Breast imaging Flashcards
What is sensitivity?
How well a test identifies a patient with disease
What is specificity?
How well a test identifies a patient without disease
What is a false positive?
The test indicates a finding that does not exist
What is a false negative?
The test does not identify the disease
What type of imaging technique is a mammography?
Radiographic (X-ray) technique
Positives to using mammography?
Images the whole of both breast
High sensitivity for detecting DCIS (ductal carcinoma in situ) and invasive cancer
Only screening modality proven to reduce population mortality
Accessible & inexpensive
Reproducible
Negatives to using mammography?
Ionising Radiation
Breast pain / discomfort
Challenging if limited mobility
Low sensitivity in dense breasts
No functional data
What are the main indications for mammography?
Symptomatic assessment > 40 years
Screening (50 – 70yrs)
Higher risk ‘family history’ screening > 40 years
What is DCIS?
Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast.
Shape of DCIS on mammogram?
Linear or branching on scan
Distribution of DCIS on mammogram?
Cluster or segmental
DCIS is pleomorphic in size and density on mammogram, what does this mean?
On mammogram it is shown to have varying sizes and densities
When breast ultrasound is carried out, what position is the patient placed in?
Lateral decubitus position - patient is instructed to lie on their side with the side that is being examined facing upwards.
Right lateral = lying on right side
Left lateral = lying on left side
Appearance of normal or benign-appearing lymph nodes on ultrasound?
Oval or lobulated shape
Smooth, well-defined margin.
Uniformly thin cortex, (usu) ≤3mm
Fatty (echogenic) hilum
Hilar blood flow
Appearance of concerning-looking lymph nodes on ultrasound?
Round (circular) shape
Absence of the fatty hilum
Increased concentric or focal cortical thickness
Positives to using ultrasounds for breast imaging?
No ionising radiation
Inexpensive
Comfort
Good sensitivity & specificity for invasive cancer
Image-guided procedures
Negatives to using ultrasounds for breast imaging?
Low specificity when used in screening
Low sensitivity for DCIS
Operator dependent
(Minimal) functional data – doppler shows blood flow
What are the main indications for ultrasound in breast imaging?
Targeted assessment
- Clinical abnormality
- Mammographic abnormality
Problems during pregnancy
Monitoring response to systemic treatment
What is the one stop breast clinic?
A One Stop Breast Clinic is an outpatient clinic where patients with any concerning breast symptoms can be assessed for an immediate and accurate diagnosis within a few hours
Symptomatic referral reasons?
Usually from GP
Any age, male & female
Suspicion of cancer
Infection / abscess
What does the triple assessment consist of in the one stop breast clinic?
Clinical examination
Imaging
Biopsy (if appropriate)
Processes used in investigating breast abnormalities?
P (E) = palpation (examination)
U = ultrasound
M = mammogram
B = biopsy (pathology)
For breast pathology, how many grades are there?
Grades 1-5
Grade 1 findings breast assessment?
Normal/no significant abnormality - no significant imaging abnormality
Grade 2 findings breast assessment?
Benign findings - imaging findings are benign
Grade 3 findings breast assessment?
Indeterminate/probably benign findings - small likelihood of malignancy, further investigations recommended
Grade 4 findings breast assessment?
Findings suspicious of malignancy - moderate likelihood of malignancy. Further investigation is indicated
Grade 5 findings breast assessment?
Findings highly suspicious of malignancy - high likelihood of malignancy. Further investigation is indicated
For breast conditions, when is imaging NOT indicated?
Entirely normal / benign history & examination
Imaging in under 40’s?
Under 40 (or pregnant / breast-feeding)
- Ultrasound first
- Mammogram only if concerning finding requiring biopsy
Imaging in over 40’s?
40 years and over
- Mammogram first
- Targeted ultrasound
Types of breast biopsies?
Core needle biopsy. A larger needle with a cutting tip is used during core needle biopsy to draw a column of tissue out of a suspicious area.
During vacuum-assisted biopsy, a suction device increases the amount of fluid and cells that is extracted through the needle.
