15.2. Breasts - Radiology and Cytology Flashcards
What are the Breast Imaging Methods?
- Mammography
- Ultrasound
- MRI
- Nuclear Medicine (PET)
- Breast Screening Programme
- Image Guided Techniques
What are the Views of Mammography?
- Mediolateral Oblique View - Sagittal Picture
- Craniocaudal View - Supero-Inferior Picture
Rarer: - Coned View
- Magnification View
- True Lateral View
- Extended Craniocaudal View
Who is Mammography performed on?
- Over 35 years old
- Under 35 years old:
- a) Strong Suspicion of Cancer
- b) Family History Risk > 40%
What are the Signs of Breast Disease?
- Dominant Mass
- Asymmetry
- Architectural Distortion
- Parenchymal Contour
- Calcifications
In Mammography, what is the difference in Soft Tissue Mass between a:
- Malignant Lesion?
- Benign Lesion?
Malignant - Irregular (Ill-Defined) / Spiculated / Dense / Distortion of Architecture
Benign - Smooth (or Lobulated) / Normal Density / Halo
What is an Ultrasound used for?
To Differentiate between:
- Solid Cystic Mass
- Solid Benign from Malignant Lesions
What are the Advantages of an Ultrasound Examination?
- No Ionising Radiation
- Improves Specificity of Imaging
Note - used > 35 Group
In an Ultrasound, what is the difference in Soft Tissue Mass between a:
- Malignant Lesion?
- Solid Benign Lesion?
Malignant - Irregular Outline / Interrupting Breast Architecture / Acoustic Shadowing and Anterior Halo
Solid Benign - Smooth Outline / Oval Shape / Acoustic Enhancement
What is involved in Triple Assesment?
- Clinical Examination
- Imaging
- Fine Needly Aspiration Cytology
Note - Very good for Breast Cancer
What are the indications of an MRI of the Breasts?
- Implants
- Indeterminate Lesion following Triple Assessment
- Screening of High Risk Women
- Dense Breasts
- Lobular Malignancy for Multifocality
What Nuclear Medicine Technique is used on the Breast?
- Sentinel Node Sampling
2. Positron Emission Tomography
What is involved in Sentinel Node Sampling?
- Peritumoral Injection of 99m Tc Sulphur Colloid +/- Isosulphan Blue Dye
- Lymphoscintigraphy
- Intraoperative Gamma Probe
- Single Lymph Node Removal
Who / What is involved in the Breast Screening Programme?
50-70 year olds, every 3 years for Mammography
What imaging techniques are used in an Image Guided Needle Biopsy?
- Stereotactic - Prone / Digital / Analogue Table / Upright
2. Ultrasound - Guided / Freehand
What are the 2 Basic Types of Image Guided Needle Biopsy?
- Fine Needle Aspiration
2. Core Biopsy
What is Cytology?
Microscopic Examination of a Thin Layer on a Slide obtained by:
- Fine Needle Aspiration
- Direct Smear from Nipple Discharge
- Scrape of Nipple with a Scalpel
What is seen in Benign Cytology?
- Low / Moderate Cellularity
- Cohesive Group of Cells
- Flat Sheets of Cells
- Bipolar Nuclei in Background
- Cells of Uniform Size
- Uniform Chromatin Pattern
What is seen in Malignant Cytology?
- High Cellularity
- Loss of Cohesion
- Crowding / Overlapping of Cells
- Nuclear Pleomorphism
- Hyperchromasia
- Absence of Bipolar Nuclei
Is a Malignant Cytology often Specific?
No, Non-Specific (i.e. Adenocarcinoma NOS) but occasionally features may suggest type:
- Lobular Carcinoma
- Tubular Carcinoma
- Cytoplasmic Vacuoles
- Cells arranged in Tubes
What is the Cytology Scoring System?
C1 - Unsatisfactory C2 - Benign C3 - Atypia (Probably Benign) C4 - Suspicious (Probably Malignant) C5 - Malignant
What happens in Aspiration of Cysts?
- Curative
- Fluid is discarded unless:
- a) Fluid is Bloodstained
- b) There is Residual Mass
What are the Advantages of Fine Needle Aspiration?
- Simple Procedure - can be done at clinic
- Well tolerated by Patients
- Inexpensive
- Immediate Results
What are the Limitations of a Fine Needle Aspiration?
- Not 100% Accuracy: False Negatives / Positives
- Invasion cannot be assessed
- Grading cannot be done
- Sampling - Lesions can be missed
- Technical - Difficult to Examine Cells
- Interpretation
What are the Complications of a Fine Needs Aspiration?
- Pain
- Haematoma
- Fainting
- Infection
- Pneumothorax - Rare
Note - No Contraindications
What is contained in the Nipple Discharge, with Duct Ectasia?
Macrophages only
What is contained in the Nipple Discharge, with Intraduct Papilloma?
Benign Cells in Papillary Groups
What is contained in the Nipple Discharge, with Intraduct Carcinoma?
Malignant Cells
When would a Nipple Scrape be performed?
- Paget’s Disease
2. Eczema
Who has a Core Biopsy?
- All cases with Clinical / Radiological / Cytological Suspicion
- Breast Screening - especially architectural Distortion and Microcalcification
- Pre-Operative Classification
What is the Purpose of a Core Biopsy?
- Confirm Invasion
- Tumour Typing and Grading
3 .Immunhistochemistry - Receptor Status - Breast Histopathology
