B8.033 Prework 1: Introduction to Breast Imaging Flashcards
most common cancer among women in the US
- breast
- lung
- colorectal
leading cause of cancer death among women in the US
- lung
- breast
- colorectal
breast cancer stats
1 in 8 women in the US will get it in their lifetime
annual screening mammography has proven to significantly reduce breast cancer mortality
risk factors for BC
age and gender genetic mutation (BRCA1, BRCA2) family history breast density hx of breast cancer early menarche/late menopause/HRT use lower parity/higher age at first birth obesity, alcohol, smoking
types of breast densities
mostly fatty
scattered density
consistent density
extremely dense
mostly fatty breast
breasts are made up of mostly fat and contain little fibrous and glandular tissue
mammogram would likely show anything that was abnormal
scattered density breast
breasts have quite a bit of fat, but there are a few areas of fibrous and glandular tissue
consistent density breast
many areas of fibrous and glandular tissue that are evenly distributed through the breasts
make it hard to see small masses in the breast
extremely dense breast
breasts have a lot of fibrous and glandular tissue
may make it hard to see a cancer on a mammogram because the cancer can blend in with the normal tissue
breast density and cancer risk
dense breasts 6x more likely to develop cancer
AND
harder for mammograms to detect breast cancer
screening imaging modalities
mammography
MRI
US
diagnostic imaging modalities
mammography
targeted US
MRI
ductography
image guided tissue sampling and surgical localization procedures
US guided biopsy
stereotactic guided biopsy
MRI guided biopsy
pre-operative wire/radioactive seed localization
what is BIRADS
breast imaging reporting and data system
standardized way to describe and report breast imaging findings, results, and recommendations
BIRAD 0
incomplete
needs further imaging
BIRAD 1
category: negative
management: routine screening
likelihood of cancer: essentially 0%
BIRAD 2
category: benign
management: routine screening
likelihood of cancer: essentially 0%
BIRAD 3
category: probably benign
management: short interval follow up
likelihood of cancer: 0-2%
BIRAD 4
category: suspicious
management: tissue diagnosis
likelihood of cancer: 2-95%
BIRAD 5
category: highly suggestive of malignancy
management: tissue diagnosis
likelihood of cancer: >95%
BIRAD 6
category: known biopsy proven
management: surgical excision when clinical appropriate
likelihood of cancer: na
breast cancer screening
in a female patient who is asymptomatic
recommendations for annual screening mammography
age 40 and older -women at average risk younger than age 40 -BRCA -women with mothers or sisters with pre-menopausal breast cancer -women with 20% or greater lifetime risk -women with history of radiation between 10 and 30 -women with biopsy proven cancer
when should you not screen for breast cancer
life expectancy < 5-7 years
when abnormal results would not be acted on
techniques for screening mammography
2 standard view of each breast: -CC and MLO -additional views for patients with implants compression paddle and detector increasing use of digital tomosynthesis low dose xray
primary goal of BC screening
detect masses, calcifications, asymmetry, and architectural distortion
what is tomosynthesis
3D mammography tube moves in a 15 deg arc 15 low dose images are acquired -1 at each degree images are reconstructed into 1 mm slices
why is there a need for tomosynthesis
tissue superimposition hides pathologies in 2D
tissue superimposition mimics pathologies in 2D
additional views needed in patients with implants
implant displaced MLO and CC
MLO
medial lateral oblique
CC
craniocaudal
recommendations for screening MRI
proven carriers of BRCA
untested first degree relatives of proven BRCA
women with 20% or greater lifetime risk
women with history of chest irradiation
women with newly diagnosed breast cancer and normal contralateral breast on mammography and physical exam
recommendations for screening ultrasound
may be considered in high risk women who can not undergo MRI
women with dense breast tissue (maybe)
who gets a diagnostic evaluation for breast cancer
symptomatic patients abnormal clinical breast exam abnormal screening exam patients with history of breast conservation therapy for prior breast malignancy symptomatic male patients silicone implant rupture
additional mammography views for diagnosis
spot compression
spot magnification
lateral
tangential
utilize metallic BB markers to localize palpable areas of concern
start with standard views in male patients
digital tomosynthesis
indications for a targeted ultrasound eval
further characterize an abnormal finding on mammography or MRI
prepare for image guided biopsy
first line imaging modality for patients < 30
first line imagine modality for palpable mass in patients with prior mastectomy
features of breast MRI for screening
sensitive, but high false positive rate
indications for breast MRI
new diagnosis of breast cancer -extent of disease -screen contralateral breast high risk annual screening evaluate response to neoadjuvant chemo scar versus recurrence positive margins after lumpectomy axillary metastases with unknown primary silicone implant rupture
when do you use image guided tissue sampling and surgical localization procedures
if a breast finding has >2% chance of malignancy based on imaging characteristics
options for image guided tissue sampling and surgical localization
US guided
stereotactic guided
MRI guided
description of image guided tissue sampling and surgical localization procedures
minimally invasive, outpatient, local anesthesia only
always place a tissue marker at the site of biopsy and obtain post procedure 2 view mammogram
preoperative wire/radioactive seed localization
US guided procedures
fast, cheap, more comfortably for the patient (no compression), real time imaging
core needle biopsy
cyst aspiration
fine needle aspiration of abnormal lymph nodes
stereotactic guided biopsy
superior to US and MRI for sampling of calcifications
prone stereotactic breast biopsy table
utilizes mammography with compression for targeting
