Breast Flashcards
Second most common IDC breast cancer subtype?
Papillary IDC (after NOS)
What is associated with Paget’s disease of nipple?
High grade DCIS
What’s the second most common breast cancer subtype?
ILC
Shrinking breast seen in?
ILC - the breast is not being compressed that much , but might look normal in size clinically.
Which view ILC is seen better?
CC- since it compresses better. Appears as an architectural distortion
ILC buzzwords:
Mammo: dark star - shrinking breast.
US: shadowing without a mass.
Most common implants complication?
Capsular contracture: due to contraction in the fibrous capsule.
Major risk factor for implant rupture?
Age on the implant
Risk of breast cancer in NF-1?
Moderate risk.
Salad oil sign
Mixing of silicone and saline in a double-lumen intracapsular rupture.
Location of oil cysts in steatocystoma multiplex?
Intradermal While in post-traumatic are intra-parenchymal.
What medication can cause focal fibrosis?
Hormone replacement therapy.
What’s the rule of multiplicity?
- at least 3 masses (one in each breast).
- benign margins
- non palpable
- no suspicion calcs
Which breast is involved in a seatbelt injury?
Driver: left breast
Passenger: right breast
Most common sites for phylloids mets?
Lung and bone (it’s hematogenous route).
Thickness of tomo slice?
1 mm
Examples of cellular fibroepithelial lesions?
Fibroadenoma
Phylloides
What’s picture framing in MRI?
Normal pattern of parenchymal enhancement from the periphery to the center.
How does fat necrosis look on MRI?
T1 non-FS: hyper similar to normal fat.
T1 FS: hypo with rim enhancement.
Thin, nonenhancing septa in MRI?
Fibroadenoma
Types of needle loc systems?
Hook wire needle system: needle is removed and wire stays in lesion.
Rigid needle and J wire: both needle and wire remains in lesions while patient awaits surgery.
In needle loc, how far the tip of the needle should be from the lesion?
The tip should be 1 to 1.5 cm beyond the lesion.
What’s stroke margin in stereo?
The calculated distance between the needle tip and the detector once needle has been fired. Calculated by computer
What’s positive stroke margin?
When there’s enough breast tissue beyond the post fired needle tip without traversing the entire breast or hitting the detector.
What’s the maximum dose of 1% lidocaine without epinephrine?
4.5 mg/kg not exceeding 300mg
What’s the maximum dose of 1% lidocaine with epinephrine?
7 mg/kg not exceeding 500 mg
Pregnant diagnosed with breast cancer, how to treat?
Immediate surgery then radiation after delivery. No chemo or radio in first trimester.
How to anesthetize nipple Areola complex?
Topical lidocaine!
What’s the upgrade risk in sclerosing adenosis?
Less that 2%, therefore, it goes back to screening.
How’s the z-axis generated in stereo?
By calculating the parallax shift of the target on the stereotactic images compared with the target location on the scout image.
What local anesthetic is administered for skin wheel?
Lidocaine 1% buffered with sodium bicarbonate (1:9) m- to reduce burning.
What local anesthetic is administered into breast parenchyma?
Lidocaine 1% with epinephrine (1:100,000) for hemostasis. Dose is 7mg/kg
Cleft like cystic spaces in a well defined mass?
Phylloids. A feature that can differentiate it from fibroadenoma
What’s the soure to image distance in mammo?
50-80 cm
how is motion in DBT compared to conventional mammo?
May be worse!
Can you BIRADS MRI without giving Gad?
NO! Gad should be there to BIRADS!
Male with clinical exam is consistent with gynecomastia
No imaging needed.
Male under 25 with suspicion clinical exam?
Do US first
Male above 25 with suspicion exam?
Do Mammo first then US.
Can biopsy epidermal inclusion cyst?
NO - It’s contraindicated.
what’s the typical compression thickness?
4-5 cm
If a mass is seen on mammo then disappears on C+ mammo
eclipse sign - it’s a cyst.
What is used for molecular breast imaging?
Tc99m-sestamibi
If radial scar if >2 cm
is called –> Complex sclerosing lesion.
Mucocele-like lesions:
fibrocystic change with columnar cell change. They are high-risk lesions.
What’s the FDA recommendation regarding implant rupture screening?
MRI every 3 years.
New fluid formed around in implant?
Aspirate and send it to r/o implant-associated lymphoma.
When to biopsy a fibroadenoma?
if size> 2.5 cm or interval growth of > 20%.
How long post-radiation changes last?
Peaks at 6 months and may last to 18 months.
Chest radiation received after the age of 30?
Not a high risk for MRI screening
When to perform Sentinel lymph node biopsy in DCIS?
Only if there’s necrosis or microinvasive disease.
Which part of breast can be excluded in MLO?
Superior medial breast.
Invasive tumors with increased through transmission
are 10-24x more likely to be high grade than invasive tumors without this feature.
What’s the position of glandular tissue after reduction mammoplasty?
INFERIOR redistribution relative to pre op.
How frequent localization accuracy is done for sterotactic machine?
Annually
Pt didn’t show up for mammogram after the initial screening exam, for how long her record should be kept?
10 years.
If follow ups available, then records are kept for 5 years.
Reduction mammoplasty findings
- Nipple: Superiorly shifted
- Fibroglandular tissue: Inferiorly shifted
Which type of breast cancer is associated with lymphoid infiltration?
Medullary carcinoma
What’s the name of the artifact?
Blurring-ripple artifacts.
- Seen with breast tomosynthesis.
- related to the small number of projections acquired at DBT
- Analogous to volume averaging.
- Oriented perpendicular to the x-ray tube sweep direction.
- Corrected with an increasing number of projections, disappearing when the number of projections matches the number of reconstruction sections
Examples of truncation artifact in breast tomo?
- Stair-step artifact.
- Bright-edge artifact.
Which mammography QC test is this?
Flat Field Test. Done Weekly.
Developing asymmetry most likely is?
PASH
PASH
PASH
Imaging difference between lactating adenoma and a galactocele?
LA: Has Doppler vasularity
what additional views should be done in case of axillary oil cyst/fat necrosis?
Tangential
