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RRC Cards > Breast > Flashcards

Breast Flashcards

1
Q

what % of DCIS found as calcs on mammo?

A

90%

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2
Q

when are round calcs not benign?

A

linear/segmental

new

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3
Q

% DCIS visible on USS

A

50%

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4
Q

management of atypical ductal hyperplasia

A

excision

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5
Q

what kind of papilloma gets excision

A

papilloma w/ atypia

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6
Q

which breast cancer lacks e-cadherin

A

lobular neoplasia (ILC & LCIS)

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7
Q

which kind of lobular carcinoma in situ should get excised?

A

pleomorphic

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8
Q

where are cancers found in radial scars?

A

periphery

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9
Q

recommendation of radial scar & radial sclerosing lesion

A

scar - f/u image

lesion - excision

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10
Q

which is more likely to have LN mets in same size lesion? invasive lobular or ductal carcinoma?

A

invasive lobular

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11
Q

management of breast pain

A
  • <30 start with US
  • 30-35 image with US or mammogram
    >35 start with mammo - if N no further imaging, if abN do USS
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12
Q

subtypes of invasive ductal carcinoma

A
  • NOS (not otherwise specified)
  • tubular –> slow grow spiculated
  • medullary –> fast grow smooth
  • mucinous
  • papillary
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13
Q

‘circumscribed’ subtypes of ductal carcinoma

A

mucinous
medullary
papillary

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14
Q

slow growing subtypes of ductal carcinoma

A

tubular
mucinous
papillary

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15
Q

breast cancer T2 bright

A

mucinous carcinoma

invasive ductal

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16
Q

Compared to invasive ductal carcinoma, invasive lobular carcinoma is more likely to:

A

infiltrative pattern of ILC =

  • tends to be larger at diagnosis
  • present as distortion without or with a mass
  • result in a false negative FNA
  • result in mastectomy

compared with IDC.

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17
Q

What is the most common intra-cystic breast carcinoma?

A

Papillary carcinoma aka “encapsulated” carcinoma

- behaves like DCIS unless an invasive component extends outside of cyst wall

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18
Q

An apparent decrease in size of one breast is most typical of:

A

“shrinking breast” - typical of invasive lobular

- affected breast does not compress as well on mammo

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19
Q

56 yo F dx’ed w/ malignant phyllodes tumor. The next step in staging is sentinel lymph node biopsy? True/False

A

False - Malignant phyllodes tumor behaves like a sarcoma with hematogenous spread rather than lymphatic spread. A chest CT would be more appropriate for staging than axillary sampling.

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20
Q

what modifier do you use after neoadj chemo in TNM staging?

A

yTNM

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21
Q

DCIS calcification types & grade

A

fine, linear, fine linear branching (high grade)
fine pleomorphic (high grade)
amorphous (low grade)

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22
Q

why do you get posterior acoustic shadowing in birads5 masses

A

desmoplastic changes in mass

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23
Q

breast mets by subtype

A

luminal A - bone
HER 2+ - brain & liver
Triple negative - brain & viscera

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24
Q

breast ca w/ best outcome

A

ER/PR+, regardless of HER2+

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25
Q

most common invasive breast cancer subtype

A

luminal A (ER/PgR+)

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26
Q

more likely to be multicentric/focal - luminal A or B

A

luminal B (53%)

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27
Q

inflammatory breast carcinoma needs tumor cells where?

A

dermal lymphatics

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28
Q

breast MRI kinetic enhancement curves

A

type 1 - benign - initial slow uptake and persistent enhancement

type 2 - indeterminate - plateau

type 3 - malignant - initial fast uptake with washout

29
Q

axillary lymph node levels

A

level I: lateral to pec minor
level II: behind pec minor
level III: medial & superior to pec minor

30
Q

LCIS on biopsy - next step

A 
sx referral (ALH/cLCIS)
excision (pLCIS)
31
Q

most common MALE palpable lump

A

gynecomastia

32
Q

birads for biopsy proven cancer

A

birads 6

33
Q

PASH

A

pseudoangiomatous stromal hyperplasia

  • benign prolif STROMAL lesion consisting of myofibroblasts
  • responds to hormonal stimulus, usu premenopausal or postmeno on HRT
  • present as mass or asymmetry, NOT calcs
34
Q

interval breast cancer

A

clinically detected cancer during interval btwn recommended screenings

  • can be mammographically occult, missed on prior mammography, or a new mammographic finding
  • more often in dense breasts
  • more commonly high grade & triple negative
  • > 50% incr risk of death cf. screen-detected cancer
35
Q

nonpuerperal mastitis and subareolar abscess associated with…

A

heavy smoking

- results in squamous metaplasia of lactiferous ducts with resulting duct ectasia, stasis, and recurrent infection

36
Q

the goal for recall rate for screening mammography examinations should be less than or equal to…

A

10%

Radiology 2007

37
Q

modality to diagnose saline implant rupture

A

mammography (+ physical exam)

US and MRI not needed

38
Q

multifocal vs multicentric breast cancer

A

multifocal: disease in the same quadrant or within 5 cm of each other
- may be removed by a lumpectomy if breast large enough

multicentric: disease in separate quadrants or separated by >5 cm
- requires mastectomy

39
Q

modified radical mastectomy involves removal of…

A

complete breast
level I and II axillary nodes

(pectoral muscles remain intact)

40
Q

TRAM flap vs DIEP flap

A

both autologous flaps using abdominal skin, subcutaneous fat & adjoining vasculature (for breast reconstruction post-mastectomy)

DIEP: deep inferior epigastric perforator

transverse rectus abdominis MYOcutaneous flap:
- also uses rectus abdominis muscle
deep inferior epigastric perforator flap:
- does not use rectus abdominis muscle
- fewer complications, faster return to activity

Imaging: atrophied rectus abdominis muscle in the reconstructed breast = TRAM

41
Q

contraindications for breast conservation

A 
inflammatory cancer
large cancer size relative to breast
multicentric (multiple quadrants)
prior radiation to the same breast
contraindication to radiation therapy (collagen vascular disease)
42
Q

most common tumour met to breast

A

melanoma

43
Q

most important predictor of overall survival in breast ca

A

axillary status

44
Q

breast cancer T staging

A

T1 = <2cm
T2 = 2-5 cm
T3 = >5cm
T4 = any size with chest wall fixation, skin involvement, or inflammatory breast ca
Paget’s is carcinoma in situ of nipple epidermis, NOT T4

45
Q

mammo findings of extracapsular silicone rupture

A

silicone granulomas

dense lymph nodes

46
Q

patterns of gynecomastia

A

early nodular (most common)

  • flame shaped behind nipple, radiating posterior blending into fat
  • tender

late dendritic (branching tree)

  • chronic fibrosis & hyalinization; irreversible
  • usu not tender

diffuse glandular

  • diffuse incr in density (mammo looks like woman’s breast)
  • men receiving estrogen treatment
47
Q

punctate and amorphous high-density foci within axillary node

A

gold therapy

ipsilateral arm/chest tattoos

48
Q

NPV of combined negative mammography and targeted US for focal breast pain

A

100%

49
Q

idiopathic granulomatous mastitis

A

benign noninfective granulomatous inflammation in parous women that mimics malignancy
- lobulocentric, noncaseating granulomas
painful mass +/- draining sinus
50% resolve spontaneously, most resolve on oral steroids +/- intermittent relapse
US: large, ill-defined areas of hypoechogenicity

50
Q

function of BRCA 1 and 2 genes

A

regulate DNA-damage response and repair in the cell

51
Q

most likely cause for symmetric, regional, heterogeneous non-mass enhancement in the upper outer breast quadrants with persistent enhancement kinetics on MR

A

normal variant inflow phenomenon

  • this pattern is most typical during luteal phase of menstrual cycle (days 14-28)
  • why MR is best performed between days 6-12 of menstrual cycle to decrease background enhancement
52
Q

TNM of inflammatory breast ca

A

classified as T4d; at least stage IIIB

if N3 disease, then stage IIIC: many (>10) axillary LNs, an ipsilateral internal mammary LN with 1 or more positive level I or II axillary LNs, or an ipsilateral supraclavicular LN

if distant lymph nodes or organs (M1), then stage IV

53
Q

fine linear or fine linear branching calcs - % likelihood of malignancy

A

70%

BIRADS 4C (>50% to <95%)

54
Q

fine pleomorphic calcs - % likelihood of malignancy

A

30%

BIRADS 4B (>10% to <50%)

55
Q

coarse heterogeneous calcs - % likelihood of malignancy

A

<15%

BIRADS 4B (>10% to <50%)

56
Q

amorphous calcs - % likelihood of malignancy

A

20%

BIRADS 4B (>10% to <50%)

57
Q

HER2/neu positive breast cancer treatment

A

targeted therapy with trastuzumab (Herceptin)

  • HER2/neu specific antibody shown to be effective against HER2 positive breast cancer in metastatic, adjuvant, and neoadjuvant settings
  • relative risk of recurrence is decreased by 50% in early stage breast cancer after treatment with trastuzumab
58
Q

what is the desired cancer detection rate for 1000 screening mammograms?

A

5

59
Q

which breast MRI sequence is misregistration artifact seen on?

A

subtraction

secondary to motion causing movement of breast tissue between fat suppressed enhanced T1 and fat suppressed unenhanced T1 weighted sequences

60
Q

during an upright stereotactic breast biopsy, when adjusting for depth, which coordinate does not change?

A

the X coordinate is the only coordinate that does not change when moving the needle to the target on stereotactic upright biopsy
the Y changes ever so slightly because the needle is angled slightly
the Z has the most significant change as it is the depth and as you dial to the lesion, the Z approaches 0

61
Q

BIRADS for known CLL, bilateral axillary lymphadenopathy, and otherwise negative/normal mammogram

A

BIRADS 2

report also should indicate presence of lymphadenopathy and known underlying disease

e.g. negative or benign followed by “with bilateral axillary lymphadenopathy presumed due to the patient’s known lymphoma”

62
Q

when is a focus on breast MRI concerning?

A

new
washout
near a cancer

63
Q

Inflammatory breast cancer stage

A

Stage 3B

64
Q

High risk lesions (5)

A 
Radial scar
ADH 
ALH 
LCIS 
Papilloma
65
Q

Contraindications to breast conservation

A 
Inflammatory cancer
Large cancer size relative to breast 
Multi centric
Prior radiation to same breast
Contraindication to radiation (collagen vascular disease)
66
Q

Washout kinetic types & risk of cancer

A

Type I: persistent, 6% risk
Type II: plateau 7-28%
Type III: washout =>29%

67
Q

male breast lacks?

A
  • terminal lobules and acini

- cooper’s ligaments

68
Q

internal enhancement pattern of NME on MR most predictive of cancer?

A

clustered ring C+ (87% PPV)

clumped 30-40% PPV

RRC Cards (17 decks)

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