Breast Cytology and Radiology

Question 1

Breast imaging techniques

Answer 1

Mammography 
USS
Image Guided Techniques
MRI
nuclear medicine
Breast screening programme

Question 2

Views from mammography

Answer 2

ML oblique
Craniocaudal 
Coned
Magnification 
True lateral 
Extended CC

Question 3

Who is screened for breast cancer?

Answer 3

> 40
< 40 if
- strong suspicion of cancer
- FH > 40%

Question 4

How does cytology work?

Answer 4

Microscopic examination of a thin layer of cells on a slide obtained by

• FNA
• direct smear from nipple discharge
• scrape of nipple with scalpel

Question 5

Signs of breast disease

Answer 5

Dominant massA
Asymmetry
Architectural distortion
Calcifications

Question 6

Soft tissue mass; signs of malignancy vs benign

Answer 6

Malignant; 
- irregular, ill-defined 
- spiculated
- dense
- distortion of architecture
Benign 
- smooth or lobulated
- normal density
- halo

Question 7

What does USS differentiate?

Answer 7

Solid from cystic mass

Solid benign from malignant

Question 8

First line of investigation for <40 group

Answer 8

USS

Question 9

Solid benign vs solid malignant on USS

Answer 9

benign 
- smooth outline
- oval shape
- acoustic enhancement
Malignant
- irregular outline 
- interrupting breast architecture
- acoustic shadowing and anterior halo

Question 10

Triple assessment for breast cancer

Answer 10

1. Clinical examination
2. Imaging
3. FNA cytology

Question 11

Indications for MRI of breast

Answer 11

recurrent disease
implants
indeterminate lesion following triple assessment
screening high risk women

Question 12

When is Ultrasound guided FNA carried out on the breast?

Answer 12

Impalpable area seen on USS

Question 13

Microscopic features of a benign cytology

Answer 13

low/moderate cellularity
cohesive groups of cells
flat sheets of cells 
bipolar nuclei in background
cells of uniform size
uniform chromatin pattern

Question 14

microscopic features of a malignant cytology

Answer 14

high cellularity
loss of cohesion 
crowding/overlapping of cells
nuclear pleomorphism 
hyperchromasia 
absence of bipolar nuclei

Question 15

Cytology scoring system

Answer 15

C1 = unsatisfactory 
C2 = benign 
C3 = Atypia (probably benign)
C4 = suspicious (probably malignant)
C5 = Malignant

Question 16

Curative procedure for cysts

Answer 16

Aspiration

Question 17

Fluid is discarded after aspiration from a cyst unless…..

Answer 17

Fluid is bloodstained

There is a residual mass

Question 18

Complications of FNA

Answer 18

pain
haematoma
fainting
infection and pneumothorax - RARE

Question 19

Contraindications to FNA

Answer 19

NONE

Question 20

Indication to investigate a nipple lesion

Answer 20

Bloody discharge from a single duct

Question 21

Nipple discharge on the slides show….

Answer 21

Duct ectasia = macrophages only
Intraduct papilloma = benign cells in papillary groups
Intraduct carcinoma (DCIS) = malignant cells

Question 22

Nipple scrape is used to differentiate from …..

Answer 22

Pagets disease (squamous cells and malignant cells)
VS
Eczema (squamous cells from epidermis only)

Question 23

When is axillary node lymph FNA done?

Answer 23

Pre-operative planning

Question 24

When is a core biopsy done?

Answer 24

All cases with clinical OR radiological OR cytological suspicion
Breast screening; especially architectural distortion and microcalcification
Pre-operative classification
Rarely open biopsy
Confirm invasion
Tumour type and grading
Immunohistochemistry and receptor status

Question 25

Who is invited for breast screening?

Answer 25

Women aged 50-70

Question 26

How often is breast screening carried out?

Answer 26

Every 3 years

Question 27

What investigation is used in breast cancer screening?

Answer 27

Mammography

Question 28

Uptake for breast cancer screening

Answer 28

80%

Question 29

How many people get recall for further investigations in breast screening?

Answer 29

5-10%

Question 30

Aim to detect cancers at what stage during screening?

Answer 30

DCIS stage of <15mm in size i.e. impalpable