Breast

Question 1

Symmetric shrinking breast?

Answer 1

Invasive lobular breast CA

Question 2

Breast MR is best performed during which days of the menstrual cycle?

Answer 2

days 6-12 (less background enhancement)

Question 3

What is the difference between multifocal and multicentric breast cancer?

Answer 3

Same quadrant versus different quadrant.

Question 4

At the time of biopsy, DCIS will have what % chance of having invasive component?

Answer 4

10%

Question 5

At the time of surgical excision, DCIS will have what % chance of invasive component?

Answer 5

25%

Question 6

How often will DCIS present as a mass without calcs?

Answer 6

8/100

Question 7

Most common cause of bloody discharge?

Answer 7

intraductal papilloma.

Question 8

Malignant degeneration risk of phyllodes?

Answer 8

10% (some texts 25%)

Question 9

What lifetime risk qualifies for screening MRI?

Answer 9

20-25%, 20Gy rad to chest as a kid

Question 10

During which menstrual cycle phase is parenchymal enhancement the worst?

Answer 10

Luteal- days 14-28

Question 11

What is the required resolution of the line pairs in mammography?

Answer 11

13 lp/mm in anode/cat direction and 11 in R to L

Question 12

Target range for medical audit: recall rate

Answer 12

5-7%

Question 13

Target range for medical audit: cancers/1000 screened

Answer 13

3-8

Question 14

Which cyst features are LEAST likely to show posterior acoustic enhancement?

Answer 14

small and deep

Question 15

Which type of calcifications “tend to coalesce”?

Answer 15

Coarse heterogenous.

Question 16

The proliferative phase of the menstrual cycle includes which days?

Answer 16

days 3-14, aka “follicular phase”

Question 17

Screening MRI for high risk patients is not recommended until atleast what age?

Answer 17

25

Question 18

Alternate name for hamartoma?

Answer 18

Fibroadenolipoma

Question 19

What do the BRCA 1/2 genes do?

Answer 19

DNA damage response/repair

Question 20

What is the strongest risk factor for developing breast cancer?

Answer 20

patient age

Question 21

What percent chance is there that an intraductal papilloma gets upgraded?

Answer 21

15-20%

Question 22

What is the study of choice when seaching for primary CA with breast origin?

Answer 22

MR

Question 23

Anatomically, where do most breast cancers start?

Answer 23

TDLU

Question 24

60% of blood flow to breast is from___?

Answer 24

internal mammary

remaining is lateral thoracic and intercostal perforators

Question 25

breast lymph drains to \_\_\_\_?

Answer 25

97% to axilla and 3% to internal mammary

Question 26

What are the axillary lymph node levels?

Answer 26

1. Lateral to pec minor 2. under pec minor 3. medial to pec minor 4. between pec major and minor

Question 27

if you see interanl mammary node on u/s...

Answer 27

cancer

Question 28

Where is the sternalis seen?

Answer 28

ONLY CC view, never MLO next to sternum

Question 29

MC location for ectopic breast tissue?

Answer 29

axilla

Question 30

2nd MC place for ectopic breast tissue?

Answer 30

inframmary fold

Question 31

When is the best time to have mammo and MRI?

Answer 31

Follicular phase day 7-14 estrogren dominates

Question 32

in what phase is breast density increased?

Answer 32

luteal day 15-30 progesterone

Question 33

Nipple enhancement on MRI.

Answer 33

normal (not Pagets)

Question 34

in what quadrant do most cancers occur?

Answer 34

upper outer

Question 35

breast tenderness maxes out at day\_\_\_?

Answer 35

27-30

Question 36

Risk assoc with Bx during lactaion?

Answer 36

milk fistula

Question 37

benign fat containing lesion after lactation

Answer 37

galactocele fat fluid level

Question 38

looks like fibroadenoma, but patient is lactating

Answer 38

lactating adenoma next step: f/u 4-6 mos post-partum with ultrasound, regress after lactation

Question 39

What is the margin of error with posterior nipple lines in MLO and CC views?

Answer 39

1 cm

Question 40

What view do you get sometimes in women with kyphosis or pectus excavatum?

Answer 40

LMO view also can be used to avoid a medial pacemaker or cental line

Question 41

which standard view contains the most breast tissue?

Answer 41

MLO

Question 42

what are the standard mag views?

Answer 42

cc and ML views (milk of Ca2+)

Question 43

If cooper ligaments are thick or fuzzy, what artifact are we dealing with?

Answer 43

blur 2/2 motion or inadequate compression. could also be edema- look for skin thickening

Question 44

When is a grid not used?

Answer 44

mag views

Question 45

how many breast cancers are you trying to find per 1k mams?

Answer 45

3-8

Question 46

explain: "lead sinks muffins rise"

Answer 46

lesion that is medial on the CC film will be superior on the MLO and even more superior on ML Lesion that is lateral will become more inferior

Question 47

What does BIRADS stand for?

Answer 47

Breast Imaging-Reportand and Data System

Question 48

What is BI-RADS 0?

Answer 48

needs further workup or technical repeat

Question 49

BI-RADS 1

Answer 49

normal

Question 50

BI-RADS 2

Answer 50

Benign. cysts, secretory calcs, fat containing lesions "mult bilat well circ similar appearing masses" "mult foci"

Question 51

BI-RADS 3

Answer 51

less than 2% chance cancer fibroadenoma focal asymmetry that becomes less dense on compression (breast tissue) grouped or clustered round calcifications

Question 52

BI-RADS 4

Answer 52

2-95% chance malignancy going to bx it (regardless of 4A, 4B, 4C) prepare for B9 result

Question 53

BI-RADS 5

Answer 53

\>95% chance CA if path comes back B9, recommend surg bx

Question 54

BI-RADS 6

Answer 54

path proven cancer

Question 55

Definition of "mass" on mammo?

Answer 55

spcae occupying lesion seen in 2 projections

Question 56

vocab to describe a mass?

Answer 56

1. Shape: round, oval, irregular **ROI** 2. margin: circ, obscured, microlobulated, indistict, spiculated **COMIS** 3. density: fat, hypo, iso, hyperdense \*margin is most important

Question 57

What is the definition of "asymmetry" on mammo?

Answer 57

unilateral deposition of tissue that doesn't quite look like a mass seen in 1 view * global* asymmetry is volume asymmetry * focal* seen in two projections, needs spot comp, might be a mass * developing* is new or growing

Question 58

How to describe a mass on ultrasound.

Answer 58

1. Shape: round, oval, irregular 2. orientation: parallel, antiparallel 3. margin: circ, indistinct, angular, microlobulated, spiculated 4. echo pattern: anechoic, hyperechoic, hypoechoic, isoechoic, complex 5. posterior features: none, enhancement, shadowing

Question 59

Descriptors for masses on MRI

Answer 59

irregular: shape and margin oval circumscribed T2 signal

Question 60

descriptors for non-mass like enhancement on MRI

Answer 60

linear and linear branches clustered ring T2 signal

Question 61

Earliest mammo finding of breast cancer according to some

Answer 61

calcs

Question 62

high density material in the axilla

Answer 62

deodorant

Question 63

What is the most suspicious calc distribution? least?

Answer 63

segmental-\> linear -\> grouped/clustered -\> regional -\> scattered

Question 64

what view is good for confirming dermal calcs?

Answer 64

tangential view

Question 65

fancy name for hamartoma?

Answer 65

fibroadenolipoma

Question 66

what is the risk of sclerosis adenosis transforming to carcinoma?

Answer 66

~2% if there is ADH- risk is closer to 7% biopsy is recommended