then we will check-in again to Hotel Intercontinental for the last four nights - once again in river-view rooms. Matyas (Matthew) church adjacent to Hotel Hilton in daylight and night time, through the window of our hotel room Welcome party at 7:00 PM. An opportunity to get together with old-time friends and make new friends. V

6 Day 1, Aug 31 9:30 GUIDED TOUR, SIGHTSEEING. The Parliament building VI The Parliament building lit during the night 12:00 LUNCH for the entire group

7 Day 1, Aug 31 Guided tour, sightseeing The Royal Castle The cable car leading to the Castle The Parliament building in Pest seen from Buda VII

8 Day 1, Aug 31 Additional photographs of Budapest The Royal Castle by night, the Chain Bridge and Pest seen from Buda VIII The Chain Bridge daytime

9 Day 1, Aug 31 Additional photographs of Budapest The Museum of Art and the Heros' Square Dinner for the whole group The Chain Bridge by night IX

Day 2, Sept 1 Lectures for the physicians, social program with guides for the spouses and guests 9:00-12:00 9:00 INTRODUCTION FOLLOWED BY DIDACTIC LECTURES COVERING: A NEW ERA in the DIAGNOSIS and

10 Day 2, Sept 1 Lectures for the physicians, social program with guides for the spouses and guests 9:00-12:00 9:00 INTRODUCTION FOLLOWED BY DIDACTIC LECTURES COVERING: A NEW ERA in the DIAGNOSIS and TREATMENT of BREAST CANCER. A proposal to unify the classification of breast and prostate cancers based on the anatomic site of cancer origin and on long-term patient outcome Correlating prostate and breast cancer terminology based on 3-dimensional histology and long-term follow-up results The problem: The terminology to describe prostate cancers takes the site of origin and long-term outcome into account; breast cancer classification follows the outdated TNM classification, created before the widespread use of mammography screening. The solution: classification into structural subtypes, based on 3D/subgross histologicmammographic correlation.introduction of the mammographic appearance as one of the prognostic features. Result: better communication between the diagnostic and therapeutic team members and more rational treatment planning for the benefit of their patients. Break at 10:15 Cumulative 25-year survival of 1,087 consecutive year old women having 1-14 mm invasive breast cancers according to the mammographic tumor features. Dalarna County, Sweden, :00 L u n c h for the entire group X

11 Day 2, Sept 1 Guided social program for the entire group Photographs I took when I visited Budapest last time Matyas (Matthew) church in Buda, between the Royal Castle the Hotel Hilton (the third photograph is the reflection of the church at night in the mirror-like window of the Hilton). Dinner for the entire group XI

Day 3, Sept 2 Lectures for the physicians, guided social program for the

ACCORDING TO THEIR SITE OF ORIGIN Breast diseases originating in the major

disease type calcifications Malignant type calcifications originating in the

type, b) dotted, snake skin-like, c) skipping stone-like and d) pearl

concept of neoductgenesis. Long-term follow-up results.

12 Day 3, Sept 2 Lectures for the physicians, guided social program for the spouses and guests 9:00-12:00 ALGORITHM FOR CLASSIFYING BREAST DISEASES ACCORDING TO THEIR SITE OF ORIGIN Breast diseases originating in the major ducts Benign type calcifications originating in the major ducts a) Secretory disease type calcifications Malignant type calcifications originating in the major ducts: Four different types of clacifications: a) fragmented casting type, b) dotted, snake skin-like, c) skipping stone-like and d) pearl necklace-like Break at 10:00 a) Fragmented casting type calcifications * The concept of neoductgenesis. Long-term follow-up results. New aspects, correct terminology. Break at 10:15 12:00 Lunch XII b) Dotted casting type calcifications Snake skin-like calcifications

13 Day 3, Sept 2 Guided social program for the entire group One of the most beautiful synagogues is in Budapest Dinner for the entire group Budapest by night XIII

Day 4, Sept 3 Lectures for the physicians,

guests 9:00-12:00 * Mammographic /3D histologic

pathophysiology and outcome of fluid-producing

Skipping stone-like calcifications 2) String of

discharge, without calcifications on the

14 Day 4, Sept 3 Lectures for the physicians, guided social program for the spouses and guests 9:00-12:00 * Mammographic /3D histologic correlation to explain the underlying pathophysiology and outcome of fluid-producing carcinoma originating in th emajor ducts: 1) Skipping stone-like calcifications 2) String of pearl-like calcifications c) Skipping stone-like calcifications d) Pearl necklace-like calcifications Break at 10:15 * Practice of calcification analysis. Faculty-audience interaction. * Fluid-producing extensive DAB (ductal adenocarcinoma of the breast) with nipple discharge, without calcifications on the mammograms. The role of breast MRI in the diagnosis/differential diagnosis and determination of disease extent. * Discussion 12:00 L u n c h XIV

15 Day 4, Sept 3 Guided social program for the spouses and guests 9:00-12:00 XV

16 Day 4, Sept 3 Check out of Hotel Intercontinental and travel to Tokaj Check in to the Andrassy Residence "Wine and Spa" in Tokaj, where we are going to spend two nights Dinner for the entire group XVI

17 Day 5, Sept 4 Relaxation at the Andrassy Residence "Wine and Spa" in Tokaj Pre-dinner one-hour discussion and Q & A for the physicians. Dinner for the entire group XVII

18 Day 6, Sept 5 Check out of the Andrassy Residence. Visiting a horse-show in Hortobagy, the famous "puszta". XVIII

19 Day 6, Sept 5 Travel to Balatonfured. Check in to Hotel Silver Resort and will spend two nights there After a long day on the road - it is time to relax and visit the spa / pool. Pre-dinner one-hour discussion and Q & A for the physicians. Dinner for the entire group. XIX

20 Day 7, Sept 6 Day of relaxation, boat tour on Lake Balaton, sightseeing XX

21 Day 7, Sept 6 Day of relaxation, boat tour on Lake Balaton, sightseeing Pre-dinner one-hour discussion and Q & A for the physicians. Dinner for the entire group XXI

22 Day 8, Sept 7 Late morning check out. Traveling back to Budapest. Check in to Hotel Intercontinental. Afternoon guided program for all attendees: Visit the Hungarian Parliament building. XXII

23 Day 8, Sept 7 More photographs of the Hungarian Parliament building (cont). Dinner for the entire group Cultural program. Holy Crown of Hungary (the Crown of St. Istvan, the first king of Hungary, year 1000). XXIII

24 Day 9, Sept 8 Morning program for the physicians: Lectures 9:00 AM - 12:00 PM 9:00 DISCUSSION OF THE SO-CALLED MAMMOGRAPHY CONTROVERSY EARLY DETECTION OF BREAST CANCER RESULTS IN A SIGNIFICANTLY DECREASED MORTALITY FROM THE DISEASE * Overview of the scientific evidence The mortality benefit in relative and absolute terms and related issues. Is there really a controversy about breast cancer screening? The alleged harm of attending versus the actual harm of not attending mammography screening. The prerequisite of a successful screening: significant decrease of advanced cancers. Critique of the most recent anti-screening activities. Failure analysis Break at 10:15 12:00 L u n c h XXIV

25 Day 9, Sept 8 Guided tour for the spouses and guests Shopping tour and visiting the farmers' market-hall. XXV

26 Day 10, Sept 9 Lectures for the physicians 9:00 AM - 12:00 PM 9:00 DISCUSSION OF COMPLEX CASES. MULTIMODALITY WORKUP PRINCIPLES AND PRACTICE. PART I. Break at 10:15 Architectural distortion on the mammogram: one of the most difficult challenges we face. Description of the problem and solution. Multimodality workup of a huge invasive lobular carcinoma 12:00 L u n c h XXVI

27 Day 10, Sept 9 Guided tour for the spouses and guests 9:00 AM - 12:00 PM Sightseeing. Visiting boutiques, getting acquainted with Hungarian folklore, ceramics, etc. XXVII

28 Day 10, Sept 9 Afternoon: Joint program for the entire group Buda: The Fisherman's bastion in daylight and at night. XXVIII

29 Day 10, Sept 9 Afternoon: Joint program for the entire group The Chain Bridge. Hotel Hilton melted into the ruins of a cloister from 1200s Pre-dinner one-hour discussion and Q & A for the physicians. Evening program: Cultural program for the entire group XXIX

30 Day 11, Sept 10 Lectures for the physicians 9:00 AM - 12:00 PM 9:00 DISCUSSION OF COMPLEX CASES. MULTIMODALITY WORKUP PRINCIPLES AND PRACTICE. PART II. Multifocal invasive and in situ carcinoma on an area measuring 180X60 mm. pn 4/9 Break at 10:15 Malignant breast diseases originating in the TDLU(s) and associated with calcifications on the mammogram (Grade 1 and 2): Grade 2 cancer in situ: Mammographic / 3-D histologic / MRI correlation of cases with crushed stone-like/pleomorphic calcifications on the mammogram. 12:00 L u n c h XXX

31 Day 11, Sept 10 Spouse program 8:00 AM - 12:00 PM: choice of guided program / day of rest. Afternoon: Joint program for the entire group Flowers I have photographed on Margareta Island (the island in the middle of the river Dina, between Buda and Pest). This is an island worth visiting - no cars, no traffic. Farewell party XXXI

32 Day12, Sept 11 The day of traveling home Transport to the airport from Hotel Intercontinental will be taken care of by our guides. The organizers would appreciate to receive your itinerary in time. XXXII Thank you for having attended!

For more information and registration please contact: Mammography Education, Inc. 4429 E. Spur Drive CAVE CREEK, AZ 85331, USA Phone: (480) 419 0227 Fax: (480) 419 0219 e-mail: info@mammographyed.

33 For more information and registration please contact: Mammography Education, Inc E. Spur Drive CAVE CREEK, AZ 85331, USA Phone: (480) Fax: (480) Internet: The schedule is subject To change without notice and does not represent a commitment on The part of m.e.i. all rights reserved including The right of reproduction in whole or in part of any form visit us on The internet: copyright Images from the non-profit Tabar Foundation for Research and Education for Breast Cancer XXXIII

34 3-D histologic image of TDLUs Computer simulation images of the development of Grade 2 in situ carcinoma within the TDLU. The lobule becomes gradually distended and deformed. Calcifications are formed within the necrotic debris and are seen on the mammogram as crushed stone-like calcifications.

37 László Tabár, MD Tibor Tot, MD, Peter B. Dean, MD Breast cancer of ductal origin with microcalcifications Ductal Adenocarcinoma of the Breast (DAB), Part 1 In 3D László Tabár, MD Tibor Tot, MD, Peter B. Dean, MD An axillary lymph node populated with metastases mimicking in situ cancer Ductal Adenocarcinoma of the Breast (DAB), Part 2 In 3D

e László Tabár, MD Tibor Tot, MD, Peter B.

associated with a normal TDLU Ductal Adenocarcinoma of the

angioneogenesis In 3D In 3D Normal atrophic ducts and cancerous,

the major milk ducts (ductal adenocarcinoma of the breast, DAB)

The disease may occupy an entire lobe from the nipple to the

For these reasons, breast conserving surgery and skin or nipple

38 e László Tabár, MD Tibor Tot, MD, Peter B. Dean, MD Micropapillary breast cancer of ductal origin associated with a normal TDLU Ductal Adenocarcinoma of the Breast (DAB), Part 3 Neoductgenesis (DAB) associated with angioneogenesis In 3D In 3D Normal atrophic ducts and cancerous, distended ducts side by side Breast cancers that originate in the major milk ducts (ductal adenocarcinoma of the breast, DAB) are diffuse and often extensive. The disease may occupy an entire lobe from the nipple to the chest wall, and frequently extends close to the skin. For these reasons, breast conserving surgery and skin or nipple sparing mastectomy of DAB cases carry a higher risk of local/ regional/distant recurrence. In addition: 1) a considerable portion of the disease may lack calcifications, often occult for the imaging methods. 2) This subtype of breast cancer is less responsive to postoperative radiotherapy.

Advanced Course on Multimodality Detection and Diagnosis of Breast Diseases

BREAST SEMINAR Advanced Course on Multimodality Detection and 3D image of the breast tissue Invited speaker LÁSZLÓ TABÁR, MD,FACR (Hon) Falun, Sweden Nov 22-23, 2014 ATHENS, Greece Royal Olympic Hotel