Breast

Question 1

What are the indications for breast imaging?

Answer 1

1. Symptoms of breast: lump, mass, skin changes, shape changes, pain, nipple discharge
2. Breast screening programme (asymptomatic women)
3. Strong FHx surveillance
4. Surveillance after breast cancer

Question 2

How many projections does a mammogram take of the breast?

Answer 2

9

Question 3

How are mammograms obtained?

Answer 3

Mammograms use low energy XRs

The breast is compressed

The mammogram takes 9 projections of the breast (rotating around it) (2D images)

If digital mammography is used you can create a 3D image (3D digital tomosynhesis) –> used in America

Question 4

What are the advantages and disadvantages of mammography?

Answer 4

Advantages: quick, cheap, good visualisation, can be used to guide biopsy, portable, non-invasive

Disadvantages: radiation, false +ves, 2D images of a 3D structure, can’t use <35 or dense breast tissue

Question 5

Other than the breast, what else does USS examine?

Answer 5

Axilla / lymph nodes

If suspicious –> fine needle aspiration cytology –> if -ve then sentinel node biopsy at surgery

Question 6

What are the advantages and disadvantages of US scan of breast?

Answer 6

Advantages: cheap, portable, non invasive, non ionising, execellent info about the mass (size shape fluid-filled), real time, guide biopsy

Disadvantages: operator dependent (technique + intepretation), not good for obesity

Question 7

What are some US features of breast malignancy?

Answer 7

Irregular mass

Poorly defined borders

Posterior acoustic shadowing

Hypoechoic

May have internal echoes

Question 8

What and how can advanced imaging techniques be used for the breast in Ca?

Answer 8

1) CT (not used for initial assessment but is used once diagnosis made –> staging + further mass evaluation)
2) MRI (contrast enhanced) can be used in both the initial assessment (e.g. If breast tissue is too dense even for USS) and cofirmed Dx (LOBAR CARCINOMA, advanced breast cancer, pregnancy…)

MRI is useful in women who are pregnant and younger (preferred over CT) also women with very dense breast tissue

Question 9

How can nuclear medicine be used in breast cancer?

Answer 9

1) sentinel node imaging (T99)
2) bone scintigraphy (assess for bone mets if symptoms suggest e.g. Pathological fracture)
3) PET can be used to look for mets

Question 10

What is the difference between mammography and tomography?

Answer 10

Mammography is 2D

Tomography is mammography digitalised into a 3D image

Question 11

If you can’t use PET-CT in advanced breast cancr, what can you use?

Answer 11

MRI