Breast Flashcards
Symmetric shrinking breast?
Invasive lobular breast CA
Breast MR is best performed during which days of the menstrual cycle?
days 6-12 (less background enhancement)
What is the difference between multifocal and multicentric breast cancer?
Same quadrant versus different quadrant.
At the time of biopsy, DCIS will have what % chance of having invasive component?
10%
At the time of surgical excision, DCIS will have what % chance of invasive component?
25%
How often will DCIS present as a mass without calcs?
8/100
Most common cause of bloody discharge?
intraductal papilloma.
Malignant degeneration risk of phyllodes?
10% (some texts 25%)
What lifetime risk qualifies for screening MRI?
20-25%, 20Gy rad to chest as a kid
During which menstrual cycle phase is parenchymal enhancement the worst?
Luteal- days 14-28
What is the required resolution of the line pairs in mammography?
13 lp/mm in anode/cat direction and 11 in R to L
Target range for medical audit: recall rate
5-7%
Target range for medical audit: cancers/1000 screened
3-8
Which cyst features are LEAST likely to show posterior acoustic enhancement?
small and deep
Which type of calcifications “tend to coalesce”?
Coarse heterogenous.
The proliferative phase of the menstrual cycle includes which days?
days 3-14, aka “follicular phase”
Screening MRI for high risk patients is not recommended until atleast what age?
25
Alternate name for hamartoma?
Fibroadenolipoma
What do the BRCA 1/2 genes do?
DNA damage response/repair
What is the strongest risk factor for developing breast cancer?
patient age
What percent chance is there that an intraductal papilloma gets upgraded?
15-20%
What is the study of choice when seaching for primary CA with breast origin?
MR
Anatomically, where do most breast cancers start?
TDLU
60% of blood flow to breast is from___?
internal mammary
remaining is lateral thoracic and intercostal perforators
breast lymph drains to ____?
97% to axilla and 3% to internal mammary
What are the axillary lymph node levels?
- Lateral to pec minor
- under pec minor
- medial to pec minor
- between pec major and minor
if you see interanl mammary node on u/s…
cancer
Where is the sternalis seen?
ONLY CC view, never MLO next to sternum
MC location for ectopic breast tissue?
axilla
2nd MC place for ectopic breast tissue?
inframmary fold
When is the best time to have mammo and MRI?
Follicular phase
day 7-14
estrogren dominates
in what phase is breast density increased?
luteal
day 15-30
progesterone
Nipple enhancement on MRI.
normal (not Pagets)
in what quadrant do most cancers occur?
upper outer
breast tenderness maxes out at day___?
27-30
Risk assoc with Bx during lactaion?
milk fistula
benign fat containing lesion after lactation
galactocele
fat fluid level
looks like fibroadenoma, but patient is lactating
lactating adenoma
next step: f/u 4-6 mos post-partum with ultrasound, regress after lactation
What is the margin of error with posterior nipple lines in MLO and CC views?
1 cm
What view do you get sometimes in women with kyphosis or pectus excavatum?
LMO view
also can be used to avoid a medial pacemaker or cental line
which standard view contains the most breast tissue?
MLO
what are the standard mag views?
cc and ML views (milk of Ca2+)
If cooper ligaments are thick or fuzzy, what artifact are we dealing with?
blur 2/2 motion or inadequate compression.
could also be edema- look for skin thickening
When is a grid not used?
mag views
how many breast cancers are you trying to find per 1k mams?
3-8
explain: “lead sinks muffins rise”
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
What does BIRADS stand for?
Breast Imaging-Reportand and Data System
What is BI-RADS 0?
needs further workup or technical repeat
BI-RADS 1
normal
BI-RADS 2
Benign.
cysts, secretory calcs, fat containing lesions
“mult bilat well circ similar appearing masses”
“mult foci”
BI-RADS 3
less than 2% chance cancer
fibroadenoma
focal asymmetry that becomes less dense on compression (breast tissue)
grouped or clustered round calcifications
BI-RADS 4
2-95% chance malignancy
going to bx it (regardless of 4A, 4B, 4C)
prepare for B9 result
BI-RADS 5
>95% chance CA
if path comes back B9, recommend surg bx
BI-RADS 6
path proven cancer
Definition of “mass” on mammo?
spcae occupying lesion seen in 2 projections
vocab to describe a mass?
- Shape: round, oval, irregular ROI
- margin: circ, obscured, microlobulated, indistict, spiculated COMIS
- density: fat, hypo, iso, hyperdense
*margin is most important
What is the definition of “asymmetry” on mammo?
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
How to describe a mass on ultrasound.
- Shape: round, oval, irregular
- orientation: parallel, antiparallel
- margin: circ, indistinct, angular, microlobulated, spiculated
- echo pattern: anechoic, hyperechoic, hypoechoic, isoechoic, complex
- posterior features: none, enhancement, shadowing
Descriptors for masses on MRI
irregular: shape and margin
oval
circumscribed
T2 signal
descriptors for non-mass like enhancement on MRI
linear and linear branches
clustered ring
T2 signal
Earliest mammo finding of breast cancer according to some
calcs
high density material in the axilla
deodorant
What is the most suspicious calc distribution? least?
segmental-> linear -> grouped/clustered -> regional -> scattered
what view is good for confirming dermal calcs?
tangential view
fancy name for hamartoma?
fibroadenolipoma
what is the risk of sclerosis adenosis transforming to carcinoma?
~2%
if there is ADH- risk is closer to 7%
biopsy is recommended
