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Breast Flashcards

1
Q

Symmetric shrinking breast?

A

Invasive lobular breast CA

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2
Q

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

A

days 6-12 (less background enhancement)

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3
Q

What is the difference between multifocal and multicentric breast cancer?

A

Same quadrant versus different quadrant.

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4
Q

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

A

10%

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5
Q

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

A

25%

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6
Q

How often will DCIS present as a mass without calcs?

A

8/100

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7
Q

Most common cause of bloody discharge?

A

intraductal papilloma.

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8
Q

Malignant degeneration risk of phyllodes?

A

10% (some texts 25%)

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9
Q

What lifetime risk qualifies for screening MRI?

A

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

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10
Q

During which menstrual cycle phase is parenchymal enhancement the worst?

A

Luteal- days 14-28

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11
Q

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

A

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

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12
Q

Target range for medical audit: recall rate

A

5-7%

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13
Q

Target range for medical audit: cancers/1000 screened

A

3-8

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14
Q

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

A

small and deep

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15
Q

Which type of calcifications “tend to coalesce”?

A

Coarse heterogenous.

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16
Q

The proliferative phase of the menstrual cycle includes which days?

A

days 3-14, aka “follicular phase”

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17
Q

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

A

25

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18
Q

Alternate name for hamartoma?

A

Fibroadenolipoma

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19
Q

What do the BRCA 1/2 genes do?

A

DNA damage response/repair

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20
Q

What is the strongest risk factor for developing breast cancer?

A

patient age

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21
Q

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

A

15-20%

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22
Q

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

A

MR

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23
Q

Anatomically, where do most breast cancers start?

A

TDLU

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24
Q

60% of blood flow to breast is from___?

A

internal mammary

remaining is lateral thoracic and intercostal perforators

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25
Q

breast lymph drains to ____?

A

97% to axilla and 3% to internal mammary

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26
Q

What are the axillary lymph node levels?

A
  1. Lateral to pec minor
  2. under pec minor
  3. medial to pec minor
  4. between pec major and minor
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27
Q

if you see interanl mammary node on u/s…

A

cancer

28
Q

Where is the sternalis seen?

A

ONLY CC view, never MLO next to sternum

29
Q

MC location for ectopic breast tissue?

A

axilla

30
Q

2nd MC place for ectopic breast tissue?

A

inframmary fold

31
Q

When is the best time to have mammo and MRI?

A

Follicular phase

day 7-14

estrogren dominates

32
Q

in what phase is breast density increased?

A

luteal

day 15-30

progesterone

33
Q

Nipple enhancement on MRI.

A

normal (not Pagets)

34
Q

in what quadrant do most cancers occur?

A

upper outer

35
Q

breast tenderness maxes out at day___?

A

27-30

36
Q

Risk assoc with Bx during lactaion?

A

milk fistula

37
Q

benign fat containing lesion after lactation

A

galactocele

fat fluid level

38
Q

looks like fibroadenoma, but patient is lactating

A

lactating adenoma

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

39
Q

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

A

1 cm

40
Q

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

A

LMO view

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

41
Q

which standard view contains the most breast tissue?

A

MLO

42
Q

what are the standard mag views?

A

cc and ML views (milk of Ca2+)

43
Q

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

A

blur 2/2 motion or inadequate compression.

could also be edema- look for skin thickening

44
Q

When is a grid not used?

A

mag views

45
Q

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

A

3-8

46
Q

explain: “lead sinks muffins rise”

A

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

47
Q

What does BIRADS stand for?

A

Breast Imaging-Reportand and Data System

48
Q

What is BI-RADS 0?

A

needs further workup or technical repeat

49
Q

BI-RADS 1

A

normal

50
Q

BI-RADS 2

A

Benign.

cysts, secretory calcs, fat containing lesions

“mult bilat well circ similar appearing masses”

“mult foci”

51
Q

BI-RADS 3

A

less than 2% chance cancer

fibroadenoma

focal asymmetry that becomes less dense on compression (breast tissue)

grouped or clustered round calcifications

52
Q

BI-RADS 4

A

2-95% chance malignancy

going to bx it (regardless of 4A, 4B, 4C)

prepare for B9 result

53
Q

BI-RADS 5

A

>95% chance CA

if path comes back B9, recommend surg bx

54
Q

BI-RADS 6

A

path proven cancer

55
Q

Definition of “mass” on mammo?

A

spcae occupying lesion seen in 2 projections

56
Q

vocab to describe a mass?

A
  1. Shape: round, oval, irregular ROI
  2. margin: circ, obscured, microlobulated, indistict, spiculated COMIS
  3. density: fat, hypo, iso, hyperdense

*margin is most important

57
Q

What is the definition of “asymmetry” on mammo?

A

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
58
Q

How to describe a mass on ultrasound.

A
  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
59
Q

Descriptors for masses on MRI

A

irregular: shape and margin

oval

circumscribed

T2 signal

60
Q

descriptors for non-mass like enhancement on MRI

A

linear and linear branches

clustered ring

T2 signal

61
Q

Earliest mammo finding of breast cancer according to some

A

calcs

62
Q

high density material in the axilla

A

deodorant

63
Q

What is the most suspicious calc distribution? least?

A

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

64
Q

what view is good for confirming dermal calcs?

A

tangential view

65
Q

fancy name for hamartoma?

A

fibroadenolipoma

66
Q

what is the risk of sclerosis adenosis transforming to carcinoma?

A

~2%

if there is ADH- risk is closer to 7%

biopsy is recommended

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