Breast imaging

Question 1

What is sensitivity?

Answer 1

How well a test identifies a patient with disease

Question 2

What is specificity?

Answer 2

How well a test identifies a patient without disease

Question 3

What is a false positive?

Answer 3

The test indicates a finding that does not exist

Question 4

What is a false negative?

Answer 4

The test does not identify the disease

Question 5

What type of imaging technique is a mammography?

Answer 5

Radiographic (X-ray) technique

Question 6

Positives to using mammography?

Answer 6

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

Question 7

Negatives to using mammography?

Answer 7

Ionising Radiation

Breast pain / discomfort

Challenging if limited mobility

Low sensitivity in dense breasts

No functional data

Question 8

What are the main indications for mammography?

Answer 8

Symptomatic assessment > 40 years

Screening (50 – 70yrs)
Higher risk ‘family history’ screening > 40 years

Question 9

What is DCIS?

Answer 9

Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast.

Question 10

Shape of DCIS on mammogram?

Answer 10

Linear or branching on scan

Question 11

Distribution of DCIS on mammogram?

Answer 11

Cluster or segmental

Question 12

DCIS is pleomorphic in size and density on mammogram, what does this mean?

Answer 12

On mammogram it is shown to have varying sizes and densities

Question 13

When breast ultrasound is carried out, what position is the patient placed in?

Answer 13

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

Question 14

Appearance of normal or benign-appearing lymph nodes on ultrasound?

Answer 14

Oval or lobulated shape
Smooth, well-defined margin.
Uniformly thin cortex, (usu) ≤3mm
Fatty (echogenic) hilum
Hilar blood flow

Question 15

Appearance of concerning-looking lymph nodes on ultrasound?

Answer 15

Round (circular) shape
Absence of the fatty hilum
Increased concentric or focal cortical thickness

Question 16

Positives to using ultrasounds for breast imaging?

Answer 16

No ionising radiation
Inexpensive
Comfort
Good sensitivity & specificity for invasive cancer
Image-guided procedures

Question 17

Negatives to using ultrasounds for breast imaging?

Answer 17

Low specificity when used in screening
Low sensitivity for DCIS
Operator dependent
(Minimal) functional data – doppler shows blood flow

Question 18

What are the main indications for ultrasound in breast imaging?

Answer 18

Targeted assessment
- Clinical abnormality
- Mammographic abnormality

Problems during pregnancy

Monitoring response to systemic treatment

Question 19

What is the one stop breast clinic?

Answer 19

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

Question 20

Symptomatic referral reasons?

Answer 20

Usually from GP
Any age, male & female
Suspicion of cancer
Infection / abscess

Question 21

What does the triple assessment consist of in the one stop breast clinic?

Answer 21

Clinical examination
Imaging
Biopsy (if appropriate)

Question 22

Processes used in investigating breast abnormalities?

Answer 22

P (E) = palpation (examination)
U = ultrasound
M = mammogram
B = biopsy (pathology)

Question 23

For breast pathology, how many grades are there?

Answer 23

Grades 1-5

Question 24

Grade 1 findings breast assessment?

Answer 24

Normal/no significant abnormality - no significant imaging abnormality

Question 25

Grade 2 findings breast assessment?

Answer 25

Benign findings - imaging findings are benign

Question 26

Grade 3 findings breast assessment?

Answer 26

Indeterminate/probably benign findings - small likelihood of malignancy, further investigations recommended

Question 27

Grade 4 findings breast assessment?

Answer 27

Findings suspicious of malignancy - moderate likelihood of malignancy. Further investigation is indicated

Question 28

Grade 5 findings breast assessment?

Answer 28

Findings highly suspicious of malignancy - high likelihood of malignancy. Further investigation is indicated

Question 29

For breast conditions, when is imaging NOT indicated?

Answer 29

Entirely normal / benign history & examination

Question 30

Imaging in under 40’s?

Answer 30

Under 40 (or pregnant / breast-feeding)
- Ultrasound first
- Mammogram only if concerning finding requiring biopsy

Question 31

Imaging in over 40’s?

Answer 31

40 years and over
- Mammogram first
- Targeted ultrasound

Question 32

Types of breast biopsies?

Answer 32

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.