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Medical Imaging > 11. Breast Imaging > Flashcards

11. Breast Imaging Flashcards

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USMLE® Step 1 flashcards
1
Q

Mammography in breast imaging

A

considered the gold standard; for screening and microcalcifications

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2
Q

Ultrasonography in breast imaging

A
  • useful in younger women
  • solid vs. cystosus mass
  • regional lymph nodes
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3
Q

MR in breast imaging

A
  • occult tumor search
  • multiplicity
  • scar vs. recidive tumor
  • chest wall infiltration
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4
Q

Nuclear medicine in breast imaging

A
  • sentinel lymph nodes
  • preoperative labeling
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5
Q

CT in breast imaging

A
  • not suitable for primary breast cancer detection!!
  • staging for distant metastases and lymph node status
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6
Q

PET-CT in breast imaging

A
  • not suitable for primary breast cancer detection!!
  • staging for distant metastases and lymph node status
  • disadvantages: low spatial resolution, non-FDG avid breast tumors
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7
Q

Breast tissue composition

A
  • glandular tissue shows strong hormone dependency and changes during lifetime
  • type depends on constitution, age and possible additive hormonal therapy
  • at younger ages the breast is more glandular and then becomes more fatty
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8
Q

Sensitivity of mammography according to breast type

A
  • fatty breasts shows small cancer more easily (higher sensitivity)
  • even large cancers are difficult to detect for glandular breasts (higher risk of undetected tumor)
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9
Q

What are the main mammography views?

A
  • craniocaudal (CC): upper part is the outer quadrants and the lower part is the inner quadrants
  • mediolateral oblique (MLO): upper part is the upper quadrants and the lower part is the lower quadrants
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10
Q

Digital breast tomosynthesis

A
  • less superimposition and better sensitivity
  • In dense breasts tomosynthesis has higher sensitivity than 2D mammography
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11
Q

Most important signs of malignancy on mammography

A
  • asymmetric density
  • microcalcifications
  • architectural distortion

relatively high proportion of carcinomas are localized to the upper outer quadrant of the breasts

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12
Q

What are some unique signs of malignancy on mammography?

A
  • tent sign: mall pulls on the posterior contour of the breast
  • skin thickening
  • peau d’orange sign (skin appear orange)
  • retraction of nipple (usually with spiculated mass)
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13
Q

Breast calcificiations on mammography

A

calcifications can be reliably evaluated only on breast mammography
- macrocalcifications are usually benign lesions
- clustered polymorph microcalcifications are always alarming and should be clarified
- popcorn calcification: fibroadenoma
- eggshell calcification: oil cyst

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14
Q

Strengths of breast mammography

A
  • excellent spatial resolution
  • detection of microcalcification
  • cheap, available
  • fast
  • additional views
  • suitable for breast with implants
  • digital technique
  • computer aided detection (CAD)
  • stereotaxix biopsy
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15
Q

Weaknesses of breast mammography

A
  • ionizing radiation
  • decreased sensitivity in dense breasts
  • discomfort due to compression
  • superimposition
  • skilled mammographers are required
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16
Q

What transducer is used for breast US?

A

high frequency (8-18 MHz) linear transducer

17
Q

What are the regional lymph nodes checked on breast US?

A
  • axillary, parasternal, infraclavicular and supraclavicular (poor prognosis)
  • great for US-guided biopsy
18
Q

What are the strengths of breast US?

A
  • good spatial resolution
  • no ionizing radiation
  • cheap, available
  • repeatable
  • can be performed during lactation
  • great tool in dense breasts
  • regional lymph ode visualization
  • solid vs. cystic differentiation
  • US-guided biopsy
19
Q

What are the weaknesses of breast US?

A
  • low sensitivity for microcalcifications
  • hard to detect early signs
  • not ideal for screening
20
Q

Significance of MRI studies in breast imaging

A
  • important for the staging of cancer and evaluation of response to neoadjuvant therapy
  • provides functional information using MR contrast-enhancement dynamics
    - washout pattern is considered to strongly suggest malignancy
  • US shows suspicious sign but MR gives a definitive diagnosis
21
Q

What are the strengths of breast MR?

A
  • good spatial resolution
  • non-ionizing
  • sensitive
  • 3D
  • iv. contrast enhancement kinetics
  • differentiation b/w scar and recurrent tumor
  • chest wall infiltration
  • multiplicity, bilateral lesions
  • implant rupture detection
  • MR-guided interventions
22
Q

What are the weaknesses of breast MR?

A
  • false negative for microcalcifications
  • not suitable for screening
  • expensive, limited availability
  • MRI-contraindications
  • lower specificity (false positives)
  • cannot substitute biopsy
23
Q

What is the BI-RADS classification?

A
  • scoring system for risk assessment
  • based on mammography, US and MR signs
  • according to the score, subsequent management of the lesion is decided

BI-RADS 3: FNAB is an option
BI-RADS 4: Core biopsy is mandatory

24
Q

Which modality to choose for screening breast imaging?

A
  • screening breast imaging is in case of asymptomatic patients
  • mammography
  • annual screening is recommended as early as age 25 in case of BRCA1/BRCA2 mutation
25
Q

Which modality to choose for clinical breast imaging?

A
  • clinical breast imaging is in case of symptomatic patients
  • modality depends on patient’s age
    - <30 : US
    - >30 : mammography + US
    - 30-35 : mammography or US
26
Q

What is FNAB?

A
  • fine needle aspiration biopsy
  • provides cytologic information by aspirating cells from the lesion
  • 20-22G needle + cameco pistol
  • commonly US-guided
  • can be CT-guided, MR-guided, or fluoroscopy-guided
27
Q

What is core biopsy?

A
  • provides accurate histological type, grade, immune phenotype of specimen
  • 14G needle + core biopsy pistol
  • local anesthesia is required and 2-6 tissue columns are removed
28
Q

What are male breasts?

A
  • gynecomastia: symmetrical enlargement of male breast tissue
  • male breast carcinoma is usually one sided, hard and immobile

Medical Imaging (17 decks)

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