15.2. Breasts - Radiology and Cytology

Question 1

What are the Breast Imaging Methods?

Answer 1

1. Mammography
2. Ultrasound
3. MRI
4. Nuclear Medicine (PET)
5. Breast Screening Programme
6. Image Guided Techniques

Question 2

What are the Views of Mammography?

Answer 2

1. Mediolateral Oblique View - Sagittal Picture
2. Craniocaudal View - Supero-Inferior Picture
   Rarer:
3. Coned View
4. Magnification View
5. True Lateral View
6. Extended Craniocaudal View

Question 3

Who is Mammography performed on?

Answer 3

1. Over 35 years old
2. Under 35 years old:
3. a) Strong Suspicion of Cancer
4. b) Family History Risk > 40%

Question 4

What are the Signs of Breast Disease?

Answer 4

1. Dominant Mass
2. Asymmetry
3. Architectural Distortion
4. Parenchymal Contour
5. Calcifications

Question 5

In Mammography, what is the difference in Soft Tissue Mass between a:

1. Malignant Lesion?
2. Benign Lesion?

Answer 5

Malignant - Irregular (Ill-Defined) / Spiculated / Dense / Distortion of Architecture

Benign - Smooth (or Lobulated) / Normal Density / Halo

Question 6

What is an Ultrasound used for?

Answer 6

To Differentiate between:

1. Solid Cystic Mass
2. Solid Benign from Malignant Lesions

Question 7

What are the Advantages of an Ultrasound Examination?

Answer 7

1. No Ionising Radiation
2. Improves Specificity of Imaging
   Note - used > 35 Group

Question 8

In an Ultrasound, what is the difference in Soft Tissue Mass between a:

1. Malignant Lesion?
2. Solid Benign Lesion?

Answer 8

Malignant - Irregular Outline / Interrupting Breast Architecture / Acoustic Shadowing and Anterior Halo

Solid Benign - Smooth Outline / Oval Shape / Acoustic Enhancement

Question 9

What is involved in Triple Assesment?

Answer 9

1. Clinical Examination
2. Imaging
3. Fine Needly Aspiration Cytology
   Note - Very good for Breast Cancer

Question 10

What are the indications of an MRI of the Breasts?

Answer 10

1. Implants
2. Indeterminate Lesion following Triple Assessment
3. Screening of High Risk Women
4. Dense Breasts
5. Lobular Malignancy for Multifocality

Question 11

What Nuclear Medicine Technique is used on the Breast?

Answer 11

1. Sentinel Node Sampling

2. Positron Emission Tomography

Question 12

What is involved in Sentinel Node Sampling?

Answer 12

1. Peritumoral Injection of 99m Tc Sulphur Colloid +/- Isosulphan Blue Dye
2. Lymphoscintigraphy
3. Intraoperative Gamma Probe
4. Single Lymph Node Removal

Question 13

Who / What is involved in the Breast Screening Programme?

Answer 13

50-70 year olds, every 3 years for Mammography

Question 14

What imaging techniques are used in an Image Guided Needle Biopsy?

Answer 14

1. Stereotactic - Prone / Digital / Analogue Table / Upright

2. Ultrasound - Guided / Freehand

Question 15

What are the 2 Basic Types of Image Guided Needle Biopsy?

Answer 15

1. Fine Needle Aspiration

2. Core Biopsy

Question 16

What is Cytology?

Answer 16

Microscopic Examination of a Thin Layer on a Slide obtained by:

1. Fine Needle Aspiration
2. Direct Smear from Nipple Discharge
3. Scrape of Nipple with a Scalpel

Question 17

What is seen in Benign Cytology?

Answer 17

1. Low / Moderate Cellularity
2. Cohesive Group of Cells
3. Flat Sheets of Cells
4. Bipolar Nuclei in Background
5. Cells of Uniform Size
6. Uniform Chromatin Pattern

Question 18

What is seen in Malignant Cytology?

Answer 18

1. High Cellularity
2. Loss of Cohesion
3. Crowding / Overlapping of Cells
4. Nuclear Pleomorphism
5. Hyperchromasia
6. Absence of Bipolar Nuclei

Question 19

Is a Malignant Cytology often Specific?

Answer 19

No, Non-Specific (i.e. Adenocarcinoma NOS) but occasionally features may suggest type:

1. Lobular Carcinoma
2. Tubular Carcinoma
3. Cytoplasmic Vacuoles
4. Cells arranged in Tubes

Question 20

What is the Cytology Scoring System?

Answer 20

C1 - Unsatisfactory
C2 - Benign
C3 - Atypia (Probably Benign)
C4 - Suspicious (Probably Malignant)
C5 - Malignant

Question 21

What happens in Aspiration of Cysts?

Answer 21

1. Curative
2. Fluid is discarded unless:
3. a) Fluid is Bloodstained
4. b) There is Residual Mass

Question 22

What are the Advantages of Fine Needle Aspiration?

Answer 22

1. Simple Procedure - can be done at clinic
2. Well tolerated by Patients
3. Inexpensive
4. Immediate Results

Question 23

What are the Limitations of a Fine Needle Aspiration?

Answer 23

1. Not 100% Accuracy: False Negatives / Positives
2. Invasion cannot be assessed
3. Grading cannot be done
4. Sampling - Lesions can be missed
5. Technical - Difficult to Examine Cells
6. Interpretation

Question 24

What are the Complications of a Fine Needs Aspiration?

Answer 24

1. Pain
2. Haematoma
3. Fainting
4. Infection
5. Pneumothorax - Rare
   Note - No Contraindications

Question 25

What is contained in the Nipple Discharge, with Duct Ectasia?

Answer 25

Macrophages only

Question 26

What is contained in the Nipple Discharge, with Intraduct Papilloma?

Answer 26

Benign Cells in Papillary Groups

Question 27

What is contained in the Nipple Discharge, with Intraduct Carcinoma?

Answer 27

Malignant Cells

Question 28

When would a Nipple Scrape be performed?

Answer 28

1. Paget's Disease | 2. Eczema

Question 29

Who has a Core Biopsy?

Answer 29

1. All cases with Clinical / Radiological / Cytological Suspicion 2. Breast Screening - especially architectural Distortion and Microcalcification 3. Pre-Operative Classification

Question 30

What is the Purpose of a Core Biopsy?

Answer 30

1. Confirm Invasion 2. Tumour Typing and Grading 3 .Immunhistochemistry - Receptor Status 4. Breast Histopathology