Breast Imaging Flashcards
Patients with high % breast density have lower/higher risk than patients very low % breast density. Breast cancer is also easier/harder to detect in dense breasts.
higher risk, harder to detect
What two views are used in mammography?
Mediolateral oblique and craniocaudal views
4 micro-calcification signs in mammography that are benign
vascular calcification,
oil cyst eggshell calcification, (often after injury)
plasma cell mastitis: long, bilateral, pointing to nipple,
dystrophic calcification in scar
3 micro-calcification signs in mammography that indicate DCIS
linear or branching micro calcifications,
clusters or segmental,
pleomorphic size and density
Mammography pros (3)
images whole breast,
high sensitivity for DCIS & invasive,
accessible
Mammography cons (4)
ionising radiation,
breast pain/discomfort,
challenging if limited mobility,
bad for dense breasts
Indications for mammography (6)
screening (50-70yrs),
higher risk screening >40,
symptomatic assessment >40,
monitoring response to systemic treatment,
follow up,
image guided techniques e.g. biopsy/localisation
Patients who had surgery for breast cancer will receive annual mammograms for approx. how long after?
3-5yrs
Grey-scale USS uses?
breast or axilla
USS benign signs
wide,
well-defined,
anechoic (black) - cysts,
hypo echoic
USS malignant signs
tall,
ill-defined,
hypo echoic,
heterogeneous (dark/mixed)
Treatment for cyst?
aspiration
Grey-scale USS pros (3)
no radiation,
comfortable,
good sensitivity and specificity for invasive
Grey-scale USS cons (2)
low specificity in screening,
low sensitivity for DCIS
Grey-scale USS indications (5)
assess clinical/mammographic abnormality,
during pregnancy,
monitoring response to systemic treatment,
follow-up for cancers not visible in mammography,
image-guided procedures
Both mammography and USS are useful for guiding biopsy/VAE and localisation. USS also has use for what other image-guided procedure?
aspiration of cyst or abscess
What is tomosynthesis?
Pseudo 3D technique by taking images at diff. angles in arc then reconstructing int multiple slices
Tomosynthesis pros? (2)
removes overlapping tissue,
lesion outline
Tomosynthesis cons? (3)
more radiation,
accessibility,
low sensitivity in v. dense breasts
Tomosynthesis indications? (3)
assessing mammography abnormalities,
screening sometimes in denser breasts,
not really used in follow up
What is Contrast Enhanced Spectral Mammography (CESM)?
IV contrast given and two images made - one normal mammography and one that shows enhanced bits
Why are mammographies usually only used in older women?
Because visibility not as good in younger breasts
CESM pros (2)
good sensitivity and specificity for dense breasts,
shows tumour blood supply
CESM cons (3)
radiation,
contrast use,
breast pain/discomfort
USS technique strain elastography measures what and how?
measures tissue stiffness - cancer tissues stiffer - by palpation with ultrasound
What is shear wave elastography?
ultra fast sequence to test tissue elasticity
Shear wave indications? (2)
adjuvant to grey-sale USS,
diagnosis of fibroadenomas (25-40yrs)
Contrast-enhanced USS (CE-US) indications? (3)
assessing response to chemo,
axillary node characterisation,
improving BIRADS classification of solid lesions
What is the name of the classification system used for assessment of breast lesion in USS, mammography and MRI?
BI-RADS
CE-US malignant features? (3)
hyper-enhanced,
irreegular margin,
rapid-iso-enhancement with penetrating vessels
Automated breast USS (ABUS) is a new technique that is particularly useful for women with?
dense breasts
Contrast-enhanced MRI contrast and patient position?
IV gadolinium,
lie prone
MRI pros (1)
most sensitivity for all
MRI cons (2)
moderate specificity (more mastectomies), may pick up parts that would've been treated by RT
MRI is particularly useful for which type of breast carcinoma and why?
lobular because usually multi-focal and multi-central
MRI indications (3)
for monitoring neoadjuvant chemotherapy,
to figure out discrepancy between USS and mammogram or imaging and palpation,
mammographically occult lesions
