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3rd Year - Reproductive Diseases > 15.2. Breasts - Radiology and Cytology > Flashcards

15.2. Breasts - Radiology and Cytology Flashcards

1
Q

What are the Breast Imaging Methods?

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

What are the Views of Mammography?

A
  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
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3
Q

Who is Mammography performed on?

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

What are the Signs of Breast Disease?

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

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

  1. Malignant Lesion?
  2. Benign Lesion?
A

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

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

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6
Q

What is an Ultrasound used for?

A

To Differentiate between:

  1. Solid Cystic Mass
  2. Solid Benign from Malignant Lesions
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7
Q

What are the Advantages of an Ultrasound Examination?

A
  1. No Ionising Radiation
  2. Improves Specificity of Imaging
    Note - used > 35 Group
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8
Q

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

  1. Malignant Lesion?
  2. Solid Benign Lesion?
A

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

Solid Benign - Smooth Outline / Oval Shape / Acoustic Enhancement

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9
Q

What is involved in Triple Assesment?

A
  1. Clinical Examination
  2. Imaging
  3. Fine Needly Aspiration Cytology
    Note - Very good for Breast Cancer
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10
Q

What are the indications of an MRI of the Breasts?

A
  1. Implants
  2. Indeterminate Lesion following Triple Assessment
  3. Screening of High Risk Women
  4. Dense Breasts
  5. Lobular Malignancy for Multifocality
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11
Q

What Nuclear Medicine Technique is used on the Breast?

A
  1. Sentinel Node Sampling

2. Positron Emission Tomography

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12
Q

What is involved in Sentinel Node Sampling?

A
  1. Peritumoral Injection of 99m Tc Sulphur Colloid +/- Isosulphan Blue Dye
  2. Lymphoscintigraphy
  3. Intraoperative Gamma Probe
  4. Single Lymph Node Removal
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13
Q

Who / What is involved in the Breast Screening Programme?

A

50-70 year olds, every 3 years for Mammography

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14
Q

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

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

2. Ultrasound - Guided / Freehand

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15
Q

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

A
  1. Fine Needle Aspiration

2. Core Biopsy

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16
Q

What is Cytology?

A

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
17
Q

What is seen in Benign Cytology?

A
  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
18
Q

What is seen in Malignant Cytology?

A
  1. High Cellularity
  2. Loss of Cohesion
  3. Crowding / Overlapping of Cells
  4. Nuclear Pleomorphism
  5. Hyperchromasia
  6. Absence of Bipolar Nuclei
19
Q

Is a Malignant Cytology often Specific?

A

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
20
Q

What is the Cytology Scoring System?

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia (Probably Benign)
C4 - Suspicious (Probably Malignant)
C5 - Malignant
21
Q

What happens in Aspiration of Cysts?

A
  1. Curative
  2. Fluid is discarded unless:
  3. a) Fluid is Bloodstained
  4. b) There is Residual Mass
22
Q

What are the Advantages of Fine Needle Aspiration?

A
  1. Simple Procedure - can be done at clinic
  2. Well tolerated by Patients
  3. Inexpensive
  4. Immediate Results
23
Q

What are the Limitations of a Fine Needle Aspiration?

A
  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
24
Q

What are the Complications of a Fine Needs Aspiration?

A
  1. Pain
  2. Haematoma
  3. Fainting
  4. Infection
  5. Pneumothorax - Rare
    Note - No Contraindications
25
Q

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

A

Macrophages only

26
Q

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

A

Benign Cells in Papillary Groups

27
Q

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

A

Malignant Cells

28
Q

When would a Nipple Scrape be performed?

A
  1. Paget’s Disease

2. Eczema

29
Q

Who has a Core Biopsy?

A
  1. All cases with Clinical / Radiological / Cytological Suspicion
  2. Breast Screening - especially architectural Distortion and Microcalcification
  3. Pre-Operative Classification
30
Q

What is the Purpose of a Core Biopsy?

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

3rd Year - Reproductive Diseases (41 decks)

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