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CORE > Breast > Flashcards

Breast Flashcards

1
Q

US –> first line eval for breast abnormality –> who? (3)

A
  • <30yo
  • pregnant
  • lactating
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2
Q

MRI –> breast screen –> who?

A

high risk pt (>20% lifetime risk of breast CA)

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3
Q

MRI breast –> indications? (6)

A
  • screen in high risk pt
  • breast CA –> new dx –> eval extent of dz
  • eval neoadjuvant ctx response
  • positive surgical margins –> assess residual dz
  • eval tumor recurrence
  • axillary mets –> eval occult breast CA
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4
Q

invasive ductal breast CA –> stepwise progression?

A

1) flat epithelial atypia
2) atypical ductal hyperplasia
3) ductal carcinoma in situ (DCIS)
4) invasive ductal carcinoma

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5
Q

flat epithelial atypia (FEA) & atypical ductal hyperplasia (ADH) –> obligatory or non-obligatory precursor lesion for breast CA?

A

non-obligatory –> inc risk

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6
Q

breast CA –> RF? (7) which are most important RF?

A
  • # 1 F
  • # 1 age
  • BRCA1/2
  • 1st deg relative
  • chest radiation
  • long-term estrogen exposure (early menarche, late menopause, late first preg, nullipartiy, obesity)
  • bx high risk lobular lesion (ie atypical lobular hyperplasia, lobular CA in situ)
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7
Q

breast CA –> MC type?

A

invasive ductal CA (IDC) not otherwise specified

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8
Q

breast CA –> invasive ductal CA (IDC) –> MC clinical presentation?

A

palpable mass

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9
Q

breast CA –> invasive ductal CA (IDC) –> classic mammo appearance?

A
  • spiculated mass
  • architectural distortion
  • pleomorphic calcs
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10
Q

ductal breast CA –> subtypes? (5)

A
  • invasive ductal, not otherwise specified
  • tubular
  • mucinous (colloid/mucoid/gelatinous)
  • medullary
  • papillary
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11
Q

invasive ductal CA vs other ductal breast CA –> better prognosis –> T/F?

A

F –> other ductal breast CA have better prognosis than invasive ductal

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12
Q

breast CA –> tubular CA –> mammo appearance?

A

small spiculated mass

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13
Q

breast CA –> mucinous (colloid/mucoid/gelatinous) CA –> US appearance? T2 MRI?

A
  • US: low density circumscribed mass –> mimic fibroadenoma

- T2 –> hyper

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14
Q

breast CA –> medullary CA –> epidemiology?

A

young F –> BRCA1

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15
Q

breast CA: invasive lobular CA –> mammo appearance?

A

architectural distortion –> “dark star”

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16
Q

breast CA: what is inflamm CA?

A

tumor invasion of dermal lymphatics

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17
Q

breast CA: inflamm CA –> clinical presentation?

A

breast:
- erythema
- edema
- firm

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18
Q

breast CA: inflamm CA –> mammo appearance?

A
  • breast –> lrg, dense
  • trabecula thick
  • skin thick
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19
Q

what is Paget dz of nipple?

A

form of DCIS –> infiltrate nipple epidermis

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20
Q

Paget dz of nipple –> clinical appearance?

A

nipple:
- erythema
- ulcer
- eczematoid changes

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21
Q

breast CA –> prognosis –> most important factor?

A

axillary LN status

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22
Q

breast CA –> axillary LN involvemt –> how to detect?

A

sentinel LN bx

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23
Q

breast CA –> surgical axillary LN dissection –> indication? (2)

A

sentinel LN:

  • positive
  • not ID
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24
Q

estrogen receptor (ER) & progesterone receptor (HR) –> positive –> longer disease free survival –> T/F?

A

T

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25
Q

ER, PR, HER2/neu negative –> triple neg CA –> poor prognosis –> MC epidemiology?

A

BRCA1

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26
Q

triple neg CA –> MC mammo appearance? MC location?

A

breast –> posterior –> round –> smooth margin –> no calcs

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27
Q

DCIS –> prognosis –> key factor?

A

presence of necrosis

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28
Q

DCIS –> which subtype gets sentinel LN bx?

A

DCIS w necrosis –> high grade

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29
Q

high grade DCIS –> MC mammo appearance?

A

calcs:
- pleomorphic
- fine linear branching

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30
Q

breast –> fibrocystic change –> epidemiology? clinical presentation?

A

pre-menopause:

  • cyclic breast pain
  • sometimes –> palpable lump
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31
Q

breast –> fibrocystic change –> imaging dx –> T/F?

A

F

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32
Q

sclerosing adenosis –> mammo appearance?

A

microcalcs –> can mimic DCIS

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33
Q

mastitis –> MC org?

A

Staph aureus

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34
Q

mastitis –> 2 MC epidemiology?

A
  • nursing

- diabetes

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35
Q

mastitis –> clinical presentation?

A

breast:
- pain
- induration
- erythema

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36
Q

mastitis –> imaging (mammo/US) appearance?

A
  • skin thicken –> focal/diffuse
  • edema
  • adenopathy
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37
Q

breast abscess –> MC location?

A

subareolar

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38
Q

breast abscess –> mammo appearance?

A

irreg mass –> mimic carcinoma

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39
Q

breast abscess –> tx?

A
  • US-guide aspiration

- abx

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40
Q

what is granulomatous mastitis? epidemiology?

A

young F –> after childbirth –> rare idiopathic –> breast inflamm –> noninfx

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41
Q

granulomatous mastitis –> assoc RF? (2)

A
  • breastfeed

- OCP

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42
Q

granulomatous mastitis –> mammo/US finding? –> next step? why?

A

mimic breast CA –> bx

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43
Q

periductal mastitis (plasma cell mastitis) –> epidemiology?

A

post-menopause

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44
Q

periductal mastitis (plasma cell mastitis) –> MOA? classic mammo appearance?

A

intraductal lipids –> irritating –> large rod-like calcs

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45
Q

diabetic mastopathy –> MOA?

A

long term diabetes –> chronic hyperglycemia –> autoimmune rxn to matrix proteins –> firm mass –> can be painful

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46
Q

diabetic mastopathy –> mammo appearance? calcs?

A
  • ill-defined asymm density

- no microcalcs

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47
Q

diabetic mastopathy –> US appearance? next step?

A
  • hypoechoic mass
  • regional acoustic shadow

–> mimic scirrhous breast CA –> bx

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48
Q

what is Mondor thrombophlebitis?

A

breast –> superficial V –> thrombophlebitis

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49
Q

Mondor thrombophlebitis –> MC vein?

A

thoracoepigastric V

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50
Q

Mondor thrombophlebitis –> clinical presentation?

A
  • superficial mass –> cordlike/elongated

- pain/tender

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51
Q

Mondor thrombophlebitis –> US appearance?

A

dilated tubular struct –> “bead-like” –> no color flow

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52
Q

cleavage view –> purpose?

A

image medial breast tissue of both breasts

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53
Q

what is exaggerated CC (XCC) view?

A

pull lat/med tissue into image detector

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54
Q

what is online screening?

A

screen mammo –> pt wait for final read

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55
Q

online vs offline screen –> cons? (2)

A

online:
- more imaging
- more false pos
- same cancer detection rate

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56
Q

image quality –> how determine if CC and MLO view have imaged adequate tissue?

A

posterior nipple line –> w/in 1 cm

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57
Q

image quality –> nipple?

A

nipple should be in profile in at least 1 view

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58
Q

mammo signs of malig? (4)

A
  • mass
  • calc
  • architectural distortion
  • asymm
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59
Q

BI-RADS categories?

A
  • 0: need additional imaging
  • 1: neg
  • 2: benign
  • 3: prob benign
  • 4: suspicious
  • 5: highly sugg malig
  • 6: known bx-proven malig
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60
Q

BI-RADS 3 –> next step?

A

short interval fu –> usu 6mo

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61
Q

screen mammo –> BI-RADS 3 –> T/F?

A

F

can only be categorized 3 after dx mammo

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62
Q

BI-RADS 3 –> %malig?

A

<2%

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63
Q

BI-RADS 4 –> %malig?

A

2-95%

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64
Q

BI-RADS 4 –> next step?

A

bx or aspiration

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65
Q

breast abscess –> BIRADS?

A

4

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66
Q

BI-RADS 5 –> % malig?

A

> 95%

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67
Q

BI-RADS 5 –> next step?

A
  • bx

- surg

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68
Q

fibroglandular density –> categories? (4)

A
  • almost entirely fatty
  • scattered
  • heterogeneous
  • extremely dense
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69
Q

almost entirely fatty vs extremely dense fibroglandular tissue –> which has inc risk of breast CA?

A

extremely dense fibroglandular –> 5x more risk –> than almost entirely fatty

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70
Q

inc fibroglandular density –> bilat –> ddx? (2)

A

benign:
- hormone
- edema

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71
Q

inc fibroglandular density –> unilat –> ddx? (1)

A

malig –> lymph obstruct

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72
Q

skin thickening –> benign cause? (3)

A
  • radiation
  • acute mastitis
  • fluid overload (CHF, renal fail, liver fail)
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73
Q

what is “mass”?

A

2 projections –> space occupying lesion –> convex borders

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74
Q

asymm –> seen on how many views?

A

1

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75
Q

mass –> margins? (5)

A
  • circumscribed
  • microlobulated
  • obscured
  • indistinct
  • spiculated
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76
Q

margin –> circumscribed –> % margin that must be well-defined?

A

75%

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77
Q

mass –> densities? (4)

A
  • radiolucent (fat)
  • low density
  • equal density
  • high density
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78
Q

mammo: mass –> shape? (3)

A
  • round
  • oval
  • irreg
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79
Q

mammo vs US –> preferred terminology for location?

A
  • mammo: quadrants

- US: clockface

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80
Q

mammo –> quadrants? (4)

A
  • upper outer
  • upper inner
  • lower outer
  • lower inner
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81
Q

assoc features? (7)

A
  • architectural distortion
  • microcalc
  • skin retraction
  • nipple retraction
  • skin thick
  • trabecular thick
  • axillary LN
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82
Q

what is architectural distortion? concerning for CA?

A

radiating linear densities –> no definite mass

highly concerning for CA

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83
Q

skin retraction –> ddx? (2)

A
  • postsurg

- desmoplastic tumor rxn

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84
Q

calcs –> indeterminate or susp for malig –> require what view?

A

spot compression –> mag

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85
Q

skin calcs –> mammo appearance?

A

MC medial location:

  • punctate
  • lucent center
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86
Q

calcs –> how to determine if skin calcs?

A

tangential view

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87
Q

popcorn calc –> dx?

A

involuting fibroadenoma

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88
Q

large rod-like calc –> dx?

A

plasma cell mastitis (duct ectasia)

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89
Q

milk of calcium –> etiology

A

fibrocystic change

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90
Q

milk of calcium calc –> mammo appearance?

A
  • CC view: fuzzy round amorphous

- lat: semilunar/crescent shape

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91
Q

what is suture calc?

A

suture material –> calcium (usu after radiation)

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92
Q

dystrophic calc –> etiology? (4)

A

sequela:
- surg
- bx
- trauma
- rad

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93
Q

punctate calc –> shape? size (mm)?

A

round –> <0.5mm

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94
Q

lucent-center calc –> size?

A

<1mm - >1cm

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95
Q

eggshell (rim) calc –> ddx? (2)

A
  • fat necrosis

- cyst –> calc wall

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96
Q

benign calcs (BI-RADS 2)? (11)

A
  • skin
  • vascular
  • suture
  • popcorn
  • lrg rod-like
  • milk of Ca
  • dystrophic
  • round
  • punctate
  • lucent-center
  • eggshell (rim)
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97
Q

interm concern calcs (BI-RADS 4)? (2)

A
  • amorphous/indistinct

- coarse heterogeneous

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98
Q

amorphous calc –> appearance?

A

too small or hazy to ascertain morphology

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99
Q

amorphous calc –> diffuse vs focal –> benign vs suspicious?

A
  • diffuse –> benign

- focal –> susp

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100
Q

coarse heterogeneous calc –> appearance?

A
  • irreg

- >0.5mm but smaller than dystrophic calc

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101
Q

higher prob of malig (BI-RADS 4-5) –> calcs? (2)

A
  • fine pleomorphic

- fine linear (branching)

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102
Q

fine pleomorphic calc –> appearance?

A

vary in shape & size –> “dot-dash” appearance

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103
Q

fine pleomorphic calc –> ddx? (2)

A
  • DCIS

- invasive ductal CA

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104
Q

calc –> distribution? (5) which are usu benign? more suspicious?

A

usu benign:

  • diffuse/scattered
  • regional

more suspicious:

  • linear
  • grped/cluster
  • segmental
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105
Q

calc –> what is regional distribution?

A

lrg vol (>2cc) breast tissue –> not conform to ductal distribution

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106
Q

calc –> grped/cluster –> definition?

A

at least 5 calc in <1cc of breast tissue

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107
Q

what is rolled view? purpose?

A

CC view –> roll top breast med (RCCM) or lat (RCCL) –> localize lesion seen only on CC –> lesion mv med on RCCM –> in sup breast

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108
Q

what is reduced compression view? purpose?

A

reduced compression –> image far post lesions that slip out when full compression applied

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109
Q

true lat view –> when LM preferred over ML?

A

medial lesion –> LM –> lesion closer to detector

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110
Q

MLO –> lesion –> superior on lat view –> lesion is located med or lat?

A

med (Medial: Muffins rise)

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111
Q

MLO –> lesion –> inf on lat view –> lesion is located med or lat?

A

lat (Lat: Lead sinks)

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112
Q

punctate or round calc –> grp/cluster –> BI-RADS?

A

3

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113
Q

amorphous calc –> cluster –> next step?

A

indeterminate –> bx

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114
Q

what is focal asymm?

A

nonpalpable non-mass lesion –> seen on 2 projections

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115
Q

focal asymm –> US –> no correlate –> BI-RADS?

A

3

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116
Q

what is developing asymm? benign or suspicious?

A

focal asymm –> inc in size

suspicious

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117
Q

epidermal inclusion cyst –> US appearance?

A

circumscribed –> variable internal echotexture –> anechoic to heterogeneous

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118
Q

breast lesion –> dermis + hypodermis –> findings that dermal origin? (2)

A
  • claw of dermal tissue –> wrap around lesion

- lesion –> tract to epidermal surface

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119
Q

what is mammary zone? contains what tissue/structures?

A

zone bw subcutaneous & retromammary:

  • ducts/TDLU
  • fat
  • fibrous tissue
  • Cooper’s lig
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120
Q

ultrasound: mass –> shape? (3)

A
  • round
  • oval
  • irreg
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121
Q

ultrasound: mass –> orientation? (2)

A
  • parallel

- non-parallel

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122
Q

ultrasound: mass –> margin? (5)

A
  • circumscribed
  • indistinct
  • angular
  • microlobulated
  • spiculated
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123
Q

ultrasound: mass –> what is lesion boundaries? 2 types?

A

transition bw mass & surrounding tissue:

  • abrupt interface
  • echogenic halo
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124
Q

ultrasound: mass –> echogenic halo –> ddx? (2)

A
  • CA

- abscess

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125
Q

ultrasound: mass –> posterior acoustic features? (4)

A
  • no post acoustic feature
  • enhancemt
  • shadowing
  • combined pattern
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126
Q

ultrasound: mass –> posterior acoustic shadowing –> ddx? (1)

A

fibrosis:
- neoplastic desmoplastic rxn
- surg scar

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127
Q

ultrasound: mass –> internal echo pattern? (5)

A
  • anechoic
  • hypoechoic
  • isoechoic
  • hyperechoic
  • complex
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128
Q

benign mass –> ultrasound features? (5)

  • internal echo pattern
  • margin
  • orientation
  • shape
A
  • marked hyperechoic
  • circumscribed –> thin echogenic pseudocapsule
  • parallel
  • oval/few gentle macrolobulation
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129
Q

malig mass –> ultrasound features? (7) which 2 are most specific for malig?

A
  • # 1 spiculated
  • # 2 non-parallel
  • angular, microlobulated
  • post shadow
  • marked hypoechoic
  • assoc calcs
  • wide zone of transition
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130
Q

lipoma vs oil cyst –> margin?

A
  • lipoma –> no peripheral cacl

- oil cyst –> peripheral calc

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131
Q

lipoma –> should be eval by US prior to dx –> T/F?

A

F

can be dx w mammo alone

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132
Q

oil cyst –> MOA?

A

trauma or surg –> fat necrosis

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133
Q

what is hamartoma (fibroadenolipoma)?

A

benign mass –> fat & glandular tissue

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134
Q

hamartoma (fibroadenolipoma) –> classic mammo appearance?

A

breast w/in breast –> displace normal breast tissue

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135
Q

hamartoma (fibroadenolipoma) –> should be eval by US prior to dx –> T/F?

A

F

mammo almost always diagnostic

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136
Q

what is galactocele?

A

lactating –> cystic collection of milk –> palpable mass

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137
Q

galactocele –> mammo appearance?

A
  • circumscribed
  • macrolobulated
  • mixed high density + fat
  • true lat view –> fat-fluid level
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138
Q

intramammary LN –> MC location?

A

lat –> upper outer quad –> adj to vessel

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139
Q

medial breast –> lesion that look like intramammary LN –> benign or suspicious?

A

suspicious

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140
Q

fibroadenoma –> mammo XR –> density?

A

equal density

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141
Q

fibroadenoma –> US –> density?

A
  • hypoechoic

- central hyperechoic band

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142
Q

fibroadenoma –> BI-RADS?

A

3

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143
Q

fibroadenoma –> variants? (3)

A
  • complex
  • juvenile
  • giant
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144
Q

complex fibroadenoma –> characteristics? (2)

A
  • prolif elements & internal cysts

- inc risk of breast CA

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145
Q

juvenile fibroadenoma –> characteristics? (2)

A
  • adol

- very rapid growth

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146
Q

giant fibroadenoma –> characteristic? (1)

A

> 8cm

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147
Q

fibroadenoma –> ddx? (1)

A

phyllodes tumor

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148
Q

what is intraductal papilloma? epidemiology?

A

30-50yo –> benign tumor of lactiferous ducts

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149
Q

intraductal papilloma –> clinical presentation?

A

nipple discharge:

  • bloody
  • serous
  • serosanguinous
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150
Q

bloody nipple discharge –> ddx? (2)

A
  • intraductal papilloma

- DCIS

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151
Q

intraductal papilloma –> mammo XR –> shape? margin? MC location?

A
  • round/oval
  • circumscribed/irreg
  • subareolar
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152
Q

intraductal papilloma –> galactography appearance?

A

intraductal filling defect

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153
Q

intraductal papilloma –> US –> appearance? solid/cyst? shape?

A
  • solid
  • round/oval
  • mass in fluid-filled duct
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154
Q

intraductal papilloma –> dx by mammo/US alone –> T/F?

A

F –> dx by bx

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155
Q

bx –> intraductal papilloma –> next step? why?

A

surg excise

papillary CA may appear same

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156
Q

what is pseudoangiomatous stromal hyperplasia (PASH)?

A

hormone –> stromal & epithelial prolif

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157
Q

pseudoangiomatous stromal hyperplasia (PASH) –> mammo appearance?

A

mass:
- circumscribed
- oval/irreg

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158
Q

pseudoangiomatous stromal hyperplasia (PASH) –> US appearance?

A

mass:
- hypoechoic/mixed echogenicity
- oval/irreg

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159
Q

pseudoangiomatous stromal hyperplasia (PASH) –> demonstrate slow growth –> next step? why?

A

excisional bx

PASH can mimic low-grade angiosarcoma

160
Q

mammo –> circumscribed round mass –> breast CA ddx? (2)

A
  • medullary

- mucinous

161
Q

phyllodes tumor –> epidemiology?

A

40-50yo

162
Q

phyllodes tumor –> benign or malig?

A
  • most benign

- 25% –> malig

163
Q

lactational adenoma –> epidemiology?

A
  • 2nd-3rd trimester

- postpartum

164
Q

lactational adenoma –> benign or malig?

A

benign

165
Q

lactational adenoma –> tx?

A

none –> regress when stop lactating

166
Q

mult intraductal papillomas –> epidemiology?

A

younger

167
Q

mult intraductal papillomas –> location?

A

bilat breasts –> peripheral

168
Q

mult intraductal papillomas –> inc risk of breast CA –> T/F?

A

T

169
Q

what is steatocystoma multiplex?

A

AD –> mult intradermal oil cysts

170
Q

simple cyst –> BI-RADS?

A

2

171
Q

new –> complicated cyst –> next step?

A
  • BIRADS 3

- aspiration

172
Q

complicated cyst –> aspiration –> fluid is white/clear/yellow –> next step?

A

discard fluid

173
Q

complicated cyst –> aspiration –> fluid is bloody –> next step?

A

send fluid to cytology

174
Q

what is complex mass?

A

cyst w complex feature:

  • thick wall
  • septation
  • solid/nodular compont
175
Q

complex mass –> BI-RADS?

A

4

176
Q

complex mass –> cancer ddx? (4)

A
  • intracystic CA
  • intracystic papilloma
  • cystic phyllodes tumor
  • solid CA w central necrosis
177
Q

what is intracystic CA?

A

cyst wall –> CA

178
Q

complex mass –> benign ddx? (5)

A
  • hematoma
  • abscess
  • fat necrosis
  • galactocele
  • benign cyst w adherent debris
179
Q

what is clustered microcyst?

A

apocrine metaplasia or fibrocystic change –> several tiny 2-5mm cystic spaces separated by thin septae

180
Q

clustered microcyst –> BI-RADS?

A

2

181
Q

MC breast CA?

A

invasive ductal CA (IDC)

182
Q

invasive ductal CA (IDC) –> typical mammo appearance?

A
  • spiculated mass –> high density

- often: pleomorphic or fine linear branching calcs

183
Q

invasive lobular CA –> differences from invasive ductal CA (IDC)? (3)

A

invasive lobular:

  • rare calc
  • more often multifocal
  • more often bilat
184
Q

tubular CA –> typical mammo appearance?

A

small spiculated mass –> slow growing

185
Q

possible precursor lesion to tubular CA?

A

radial scar

186
Q

what is radial scar?

A

uncertain etiology –> dense fibrosis around ducts –> spiculated mass or architectural distortion

187
Q

what is complex sclerosing lesion?

A

radial scar –> >1cm

188
Q

radial scar/complex sclerosing lesion –> tx?

A

surg excision

189
Q

postsurgical scar –> can get larger over time –> T/F?

A

F

190
Q

what is sclerosing adenosis?

A

benign –> lobular hyperplasia –> fibrous tissue envelop & distort glandular elements –> sclerosis –> breast lesion –> maybe microcalcs

191
Q

what is diabetic mastopathy?

A

long-term insulin-dep diabetes –> inflamm lymphocytes & fibrosis –> large painless firm mass

192
Q

diabetic mastopathy –> mammo appearance? US?

A
  • mammo: ill-defined mass or asymm density

- US: hypoechoic shadowing mass

193
Q

benign breast fibrosis conditions? (2)

A
  • sclerosing adenosis

- diabetic mastopathy

194
Q

LN metastasis –> suspicious US features? (5)

A
  • round
  • thick cortex >3mm
  • eccentric thick cortex
  • focal outward cortical bulge
  • thick cortex –> indent or obliterate hilum
195
Q

1ary breast lymphoma –> MC etiology?

A

diffuse lrg B-cell lymphoma

196
Q

breast lymphoma –> calcs or no calcs?

A

no calcs

197
Q

known lymphoma –> new breast mass –> most likely mets or breast CA?

A

breast CA

198
Q

2ary angiosarcoma of breast –> etiology?

A

prior breast conservation –> rtx

199
Q

2ary angiosarcoma of breast –> T2 appearance? enhancemt?

A
  • T2 hyper

- intense enhance

200
Q

new mult masses –> non-ductal distribution –> dx?

A

hematogenous mets to breast

201
Q

mets to breast –> what 1ary cancers? (2)

A
  • melanoma

- RCC

202
Q

what is asymm?

A

1 view –> prominent breast tissue

203
Q

asymm –> MCC?

A

superimposed gland tissue

204
Q

what is global asymm?

A

1 breast –> majority (>1 quad) –> asymm density

205
Q

global asymm –> MCC?

A

greater vol of parenchyma in 1 breast

206
Q

what is focal asymm?

A

abnormality –> 2 views –> <1quad –> concave contour

207
Q

what is sternalis muscle?

A

<10% –> access parasternal chest wall muscle

208
Q

sternalis muscle –> MC location?

A

unilat –> med –> far-post –> only see on CC view

209
Q

access nipple (polythelia) –> mammo appearance?

A

mammo crest –> round mass

210
Q

what is Poland synd? (3)

A

congenital:
- unilat –> pect major absent
- ispilat breast absent
- syndactyly

211
Q

access (ectopic) breast tissue –> MC location?

A

axillary tail

212
Q

breast MRI –> enhancemt kinetics –> enhancemt curve –> 2 parts (time)?

A
  • early (2min) phase

- delayed

213
Q

breast MRI –> early enhancemt –> 3 categories?

A
  • slow
  • med
  • rapid
214
Q

breast MRI –> delayed enhancemt –> 3 categories?

A
  • type 1 persistent
  • II plateau
  • III washout
215
Q

breast MRI –> delayed enhancemt –> what is type 1 persistent? assoc w benign/suspicious/malig?

A

continuous inc enhance (>10%)

83% –> benign

216
Q

breast MRI –> delayed enhancemt –> what is type II plateau? assoc w benign/suspicious/malig?

A

level off (w/in 10%)

susp –> PPV 64-77%

217
Q

breast MRI –> delayed enhancemt –> what is type III washout? assoc w benign/suspicious/malig?

A

> 10% dec in enhancemt

malig –> PPV 87-92%

218
Q

breast MRI –> delayed enhancemt –> type III washout –> benign ddx? (3)

A
  • LN
  • adenosis
  • papilloma
219
Q

morphology vs enhancemt kinetics –> which is more important to determine if lesion is benign or suspicious?

A

morphology

220
Q

breast MRI –> internal enhancemt? (4)

A
  • homogeneous
  • heterogeneous
  • rim enhance
  • dark internal septations
221
Q

breast MRI –> dark internal septations –> highly specific for what condition?

A

fibroadenoma

222
Q

breast MRI –> what is focus?

A

<5mm dot of enhancemt –> too small for accurate assess:

  • no mass effect
  • no correlate on precontrast seq
223
Q

what is non-masslike enhancemt?

A

enhancing region –> not mass or focus

224
Q

non-masslike enhancemt –> distribution? (6)

A
  • linear/ductal
  • segmental
  • focal
  • regional
  • mult region
  • diffuse
225
Q

non-masslike enhancemt –> what is focal distribution? regional?

A
  • focal: <25% quadrant

- regional: >25% quadrant

226
Q

non-masslike enhancemt –> internal enhancemt? (4)

A
  • homogeneous
  • heterogeneous
  • clumped
  • clustered ring
227
Q

non-masslike enhancemt –> int enhancemt –> clustered ring –> ddx? (2)

A
  • DCIS

- invasive ductal

228
Q

non-masslike enhancemt –> stippled/punctate enhancemt –> assoc w benign or malig?

A

benign

229
Q

mass –> enhancing portion –> T2 hyper –> highly sugg benign or malig?

A

benign

230
Q

breast MRI: type I kinetic curve + benign morphology –> BI-RADS? (3)

A
  • 2
  • 3
  • 4
231
Q

breast MRI: type II kinetic curve + benign morphology –> BI-RADS? (1)

A

4

232
Q

breast MRI: type III kinetic curve + benign morphology –> BI-RADS? (1)

A

4

233
Q

breast MRI: type I kinetic curve + malig morphology –> BI-RADS? (1)

A

4

234
Q

breast MRI: type II/III kinetic curve + malig morphology –> BI-RADS? (2)

A
  • 4

- 5

235
Q

high risk for breast CA –> definition?

A

> 20% lifetime risk of develop breast CA

236
Q

what is breast conservation therapy?

A

lumpectomy + rtx

237
Q

status post lumpectomy –> enhancemt at lumpectomy site –> can be normal for how long?

A

6-18mo

238
Q

MRI –> evaluate silicone or saline implants?

A

silicone

239
Q

how differentiate silicone vs saline implant on screen mammo?

A

saline:
- valve
- wall is denser than center

silicone:
- uniformly dense
- no valve

240
Q

breast implant –> screen mammo –> special view?

A

Eklund (implant-displaced) view

241
Q

saline implant –> rupture –> clinical presentation?

A

sudden collapse –> instant dec breast size

242
Q

silicone implant –> rupture –> clinical presentation?

A
  • subtle change in implant contour

- no change in size or shape

243
Q

silicone implant –> rupture –> MRI sign?

A

linguine

244
Q

silicone implant –> rupture –> US appearance?

A

snowstorm

245
Q

reduction mammoplasty –> mammo findings? (2)

A

lower breast:

  • skin thick
  • curvilinear architectural distortion
246
Q

gynecomastia –> clinical presentation?

A

subareolar palpable abnormality

247
Q

gynecomastia –> mammo appearance?

A

subareola –> flame/triangle-shape density

248
Q

male –> breast mass –> benign features –> benign or suspicious?

A

male –> any breast mass –> susp

249
Q

breast bx –> path discordant –> next step?

A

repeat bx –> core or excision

250
Q

benign-appearing cyst –> aspirate –> bloody –> next step?

A

send to cytology

251
Q

benign-appearing cyst –> aspirate –> cloudy –> next step?

A

discard fluid

252
Q

benign-appearing cyst –> aspirate –> clear –> next step?

A

send to cytology

253
Q

benign-appearing cyst –> aspirate –> green –> next step?

A

discard fluid

254
Q

calc –> MC bx technique?

A

stereotactic-guided core

255
Q

stereotactic bx –> CI? (5)

A
  • thin breast –> <3cm compressed
  • far post location
  • subareolar location
  • pt can’t be positioned on stereotactic table
  • unctrl coag abnormal
256
Q

breast –> asymmetric in size –> ddx? (1) buzzword?

A

“shrinking breast” –> invasive lobular breast CA

257
Q

axillary lymph node drainage –> order?

A

level 1 (lateral) –> 2 –> 3 (medial) –> thorax

258
Q

what are Rotter nodes?

A

nodes bw pec minor & major

259
Q

Rotter nodes –> at same level as which axillary LN?

A

level 2

260
Q

sternalis M –> seen only on what view?

A

CC

261
Q

MC location for ectopic breast tissue?

A

axilla

262
Q

CA –> MC quadrant?

A

upper outer

263
Q

CA –> start in what unit?

A

terminal duct lobular unit (TLDU)

264
Q

majority (60%) of blood flow to breast –> which vessel?

A

internal mammary

265
Q

singular mets to internal mammary nodes –> common or uncommon?

A

uncommon

266
Q

singular mets to internal mammary nodes –> indicate what about the CA?

A

medial location

267
Q

sternalis M –> usu unilat or bilat?

A

unilat

268
Q

breast tenderness –> greatest at day ___?

A

day 27-30 (near end of luteal phase - progesterone dominates -> lobules prolif –> breast density inc slightly)

269
Q

mammography & MRI –> best performed in what phase of the breast/menstrual cycle?

A

follicular phase (day 7-14)

270
Q

never bx a prepubescent breast –> T/F? why?

A

T –> can damage breast developmt

271
Q

cyst formation –> greatest in pre/peri/post menopause?

A

perimenopause

272
Q

breast pain –> greatest in pre/peri/post menopause?

A

perimenopause

273
Q

fibroadenoma –> degenerate in pre/peri/post menopause?

A

(post)menopause

274
Q

secretory calcs (rod-like) –> dev in pre/peri/post menopause?

A

10-20 yrs post menopause

275
Q

lactating breast –> mammogram vs US –> which is more sensitive? why?

A

lactating breast –> more dense –> US more sensitive for mass

276
Q

bilat breasts –> inc density –> ddx? (2)

A
  • pituitary prolactinoma

- meds –> ie antipsych

277
Q

lactating breast –> bx –> comp?

A

milk fistula

278
Q

lactating breast –> bx –> milk fistula –> tx?

A

stop breastfeeding

279
Q

galactocele –> aunt minnie finding?

A

fat-fluid level

280
Q

galactocele –> typical seen when? typical location?

A
  • cessation of lactation

- sub-areolar

281
Q

lactating adenoma –> fu recommendation?

A

4-6mo postpartum/postdelivery/cessation of lactation –> US

282
Q

lactating adenoma –> natural progression of dz?

A

stop lactation –> rapid regress

283
Q

lactating adenoma –> usu single or multiple?

A

mult

284
Q

when get LMO view? (3)

A
  • kyphosis
  • pectus excavatum
  • avoid medial pacemaker/central line
285
Q

which view contains most breast tissue?

A

MLO

286
Q

spot compression view –> collimate or not?

A

leave collimator open –> larger FOV –> ensure get what you wanted

287
Q

mag view –> which positional views are obtained?

A
  • CC

- ML (true lat)

288
Q

screener –> lat breast –> microcalcs –> mag view –> ML or LM view?

A

ML

289
Q

screener –> med breast –> microcalcs –> mag view –> ML or LM view?

A

LM

290
Q

screener –> MLO only –> suspicious finding –> additional views –> ML or LM view? why?

A

ML view –> most (70%) breast cancers occur laterally

291
Q

what is “camel nose”?

A

MLO –> breast not pulled up and out –> looks saggy

292
Q

advantage of CC view over MLO?

A

maximize visualization of post medial tissue

293
Q

advantage of MLO view over CC?

A

maximize visualization of axillary & post tissue

294
Q

adequate technique: MLO –> pectoral muscle –> should be seen at level of what struct?

A

level of nipple or below

295
Q

adequate technique: MLO –> pectoral muscle –> should be convex or concave?

A

convex

296
Q

CC view –> lack adequate coverage of post lat tissue –> next step?

A

exagg lat CC view (XCCL)

297
Q

ML view –> which is closer to the detector –> medial or lat breast?

A

lat

298
Q

mass seen only on CC view –> next step?

A

rolled CC

299
Q

mass in far post medial breast –> next step?

A

cleavage view (CV)

300
Q

breast implants –> what views?

A

Eklund view (implant displaced) –> MLOID, CCID

301
Q

Cooper’s ligaments appear thick –> ddx? (2)

A
  • blur

- edema

302
Q

mammo –> blur –> etiology? (3)

A
  • motion (breathing, inadeq compression)
  • exposure –> too long
  • exposure –> too short
303
Q

mag view –> use grid or no grid?

A

no grid

304
Q

lesion seen only on MLO –> ML view –> how know if lesion is in med vs lat breast?

A

“Lead Sinks, Muffins Rise”:

  • inf on ML view –> lat breast
  • sup on ML view –> med breast
305
Q

screeners –> PPV? (anything other than BR1/2)

A

4% –> 3-8 cancers per 1000 mammos

306
Q

mammo –> bilat –> mult circumscribed similar appearing masses –> BI-RADS?

A

2

307
Q

grped round calcs –> BI-RADS?

A

3

308
Q

screening mammo –> BI-RADS options?

A
  • 0
  • 1
  • 2
309
Q

diagnostic mammo –> BI-RADS options?

A
  • 2
  • 3
  • 4
  • 5
310
Q

focal asymm –> compress –> less dense –> looks like breast tissue –> BI-RADS?

A

3

311
Q

MRI –> background parenchymal enhancemt –> categories? (5)

A
  • none
  • minimal
  • mild
  • mod
  • marked
312
Q

MRI –> mass –> shape –> categories? (3)

A

ROI:

  • round
  • oval
  • irreg
313
Q

MRI –> mass –> margin –> categories? (3)

A
  • circumscribed
  • irreg
  • spiculated
314
Q

MRI –> mass –> T2 hyperintense signal –> categories? (3)

A
  • grter than parenchyma
  • grter than or equal to fat
  • grter than or equal to water
315
Q

MRI –> non mass enhancmt (NME) –> distribution –> categories? (6)

A
  • focal
  • linear
  • segmental
  • regional
  • mult regions
  • diffuse
316
Q

complex cystic & solid mass –> BI-RADS?

A

4

317
Q

complicated cyst (cyst w debris) –> BI-RADS?

A

2 or 3

318
Q

calc –> “cigar shaped w lucent center” –> dx?

A

secretory (rod like) calcs

319
Q

calc –> “dashes but no dots” –> dx?

A

secretory (rod like) calcs

320
Q

milk of Ca –> bx –> no calcs visualized –> how to assess for milk of Ca?

A

view w polarized light –> birefringence

321
Q

amorphous calc –> ddx? (4)

A
  • # 1 fibrocystic change
  • sclerosing adenosis
  • columnar cell change
  • DCIS (low grade)
322
Q

coarse heterogeneous calc –> ddx? (4)

A
  • fibroadenoma
  • papilloma
  • fibrocystic change
  • DCIS (low-interm grade)
323
Q

fine pleomorphic calc –> ddx? (4)

A
  • fibrocystic change
  • fibroadenoma
  • papilloma
  • DCIS (high grade)
324
Q

Mondor dz –> tx?

A
  • NSAID

- warm compress

325
Q

lipoma –> enlrg –> next step?

A

bx

326
Q

bx –> pseudoangiomatous stromal hyperplasia (PASH) –> fu?

A

12mo

327
Q

young F –> MC palpable mass?

A

fibroadenoma

328
Q

MRI –> fibroadenoma –> T2 signal? enhance?

A
  • T2 bright

- type 1 enhance (progressive enhance)

329
Q

phyllodes tumor –> epidemiology?

A

middle age to older F

330
Q

phyllodes tumor –> recommend sentinel node bx –> T/F?

A

F

if mets –> hematogenous –> lung & bone

331
Q

phyllodes tumor –> rapid growth –> T/F?

A

T

332
Q

ductal CA –> medullary subtype –> assoc finding?

A

lrg axillary LN (not necessarily mets)

333
Q

ductal CA –> papillary subtype –> mass appearance?

A

complex cystic & solid

334
Q

ductal CA –> #2 MC type?

A

papillary

335
Q

breast CA –> multifocal vs multicentric?

A
  • multifocal: same quad –> <4-5cm apart

- multicentric: mult quad

336
Q

DCIS –> comedo vs non-comedo –> which is more aggressive?

A

comedo

337
Q

galactography –> mult intraductal masses –> ddx? (1)

A

DCIS

338
Q

Pagets dz of breast –> topic therapy –> skin lesion still not resolve –> next step?

A

wedge bx

339
Q

invasive lobular CA –> US appearance?

A

ill-defined area of shadowing –> “shadowing w/o mass”

340
Q

prognosis: IDC vs ILC –> which is better?

A

similar prognosis

341
Q

ILC –> often only seen on CC view –> T/F?

A

T

342
Q

ILC –> common to get axillary mets –> T/F?

A

F

axillary mets is less common –> instead, like to go to strange places ie peritoneum

343
Q

architectural distortion wo central mass (“dark star”) –> ddx? (4)

A
  • ILC
  • IDC-NOS
  • radial scar
  • surgical scar
344
Q

breast –> red, swollen, thick skin –> next step?

A

US

eval for focal lump to help target US

345
Q

breast –> red, swollen, thick skin –> US –> no focal mass –> next step?

A
  • punch bx

- abx –> see if it gets better (if IBC, will improve but not resolve)

346
Q

compare: inflamm breast CA vs locally advance breast CA

  • rapid/prolonged onset
  • age of presentation
  • mets at presentation
A

inflamm breast CA:

  • rapid onset
  • younger (mid 50s)
  • 30% mets at presentation

LABC:

  • prolonged onset
  • older (mid 60s)
  • 10% mets at presentation
347
Q

inflamm breast CA (IBC) –> tx? why?

A

1) ctx –> high chance of positive margins

2) mastectomy –> for local ctrl

348
Q

bx –> 5 classic high risk lesions?

A
  • radial scar
  • atypical ductal hyperplasia
  • atypical lobular hyperplasia
  • LCIS
  • papilloma
349
Q

MCC bloody nipple discharge?

A

papilloma

350
Q

1ary breast lymphoma –> what type of lymphoma?

A

non-Hodgkin (diffuse lrg B-cell)

351
Q

1ary breast lymphoma –> require what type of stain to confirm dx?

A

IHC

352
Q

1ary breast lymphoma –> mammo appearance?

A

hyperdense mass

353
Q

2ary breast lymphoma –> typical mammo appearance?

A

inflamm thickening wo mass

354
Q

inflamm breast CA –> painless or painful?

A

painless

355
Q

nipple discharge –> suspicious features? (4)

A
  • spontaneous
  • bloody
  • serous
  • from a single duct
356
Q

nipple discharge –> milky –> possible etiology? (3)

A
  • thyroid dz
  • pituitary adenoma –> prolactinoma
  • meds (ie antidep, neuroleptic, reglan)
357
Q

nipple discharge –> suspicious –> possible etiology? (2)

A
  • intraductal papilloma

- DCIS

358
Q

nipple discharge –> benign –> possible etiology? (2)

A
  • fibrocystic change

- ductal ectasia

359
Q

galactography –> contraindication? (4)

A
  • active infx (mastitis)
  • unable to express discharge at time of galactogram
  • contrast allergy
  • prior surg to nipple-areola complex
360
Q

architectural distortion + calcs –> ddx? (1)

A

IDC + DCIS

361
Q

architectural distortion, no calcs –> ddx? (1)

A

ILC

362
Q

mammo –> architectural distortion –> no correlate on US –> next step?

A

bx

363
Q

dx mammo –> suspicious spiculated mass –> US –> same thing –> next step?

A

US for axillary mets

364
Q

axillary LN –> suspicious features? (3) which is most specific?

A
  • # 1 specific –> loss of central fatty hilum
  • cortical thick >2.3mm
  • irreg outer margins
365
Q

male –> gender reassignmt –> hormone tx –> gynecomastia –> should get screening mammo –> T/F?

A

F

366
Q

mammo –> dense LN –> US –> snowstorm appearance –> next step?

A

US –> eval for breast implant rupture

367
Q

silicone breast implant –> intracapsular rupture –> US fiding?

A

“step ladder” appearance

368
Q

breast implant –> contraindication for core needle bx –> T/F?

A

F

369
Q

breast implant –> inc risk of breast CA –> T/F?

A

F

370
Q

saline implant –> dx of rupture –> test of choice?

A

physical exam

371
Q

breast implant –> MC comp?

A

capsular contracture

372
Q

breast implant –> what is capsular contracture?

A

fibrous capsule –> contract –> cosmetic deformity

373
Q

breast implant –> capsular contracture –> MC with…

  • silicone/saline?
  • subglandular/subpectoral?
A

subglandular silicone

374
Q

silicone in axillary LN –> ddx? (2)

A
  • breast implant rupture

- gel bleed (not a rupture)

375
Q

breast implant rupture –> #1 RF?

A

age of implant

376
Q

saline breast implant –> what imaging modality to see implant rupture?

A

mammo

377
Q

bx –> excisional vs incisional?

A
  • excision: remv entire lesion

- incision: bx portion of lesion

378
Q

breast CA –> recurrence –> peak time? (yr)

A

4yr

379
Q

breast CA –> breast conserving tx –> radiation vs no radiation –> %recurrence?

A
  • radiation: 6-8%

- no radiation: 35%

380
Q

breast CA –> lumpectomy –> immediate postop mammo demonstrates residual calcs –> Ok or not ok?

A

not ok

residual calcs –> assoc w 60% local recurrence

381
Q

DCIS –> lumpectomy –> new calcs –> benign vs recurrence –> timeline (yr)?

A
  • benign calc –> 2 yr

- recurrent calc (DCIS) –> 4yr

382
Q

breast CA –> radiation tx –> comp? (1)

A

2ary angiosarcoma

383
Q

breast CA –> radiation tx –> 2ary angiosarcoma –> classic clinical presentation?

A

red plaques/skin nodules

384
Q

MC CA that mets to breast?

A

melanoma

385
Q

breast conservation tx –> contraindications? (5)

A
  • inflamm CA
  • lrg cancer size relative to breast
  • multicentric
  • prior rtx to same breast
  • CI to rtx (ie collagen vascular dz)
386
Q

breast MRI –> focus –> size criteria?

A

<5mm

387
Q

breast MRI –> tamoxifen –> what happen to background parenchymal enhancemt?

A

dec –> then rebound

388
Q

child –> chest radiation –> how much rad (Gy) for inc risk of breast CA?

A

20gy

389
Q

child –> chest radiation –> 20gy –> when start screening mammo?

A

whichever is later:

  • 25yo
  • 8yr post exposure
390
Q

Cowden synd –> synd? (4)

A
  • breast CA
  • follicular thyroid CA
  • bowel hamartoma
  • Lhermitte-Duclos (brain hamartoma)
391
Q

breast CA risk models –> all current risk models underestimate lifetime risk –> T/F?

A

T

392
Q

breast CA risk models –> which is most comprehensive?

A

Tyrer-Cuzick

393
Q

what meds that reduce incidence of ER/PR+ cancer? (2)

A
  • tamoxifen

- SERMs (raloxifene)

394
Q

BRCA1 vs BRCA2 –> which is more common?

A

BRCA1

395
Q

men w BRCA1 vs BRCA2 –> who gets more CA?

A

BRCA2

396
Q

> 20% lifetime risk of breast CA –> when start screening?

A
  • 25-30yo

- 10yr before 1st deg relative

CORE (33 decks)

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