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Radiology > Breast > Flashcards

Breast Flashcards

1
Q

What is the target recall rate for screening mammography (not including initial screens)?

A

The Canadian target is

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2
Q

DDx fat-containing lesions

A 
Hamartoma
LN
Galactocele
Fat necrosis
Lipoma
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3
Q

What is the risk of cancer in BIRADS 3?

A

less than 2%

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4
Q

What is the risk of cancer in BI-RADS 4a?

A

2-10%

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5
Q

What is the risk of cancer in BI-RADS 4b?

A

10-50%

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6
Q

What is the risk of cancer in BI-RADS 4c?

A

50-95%

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7
Q

DDx for breast skin thickening

A
  • Tumor (inflam BrCa, lymphoma/leukemia)
  • Inflammation (mastitis, abscess, radiation, post surg)
  • Lymphatic obstruction (spread of tumor to axilla, lung/breast cancer)
  • Edema (right heart failure, central venous obstruction, nephrotic syndrome)
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8
Q

DDx for architectural distortion

A
  • Cancer
  • Radial scar
  • Post-operative (scar from bx or surgery)
  • Sclerosing adenosis
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9
Q

DDx bilateral axillary lymphadenopathy

A
  • Granulomatous dz (sarcoid, TB)
  • HIV
  • Lymphoma
  • Lymphoid hyperplasia
  • Collagen vascular disease (SLE, RA)
  • Silicone adenopathy
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10
Q

DDx fat-containing lesions

A
  • Hamartoma
  • LN
  • Galactocele
  • Fat necrosis
  • Lipoma
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11
Q

If a patient has ADH or ALH, what is the increased risk for developing cancer?

A

5x (Primer)

Other sources say 4x for ADH and ALH and 2x risk for radial scar

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12
Q

What is the increased risk for developing cancer if you have sclerosing adenoma; hyperplasia, moderate or florid, solid or papillary?

A

2x (Primer)

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13
Q

What is the most common metastasis to the breast?

A

melanoma

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14
Q

Lobular neoplasia (formerly LCIS) is not considered malignant, but carries what percentage risk of developing breast cancer?

A

30% risk of breast cancer (15% in each breast)
-Primer
10x increased risk of developing subsequent invasive carcinoma

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15
Q

DDx shrinking breast

A
  • Diffuse ILC
  • Post-surgical
  • Radiation tx
  • Diabetic mastopathy
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16
Q

What is the recommended mgmt for flat epithelial neoplasia (FEA)?

A

Surgical excision. (Commonly co-exists with more significant lesions such as ADH, DCIS, tubular ca).

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17
Q

What is the recommended mgmt for a radial scar?

A

Surgical excision. 30-40% upgrade rate to DCIS or tubular carcinoma.

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18
Q

What is the increased risk of cancer in those with radial scar?

A

2x compared to normal population (Radiopaedia)

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19
Q

What is the recommended mgmt for pseudoangiomatous stromal hyperplasia (PASH)?

A

1 year f/u for definite benign cases. Not a/w incr’d risk of malignancy.

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20
Q

What is the recommended mgmt for sclerosing adenosis?

A

1 year f/u for definite benign cases. Not a/w incr’d risk of malignancy.

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21
Q

What is Mondor disease?

A

Mondor disease is a rare benign breast condition characterized by thrombophlebitis of the superficial/subcutaneous veins of the chest wall.

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22
Q

What is considered locally advanced breast cancer (LABC)?

A

-LABC: Stage III breast cancer, excluding inflammatory breast cancer (reported separately due to distinct clinical presentation/behavior)
+T3: Primary invasive tumor > 5 cm
+T4: Tumor any size direct extension to skin or chest wall; invasion of the dermis alone does not qualify as T4 (requires skin ulceration &/or skin nodules)
+N2: Matted axillary nodes; ipsilateral internal mammary nodes in absence of axillary metastasis
+N3: Ipsilateral metastatic infra- or supraclavicular nodes or clinically apparent (includes imaging) internal mammary nodes and axillary nodes
+Stage IIIA: T0-2 N2 M0 or T3 N1-2 M0
+Stage IIIB: T4 N0-2 M0

-Chest wall invasion: Intercostal muscle invasion; Pectoralis muscle invasion should be reported but is not classified as chest wall invasion

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23
Q

What is a level 1 LN?

A

Level I includes lymph nodes that are inferior to the inferolateral border of the pectoralis minor muscle

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24
Q

What is a level 2 LN?

A

lymph nodes that are posterior to and between the lateral and medial borders of the pectoralis minor muscle

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25
Q

What is a level 3 LN?

A

lymph nodes that are medial to the superior border of the pectoralis minor muscle (including infraclavicular nodes)

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26
Q

What is the limit for average glandular dose per mammogram?

A

-limited to 3 mGy (per view)

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27
Q

DDx for dystrophic calcifications

A
  • recurrent malignancy
  • fibroadenoma, fibroadenomatoid hyperplasia
  • dermatomyositis, Ehlers-Danlos
28
Q

DDx for intraductal mass

A

-Papilloma, benign or atypical
-DCIS +/- IDC
-Periductal inflammation, abscess
(BIRADS 4A usually, 8% malignancy rate)

29
Q

What is the mgmt of clustered micro cysts on ultrasound?

A

Considered benign or probably benign in perimenopausal women. If this finding is new or enlarging in a postmenopausal woman not on HRT, bx should be considered.

30
Q

DDx for clustered micro cysts on US

A
  • Fibrocystic changes (38%)
  • Apocrine metaplasia (38%)
  • Papillary apocrine metaplasia
  • DCIS, usually papillary
  • IDC, mutinous carcinoma
31
Q

DDx hypo echoic mass on US

A
  • Malignant: DCIS, IDC, Lobular carcinoma, metastasis
  • Atypical lesions: ADH, LCIS
  • Benign: lactational changes, gynecomastia, FA, complicated cyst, papilloma, adenosine, fibrosis, fibrocystic changes, fat necrosis, abscess, post surgical changes, radial scar
32
Q

DDx for fine pleomorphic calcifications

A
  • DCIS +/- IDC
  • Fibrocystic changes
  • Fibroadenoma
  • Pleomorphic LCIS
  • (Overall risk of malignancy is moderate, 29%)
33
Q

In the 50-69 year old age group, what is the reduction in mortality from screening mammography? (%)

A

about 30% (27%)

34
Q

What are the current recommendations from the Canadian Task Force on Preventative Health on screening for breast cancer with mammography for average risk women?

A
  • 40-49 years old: routine screening is not recommended
  • 50-69 years old: routine screening every 2-3 years
  • 70-74 years old: routine screening every 2-3 years
35
Q

What are the odds that a Canadian woman will develop breast cancer in her lifetime?

A

1 in 9

36
Q

What are the odds that a Canadian woman will die from breast cancer in her lifetime?

A

1 in 25

37
Q

What are typical characteristics of dermal calcifications on mammography?

A
  • lucent centres
  • often spherical or polygonal in shape
  • have a fixed relationship on multiple mammography views, a finding termed the “tattoo sign”
  • Grouped dermal calls usually have a linear distribution on tangential views.
  • Can project deep within the breast on multiple mammographic views. Tangential views are helpful to demonstrate that the lesions are superficial in location.
38
Q

What is the upgrade rate for intraductal papilloma?

A

-6.5-10% for non-vacuum assisted core biopsy
-1% for vacuum-assisted core biopsy
(Radprimer)

39
Q

At mammography, tubular carcinoma typically presents as a _____ mass

A

spiculated mass (not a well-circumscribed mass). They are slow growing and have an irregular shape and are spiculated.

40
Q

At mammography, papillary carcinoma typically presents as a ______ mass

A

Most likely will present as a circumscribed mass. It is a relatively well-differentiated tumor with a better prognosis than ductal carcinoma, not-otherwise specified.

41
Q

Which quality control test must be performed DAILY?

a) phantom image evaluation
b) repeat analysis
c) processor QC
d) darkroom fog

A

c) Processor QC should be performed daily at the start of the workday before any patient films are put through the processor.

42
Q

Invasive lobular carcinoma accounts for what percentage of breast cancers?

A

Approx 10%

Second most common after IDC

43
Q

When is the ideal time for performing breast MRI?

A

Days 7-14 of the cycle

44
Q

At what time points are the contrast-enhanced breast MR images obtained?

A

Pre-contrast Ax T1 FS, 2 min post, 9 min post.

Subtraction sequences acquired.

45
Q

The echogenicity of a breast lesion (iso, hypo, hyperechoic) is with respect to:

A

subcutaneous fat

46
Q

DDx for high density material in axillary LNs

A
  • metastatic disease (usually breast, thyroid, ovarian)
  • chronic granulomatous disease (TB, sarcoid)
  • gold tx for RA
  • silicone from previous silicone injection or implant rupture
  • high density material from ipsilateral arm or chest tattoo
47
Q

What is multifocal vs. multi-centric breast cancer?

A

Multifocal breast cancer is defined as multiple (≥ 2) separate foci of breast cancer within 4 or 5 cm of each other, typically within the same quadrant, and usually along the same ductal system. MR is sensitive for depicting tumor extent. At least 75% of additional foci are multifocal; fewer than 25% are multicentric (foci separated by > 5 cm and/or in different quadrants).
-Radprimer

48
Q

What are the goals (in terms of size detected and % node negative) of screening mammography in Canada?

A

75% of screened cancers less than 1 cm in size and 75% node negative (as per Dr. Seely)
->50% screen-detected invasive tumors

49
Q

What is the most common source of metastases to the breast?

A

Melanoma

50
Q

What is the expected cancer detection rate in

screened paIents?

A

5 per 1000 (Rosenberg et al. Radiology 2006)

51
Q

What is the radiaIon dose from a mammogram?

A

glandular dose from standard 2 view, bilateral mammography must not exceed 3 mGy (equivalent to 7 weeks of background radiaIon)

52
Q

Should women get screening mammograms when they are breastfeeding?

A

In women >40yrs, routine screening mammography should resume 3 months after cessation of lactation to allow the breast parenchyma to involute and return to baseline density

53
Q

What are the CAR guidelines for screening mammography?

A

CAR recommendations

  • 40-49yrs: Annual screening
  • 50-74yrs: Every 1-2 years
  • > 74yrs: Every 2 years
54
Q

Axillary lymph nodes are considered abnormal when the cortical thickness measures above?

A

3 mm is the upper limit of normal for cortex thickness

55
Q

List 3 worrisome features of nipple discharge

A
  • bloody or clear
  • spontaneous
  • from a single duct orifice
56
Q

What is the Canadian target for positive predictive value for screening mammography (e.g. those with an abnormal mammogram who go on to be diagnosed with invasive or in situ cancer)?

A

The Canadian target is ≥5% for first screens and ≥6% for subsequent timely screens.
-Public Health Agency of Canada

57
Q

What is the Canadian target participation rate for screening mammography?

A

Aim for >70% of the eligible population

58
Q

What is the recommended positive biopsy rate for a radiologist? (e.g. out of every 100 breast biopsies performed, how many should come back as cancer?)

A
  • Target is 30% (applies to a screening population)
  • If your rate is 10% then you are likely performing too many biopsies
  • If your rate is 50%, then you are probably undercalling things and not performing enough biopsies.
59
Q

When is breast cyst aspiration necessary?

a) When there is a possibility that it is solid
b) When the cyst is symptomatic
c) When a simple cyst is shown to have grown in size
d) a and b
e) all of the above

A

d) A and B: A cyst should be aspirated if there are internal echoes (ie. when it is unclear whether it is a cyst or solid) or if the patient seeks relief from symptoms
Cysts get larger and smaller, come and go. Enlargement of a simple cyst is not in and of itself an indication for aspiration.

60
Q

What is the risk of DCIS developing into invasive cancer?

a) 1% per year develop into invasive cancer
b) 25% per year
c) 0.1% per year
d) 10% per year

A

a) DCIS is quoted to progress to invasive cancer at a rate of 1% per year if left untreated. The histologic grade of DCIS usually correlates with the histologic grade of invasive tumor.

61
Q

The echogenicity of a breast lesion (iso, hypo, hyperechoic) is with respect to?

A

subcutaneous fat (Stavros 2003)

62
Q

What is considered interval growth for a presumed BI-RADS 3 fibroadenoma?

A

If documented growth >20% in 6 months, biopsy or excision should be performed as findings may represent a phyllodes tumor.

63
Q

What percentage of patients with inflammatory breast cancer will have metastases at clinical presentation?

A

20-40%

64
Q

What is the likelihood of malignancy for a developing asymmetry identified at screening mammography?

A

13% (RadioGraphics 2016)

65
Q

What is the lifetime risk of developing breast cancer in a women with the BRCA1 or BRCA2 gene? Express as a percentage.

A

50-85%

Radiology (12 decks)

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