B8.033 Prework 1: Introduction to Breast Imaging

Question 1

most common cancer among women in the US

Answer 1

1. breast
2. lung
3. colorectal

Question 2

leading cause of cancer death among women in the US

Answer 2

1. lung
2. breast
3. colorectal

Question 3

breast cancer stats

Answer 3

1 in 8 women in the US will get it in their lifetime

annual screening mammography has proven to significantly reduce breast cancer mortality

Question 4

risk factors for BC

Answer 4

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

Question 5

types of breast densities

Answer 5

mostly fatty
scattered density
consistent density
extremely dense

Question 6

mostly fatty breast

Answer 6

breasts are made up of mostly fat and contain little fibrous and glandular tissue
mammogram would likely show anything that was abnormal

Question 7

scattered density breast

Answer 7

breasts have quite a bit of fat, but there are a few areas of fibrous and glandular tissue

Question 8

consistent density breast

Answer 8

many areas of fibrous and glandular tissue that are evenly distributed through the breasts
make it hard to see small masses in the breast

Question 9

extremely dense breast

Answer 9

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

Question 10

breast density and cancer risk

Answer 10

dense breasts 6x more likely to develop cancer
AND
harder for mammograms to detect breast cancer

Question 11

screening imaging modalities

Answer 11

mammography
MRI
US

Question 12

diagnostic imaging modalities

Answer 12

mammography
targeted US
MRI
ductography

Question 13

image guided tissue sampling and surgical localization procedures

Answer 13

US guided biopsy
stereotactic guided biopsy
MRI guided biopsy
pre-operative wire/radioactive seed localization

Question 14

what is BIRADS

Answer 14

breast imaging reporting and data system

standardized way to describe and report breast imaging findings, results, and recommendations

Question 15

BIRAD 0

Answer 15

incomplete

needs further imaging

Question 16

BIRAD 1

Answer 16

category: negative
management: routine screening
likelihood of cancer: essentially 0%

Question 17

BIRAD 2

Answer 17

category: benign
management: routine screening
likelihood of cancer: essentially 0%

Question 18

BIRAD 3

Answer 18

category: probably benign
management: short interval follow up
likelihood of cancer: 0-2%

Question 19

BIRAD 4

Answer 19

category: suspicious
management: tissue diagnosis
likelihood of cancer: 2-95%

Question 20

BIRAD 5

Answer 20

category: highly suggestive of malignancy
management: tissue diagnosis
likelihood of cancer: >95%

Question 21

BIRAD 6

Answer 21

category: known biopsy proven
management: surgical excision when clinical appropriate
likelihood of cancer: na

Question 22

breast cancer screening

Answer 22

in a female patient who is asymptomatic

Question 23

recommendations for annual screening mammography

Answer 23

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

Question 24

when should you not screen for breast cancer

Answer 24

life expectancy < 5-7 years

when abnormal results would not be acted on

Question 25

techniques for screening mammography

Answer 25

``` 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 ```

Question 26

primary goal of BC screening

Answer 26

detect masses, calcifications, asymmetry, and architectural distortion

Question 27

what is tomosynthesis

Answer 27

``` 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 ```

Question 28

why is there a need for tomosynthesis

Answer 28

tissue superimposition hides pathologies in 2D | tissue superimposition mimics pathologies in 2D

Question 29

additional views needed in patients with implants

Answer 29

implant displaced MLO and CC

Question 30

MLO

Answer 30

medial lateral oblique

Question 31

CC

Answer 31

craniocaudal

Question 32

recommendations for screening MRI

Answer 32

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

Question 33

recommendations for screening ultrasound

Answer 33

may be considered in high risk women who can not undergo MRI | women with dense breast tissue (maybe)

Question 34

who gets a diagnostic evaluation for breast cancer

Answer 34

``` 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 ```

Question 35

additional mammography views for diagnosis

Answer 35

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

Question 36

indications for a targeted ultrasound eval

Answer 36

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

Question 37

features of breast MRI for screening

Answer 37

sensitive, but high false positive rate

Question 38

indications for breast MRI

Answer 38

``` 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 ```

Question 39

when do you use image guided tissue sampling and surgical localization procedures

Answer 39

if a breast finding has >2% chance of malignancy based on imaging characteristics

Question 40

options for image guided tissue sampling and surgical localization

Answer 40

US guided stereotactic guided MRI guided

Question 41

description of image guided tissue sampling and surgical localization procedures

Answer 41

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

Question 42

US guided procedures

Answer 42

fast, cheap, more comfortably for the patient (no compression), real time imaging core needle biopsy cyst aspiration fine needle aspiration of abnormal lymph nodes

Question 43

stereotactic guided biopsy

Answer 43

superior to US and MRI for sampling of calcifications prone stereotactic breast biopsy table utilizes mammography with compression for targeting