Breast imaging

Question 1

standard imaging techniques of the breast

Answer 1

Mammography

USS

Question 2

advanced imaging techniques of the breast

Answer 2

contrast enhanced mammogram 
tomosynthesis 
USS contrast enhanced
elastography
ABUS
MRI

Question 3

2 views taken on mammography

Answer 3

mediolateral

craniocaudal

Question 4

how may masses on mammography be defined

Answer 4

well defined
spiculated
irregular
distortion of tissues

Question 5

where would you see oil cyst calcification

Answer 5

post trauma

Question 6

where would you see dystrophic calcification

Answer 6

scar tissue

Question 7

how may ductal CIS appear on mammography

Answer 7

linear/branching
cluster/segmental
pleomorphic size/density

Question 8

advantages of mammography

Answer 8

images whole breast 
accessible and inexpensive 
reproducible 
screening 
highly sensitive for cancer and DCIS

Question 9

disadvantages of mammography

Answer 9

ionising radiation
challenging for low mobility
uncomfortable

Question 10

indication for mammography

Answer 10

asymptomatic screening 50-70 
symptomatic screening >40 or high risk screen >40
response to tx 
image guidance 
follow up

Question 11

reassuring description of masses on USS

Answer 11

anechoic
well defined
wide
hypoechoic

Question 12

malignant description of masses on USS

Answer 12

tall
ill defined
hypoechoic and heterogenous

Question 13

advantages of USS

Answer 13

no radiation 
cheap 
comfortable 
good sensitivity and specificity 
image guided

Question 14

disadvantages of USS

Answer 14

low specificity for screening
low sensitivity for DCIS
operator dependent

Question 15

indications for USS

Answer 15

targeted 
pregnancy 
follow up
monitor systemic tx 
image guided procedures

Question 16

what is tomosynthesis

Answer 16

3d technique of images taken in angles in an arc to remove overlap

Question 17

advantages of tomosynthesis

Answer 17

removes overlapping tissue

lesion outline

Question 18

disadvantages of tomosynthesis

Answer 18

additional radiation
accessibility
low sensitivity in very dense breasts

Question 19

indications of tomosynthesis

Answer 19

assessing mammographic abnormalities

screening in some cases

Question 20

what is CESM

Answer 20

contrast enhanced mammography

two images of low energy and contrast enhanced

Question 21

advantages of CESM

Answer 21

increased sensitivity and specificity esp for dense breasts
inexpensive
quick

Question 22

disadvantages of CESM

Answer 22

more radiation
IV contrast
discomfort

Question 23

what is elastography

Answer 23

measure of tissue stiffness

cancer usually stiffer

Question 24

what is strain elastography

Answer 24

palpation with USS probe to lead to colour map on USS screen

operator dependent

Question 25

what is shear wave elastography

Answer 25

strain produced by shear waves in probe
operator dependent but stiffness can be sensitive and specific
can be used to diagnose fibreadenoma

Question 26

malignant features on CE USS

Answer 26

hyperenhancement with enlarged range or irregular margin
rapid/iso enhancement with penetrating vessels
hyper centre-petal enhancement with perfusion defect

Question 27

advantages of contrast MRI

Answer 27

best sensitivity

most accurate for sizing

Question 28

disadvantages of contrast MRI

Answer 28

contraindication
patient tolerance
small foci previously mopped up so over-tx
no increase in +ve margin, reexcision or recurrence
moderately specific

Question 29

what age and how often are people referred to the national breast screening programme

Answer 29

50-70

3 years