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NM By Myself > Breast Cancer NM > Flashcards

Breast Cancer NM Flashcards

1
Q

Breast cancer T

A
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2
Q

Breast cancer N

A
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3
Q

Breast cancer M

A

Bone
Lung
Brain (ER-, HR-)
Liver
Leptomeninges, brain, gyn, GIT (ILC)

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4
Q

Luminal A 50-55%

A

ER+
PR+
HER2-
Ki67-
Best prognosis
Hormone therapy - - aromatase inhibitor, tamoxifen

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5
Q

Luminal B 15%

A

ER+
PR+
HER2 +-(30%)
Ki67+
Hormone therapy

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6
Q

HER2 15%

A

ER-
PR-
HER2+
Trastuzumab, pertuzumab
Cardiotoxic - - MUGA

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7
Q

Basal-like type 10-20%

A

Triple negative
Cytotoxic therapy

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8
Q

ER+

A

75% of cases

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9
Q

Breast cancer US

A

More sensitive than mammography in IDC
US vs MRI to assess largest diameter
LN MTS - - focal cortical thickening >3mm, round (not reni form), no fatty hilum

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10
Q

Breast cancer MRI

A

High risk screening
Extent of disease
Recurrence vs scar
Perform in days 7-10 of cycle
Not accurate to assess cortical thickening of LN

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11
Q

Breast cancer FDG

A

No in stage I, II or operable III - - false positive
Less sensitive for <1 cm, ILC, grade 1, well diff
Stage III+, locally advanced, inflammatory, recurrent, metastatic - - not replace SLNB - - limited in LN <8 mm
IDC>ILC
Early cancer - - sensitivity to detect axillary adenopathy 20-50%

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12
Q

Breast cancer FDG
Response to treatment

A

Complete response - - complete resolution of lesions
Partial response - - reduction >15% SUV after 1 cycle, >25% after >2 cycles
PERCIST - - partial response - - reduction >30% SUL (SUV for lean body mass)
Complete response - - uptake of target lesions <liver

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13
Q

Breast cancer F-FLT (thymidine)

A

Good correlation with Ki67, but signal <FDG - - false negative
Phosphorylated by thymidine kinase

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14
Q

Breast cancer C-Methionine (amino acid)

A

Correlated with cells in S phase
T1/2 20 min - - cyclotron

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15
Q

F-fluciclovine
F-FACBC

A

Also prostate cancer

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16
Q

O15-labeled water

A

T1/2 2 min - - cyclotron
Combi with FDG
Tumor blood flow

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17
Q

F-FES
F-fluoroestradiol

A

ER expression
Patients who can not be biopsied
Sensitivity 70-100%, specificity 80-100%

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18
Q

F-FDHT
F-fluorodihydrotestosterone

A

AR expression

19
Q

F-FFNP

A

PR specific tracer
Efficacy of antiestrogen therapy

20
Q

In111-trastuzumab SPECT

A

Replaced by
Zn89 - - PET - - T1/2 78.4h - - cross BBB
Cu64 - - PET - - T1/2 12.7h - - less radiation exposure

21
Q

Breast cancer Bone scan

A

Stage I-IIIC - - CT and bone scan
Stage IV - - 70% bone MTS - - CT, bone scan, MRI
FDG - - optional for high risk
Bone scan sensitivity 88%
Response to treatment - - 6 months
Lytic bone MTS with soft tissue mass >10 mm are measurable

22
Q

Scintimammography

A

MBI = molecular breast imaging
Modern BSGI = breast specific gamma imaging
Sestamibi 20-30 mCi - - planar 5-10 min after IV - - lateral and oblique prone with hanging breasts - - anterior, oblique and SPECT supine
Radiation dose 0.07 mSv vs 0.44 mSv mammography

23
Q

MIBI interpretation

A

Accumulates within mitochondria
P-glycoprotein - - multidrug resistant gene - - efficacy of anti cancer drug
Non specific - - false positive - - surgery, fibroadenoma, atypical hyperplasia
Small non palpable - - early disease - - scan negative - - observation
>2 cm - - 100% sensitivity

24
Q

MIBI indication

A

Nipple discharge
Lesions BIRADS-3
Identified lesions
Multiple masses
Architectural distortion
Not possible MRI

25
Q

MIBI and diagnosed cancer

A

Extent
Multicentric vs multifocal vs bilateral
Response to neoadjuvant chemo

26
Q

Axillary MTS
Treatment

A

Adjuvant systemic therapy if LN>1 cm
Postmastectomy radio

27
Q

Contra to breast conserving therapy

A

Positive resection margins
Multicentric disease (>2 tumors in separate quadrants)
Prior radio
Pregnancy

28
Q

SLNB location

A

Majority to subareolar Sappey plexus
3% internal mammary chain

29
Q

SLNB injection

A

Intratumoral - - high activity up to 10 mCi, large volume up to 4 ml - - shine through
Peritumoral (deep) - - 2-4 aliquotes on each side 125-250 microCi 0.5-1.0 ml = gold standard - - 20-30% internal mammary
Intra/subdermal - - 0.1 ml - - small wheal
Periareolar (superficial) - - 2-4 injections 0.1 ml

30
Q

SLNB indication and Contra

A

Indication - T1, T2, DCIS>2.5 cm (+mastectomy), before neoadjuvant, male, old, obese without proven axillary LN MTS!!
Offer - multicentric, previous surgery or neoadjuvant
Contra - T3, T4, inflammatory, DCIS without mastectomy, pregnant

31
Q

SLNB interpretation

A

No SLN - - old, obese, tumor not in upper outer quadrant - - no ALND, but if not found during surgery - - maybe ALND
1-2 SLN - - no ALND - - breast conserving surgery + RADIO of whole breast
Positive - - mastectomy + ALND

32
Q

ROLL
Radioguided occult lesion localisation

A

Tc-MAA 2-15 MBq size 10-150 microm
Intratumoral
Add contrast to radioactive preparation - - mammogram to check correct position
Early stage non palpable breast cancer during breast conserving surgery

33
Q

ROLL with seeds

A

Similar to Brachytherapy in prostate cancer
4.5*0.8 mm titanium capsule with 1-10 MBq I125
T1/2 59.4 dayst
Low energy gamma 27 keV
In center of non palpable breast lesion few days before surgery
Excision guided by gamma probe

34
Q

SNOLL
Sentinel node and occult lesion localisation

A

TC-MAA intratumoral for ROLL + Tc-nanocolloid subdermal/intratumoral for SLNB
Only a minor fraction migrated through lymphatic channels - - most retained at injection site
If use Seeds for ROLL - - energy window of gamma probe between 27 keV of I125 and 140 keV of Tc - - discriminate gamma ray emission

35
Q
A

MIBI scintimammography

36
Q
A

PEM with FDG
Positron emission mammography

37
Q
A

MTS

38
Q
A

MTS

39
Q
A

Bone fracture

40
Q

Treatment according to N status

A

N1 - - surgery + chemo/hormone
N2 - - additional radio
N3 - - neoadjuvant chemo

41
Q

Negative PET post chemo

A

25% recurrence

42
Q
A

Postsurgical seroma

43
Q

Breast cancer risk

A

Nullipara or after 30
Breastfeeding >1 year lower risk
Early menarche, late menopause
HRT
Alco
Previous radio before 30

NM By Myself (25 decks)

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