Breast

Question 1

spiculated breast mass ddx

Answer 1

• invasive carcinoma
• tubular carcinoma (best prognosis, small spiculated mass)
• radial scar / complex sclerosing lesion
• lymphocytic mastopathy
• granulomatous mastitis
• fat necrosis

Question 2

lobulated breast mass ddx

Answer 2

• invasive carcinoma
• fibroadenoma (younger patient,septa, solid)
• fibroadenolipoma (fat densities)
• phylloides (older patient, Phyllis, high recurrence, needs wide margin)

Question 3

round breast mass ddx

Answer 3

• fibroadenoma
• lipoma
• cyst (liquid or oil)
• lymph node

Question 4

breast calcification patterns

Answer 4

• popcorn-like: Involuting fibromas
• pleomorphic linear or branching: DCIS
• large rod/cigar like calcifications: plasma cell mastitis
• parallel track: vascular
• milk of calcium saucer in cup on lateral views: cystic hyperplasia
• lucent center: dermal calcifications
• eggshell/rim calcifications: fat necrosis

Question 5

High-risk factors for breast cancer

Answer 5

• BRCA1 or BRCA2 mutation
• Li-Fraumeni syndrome
• chest radiation prior to age 30, >=8yrs earlier

‘high-risk’ is defined as 20-25% lifetime risk of developing breast cancer
these are ACR indications for screening breast MRI

Question 6

Intermediate risk factors for breast cancer

Answer 6

• personal history of breast cancer
• history of breast atypia (ADH or ALH) or lobular carcinoma in situ (LCIS)

Note that intermediate risk is 15-20% lifetime risk, and these are NOT indications for MRI screening (ACR)

Question 7

circumscribed, oval, fat and breast tissue density breast mass ddx

Answer 7

• hamartoma
• fibroadenolipoma

Question 8

Breast skin thickening ddx

Answer 8

benign
- mastitis
- cardiac/renal failure, hypoalbuminemia (will be a more global andn bilateral process)
- breast radiation (peaks 6mo post)

malignant
- inflammatory breast cancer (diffuse thickening)
- locally advanced breast cancer with upstream lymphatic obstruction (focal thickening)
- lymphoma

Question 9

‘shrinking breast’ ddx

Answer 9

• diffuse carcinoma (inflammatory carcinoma or invasive lobular carcinoma)

Question 10

postpartum breast lesions ddx

Answer 10

• galactocoele (dependent debris)
• abscess (infective symptoms and pain)
• granulomatous mastitis (within 5 yrs pregnancy)
• lactating adenoma (hormone related, can mimic carcinoma; BI-RADS 4, needs core biopsy)

Question 11

breast lesion MRI enhancement patterns with the highest positive predictive value for carcinoma

Answer 11

• segmental distribution (100%)
• clustered ring enhancement (96%)
• washout pattern (94%, type 3 enhancement washout curve)

Question 12

Regional enhancement on breast MRI ddx

Answer 12

• normal variant
• pseudoangiomatous stromal hyperplasia
• fibrocystic changes
• ductal carcinoma in situ
• lobular carcinoma in situ