Breast Cytology and Radiology Flashcards
Breast imaging techniques
Mammography USS Image Guided Techniques MRI nuclear medicine Breast screening programme
Views from mammography
ML oblique Craniocaudal Coned Magnification True lateral Extended CC
Who is screened for breast cancer?
> 40
< 40 if
- strong suspicion of cancer
- FH > 40%
How does cytology work?
Microscopic examination of a thin layer of cells on a slide obtained by
- FNA
- direct smear from nipple discharge
- scrape of nipple with scalpel
Signs of breast disease
Dominant massA
Asymmetry
Architectural distortion
Calcifications
Soft tissue mass; signs of malignancy vs benign
Malignant; - irregular, ill-defined - spiculated - dense - distortion of architecture Benign - smooth or lobulated - normal density - halo
What does USS differentiate?
Solid from cystic mass
Solid benign from malignant
First line of investigation for <40 group
USS
Solid benign vs solid malignant on USS
benign - smooth outline - oval shape - acoustic enhancement Malignant - irregular outline - interrupting breast architecture - acoustic shadowing and anterior halo
Triple assessment for breast cancer
- Clinical examination
- Imaging
- FNA cytology
Indications for MRI of breast
recurrent disease
implants
indeterminate lesion following triple assessment
screening high risk women
When is Ultrasound guided FNA carried out on the breast?
Impalpable area seen on USS
Microscopic features of a benign cytology
low/moderate cellularity cohesive groups of cells flat sheets of cells bipolar nuclei in background cells of uniform size uniform chromatin pattern
microscopic features of a malignant cytology
high cellularity loss of cohesion crowding/overlapping of cells nuclear pleomorphism hyperchromasia absence of bipolar nuclei
Cytology scoring system
C1 = unsatisfactory C2 = benign C3 = Atypia (probably benign) C4 = suspicious (probably malignant) C5 = Malignant
Curative procedure for cysts
Aspiration
Fluid is discarded after aspiration from a cyst unless…..
Fluid is bloodstained
There is a residual mass
Complications of FNA
pain
haematoma
fainting
infection and pneumothorax - RARE
Contraindications to FNA
NONE
Indication to investigate a nipple lesion
Bloody discharge from a single duct
Nipple discharge on the slides show….
Duct ectasia = macrophages only Intraduct papilloma = benign cells in papillary groups Intraduct carcinoma (DCIS) = malignant cells
Nipple scrape is used to differentiate from …..
Pagets disease (squamous cells and malignant cells)
VS
Eczema (squamous cells from epidermis only)
When is axillary node lymph FNA done?
Pre-operative planning
When is a core biopsy done?
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
Who is invited for breast screening?
Women aged 50-70
How often is breast screening carried out?
Every 3 years
What investigation is used in breast cancer screening?
Mammography
Uptake for breast cancer screening
80%
How many people get recall for further investigations in breast screening?
5-10%
Aim to detect cancers at what stage during screening?
DCIS stage of <15mm in size i.e. impalpable
