Breast

Question 1

BIRADS descriptors for margins on mammo?

Answer 1

Spiculated: presence of radiating lines extending from the margins of the mass into surrounding tissue

Indistinct: fuzzy appearance of margins

Obscured: indicates overlapping tissue that precludes defining the margin

Well-circumsribed

Question 2

BIRADS descriptors margins US?

Answer 2

Circumscribed and Non-circumscribed

Noncircumscribed includes: indistinct, microlobulated, angular, and spiculated

Question 3

best classification of calcs?

Answer 3

Punctate

usually benign, but watch how they change over time, may diffx BIRADS 3 (watch and wait) from BIRADS 4 (Bx)

Question 4

dystrophic calcifications?

Answer 4

Dystrophic calcifications are essentially very densely calcified oil cysts

part of the spectrum of fat necrosis

Question 5

Most likely?

Answer 5

Fibrocystic changes

found in mammographically dense breasts with scattered punctate calcifications and fluctuating cysts

Question 6

Answer 6

secretory calcifications

dense, thick, continuous rod-like calcifications (usually bilateral) that radiate from the nipple in a ductal distribution.

typically ≥ 1 mm diameter and 3-10 mm long

Question 7

Answer 7

Normal fibroglandular tissue, island

feathery appearance with intervening lucent areas of this finding suggests that this is an island of glandular tissue rather than a mass, and its stability would support a BI-RADS 2 (benign) or BI-RADS 1 (negative) assessment

**here called a focal asymmetry bc normal CC view doesn’t image this portion of the breast-need an extended CC view

Question 8

BIRADS 3 gives what probability

Answer 8

“Probably benign”

should have less than a 2% risk of malignancy and is not expected to change over the follow-up interval.

For example, a nonpalpable, circumscribed mass on a baseline mammogram is considered BI-RADS 3, unless it can be shown to be a cyst. Other examples of BI-RADS 3 include a focal asymmetry which becomes less dense on spot compression views, or a cluster of punctuate calcifications.

Question 9

Amorphous vs pleomorphic calcs in benign distribution - which is worrisome/warrants bx

Answer 9

pleomorphic

most suspicious fx trumps others

Diffuse calcifications related to benign processes are commonly punctate and amorphous with random groups, but pleomorphic or fine linear morphology should prompt consideration of biopsy because of the possibility of extensive DCIS

Question 10

What BIRADS

Answer 10

BIRADS 3

an oval, circumscribed, nonpalpable mass on a baseline mammogram constitutes 1 of the accepted BI-RADS 3 (probably benign) lesions.

Others:

focal asymmetry that becomes less dense on spot compression view

cluster of punctate calcifications

Question 11

What is the echogenic halo secondary to?

Answer 11

Unresolved speculation and/or tumoral edema

Abrupt margins more likely to be benign

echogenic halo more likely to reflect malignancy (around70%)

(or wide transition zone)

Question 12

where is this lesion?

Answer 12

Lower Inner breast

“Muffins rise, Lead sinks’

to tell if a lesion is medial, lateral, or central in the breast from true 90* (LM) lateral to MLO view.

–> MLO first, where does it go on LM

Question 13

Examples of BIRADS 3 findings

Answer 13

Less than 2% chance of malignancy

Examples

nonpalpable, circumscribed mass on a baseline mammogram

focal asymmetry that becomes less dense on spot compression view

or a cluster of punctate calcifications.

Question 14

What do you expect to find on US?

Answer 14

Clustered microcysts

we see a lobular mass with microlobulated borders, isodense with no fat internally

Question 15

Ddx in a woman who recently stopped breastfeeding

Answer 15

Galactocele

Hamartoma

Both fat containing

galactocele can classically have fat/fluid level from inspissated milk