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Radiology > Breast Imaging > Flashcards

Breast Imaging Flashcards

1
Q

Name 3 risk factors for breast abscess

A

Lactational mastitis

Smoking

Older women with chronic RA or DM

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2
Q

Name 2 mammographic features of sclerosing adenosis

A

Architectural distortion

Amorphous microcalcifications

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3
Q

What is complex sclerosing adenosis associated with?

A

Radial scar associated with DCIS and tubular carcinoma (30%)

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4
Q

What is breast papillomatosis?

A

Multiple papillomas in more than 1 duct system

Pre-malignant condition

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5
Q

Intra-ductal papilloma: US appearance and management?

A

Dilated ducts and well-defined intraductal mass with vascular stalk

Surgical excision needed to exclude malignancy

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6
Q

Name 2 types of DCIS

A

Comedo (60%): large cell and more aggressive

Non-comedo (40%)- small cell and less aggressive: papillary, cribriform, intracystic papillary carcinoma in situ etc

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7
Q

Name the top 5 subtypes of IDC

A

IDC NOS (65%)- scirrhous and worst Px

Tubular carcinoma (7-8%): best Px and cured by excision

Medullary carcinoma (2%): fast growing

Mucinous or colloid carcinoma (2%): slow-growing

Papillary (1-2%)

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8
Q

Name 3 features of mucinous breast cancer

A

More common in 70-75 years: slow growing

Well defined lobular mass. Calcifications rare.

Mixed solid/cystic components with acoustic enhancement

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9
Q

Name 3 features of medullary breast carcinoma

A

Young women (35 years)- fast growing

Rounded mass with ill-defined margins. No calcifications.

Homogeneously hypoechoic on US

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10
Q

Name 3 features of tubular breast carcinoma

A

Non-palpable and 50% associated with DCIS

Small, spiculated with calcifications (15% multifocal)

Hypoechoic mass with posterior acoustic shadowing

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11
Q

Name 3 features if DCIS

A

Simple mass or asymmetric density

50-75% have calcifications

Microlobulated hypoechoic mass

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12
Q

Name 3 features of LCIS

A

Pre-menopausal women (80-90%)

MMG: usually normal or non-specific calcifications

Need excisional biopsy (15-30% develop IDC or ILC)

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13
Q

Name 3 features of ILC

A

Seen on only 1 view (usually CC)- 16% occult

Similar risk of contralateral breast cancer to IDC (5-10%)

May need further assessment with MRI

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14
Q

Name 3 features of papillary carcinoma

A

Post-menopausal women: 65 years

50% in retro-areolar or sub-areolar region

Complex, solid-cystic mass with internal vascularity. Better Px than other IDC

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15
Q

Describe 3 features of Phylloides

A

Peak incidence 45 years

Large rounded mass with radiolucent halo. May have coarse calcifications

Can be benign, borderline or malignant. Histologically resembles FA but has increased cellularity and mitoses.

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16
Q

What are the features of benign, indeterminate and malignant breast lesions on MRI?

A

Benign: no enhancement or slow-gradual enhancement

Indeterminate: rapid initial enhancement followed by gradual late enhancement

Malignant: rapid initial enhancement followed by plateau or washout

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17
Q

CAD in screening mammography

A

Single reader + CAD= dual reader

CAD is good for mass and microcalcifications

CAD struggles with architectural distortion

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18
Q

Linear array transducer in breast US: refraction artefact

A

Refraction artefact commonly seen at margins of cysts

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19
Q

Breast density in different phases of menstrual cycle

A

Breast density is greater in luteal (secretory) phase compared to follicular (proliferative) phase

Women should have mammography in follicular phase (1st 2 weeks of cycle)

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20
Q

Lesion more echogenic than fat: benign or malignant?

A

Benign (most likely lipoma)

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21
Q

Fibroadenoma vs cyst on MMG

A

Similar density (can be indistinguishable)

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22
Q

Prevalence of breast cancer on 1st round screening?

A

6-10 per 1000 (prevalence screening)

Incidence screening (repeated attendance): 2-4 per 1000

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23
Q

Name 4 differentials for uniformly increased density and skin thickening.

A

Under-exposed film

Inflammatory breast cancer

Mastitis/ breast abscess

XRT

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24
Q

Flamed shaped changes in the retro-areolar tissue in a man. Dx?

A

Gynaecomastia

If there’s no mass, do not perform US as it can be confusing and lead to unnecessary biopsy!

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25
Q

DDx for bloody nipple discharge

A

Benign: intra-ductal papilloma

Paget’s disease of the nipple (usually DCIS)

Breast carcinoma

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26
Q

Name 3 proliferative disease without atypia

A

Epithelial hyperplasia

Sclerosing adenosis: increased number of acini (adenosis) + stromal fibrosis (sclerosis)

Papilloma: growth within a dilated duct (nipple discharge)

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27
Q

Name 3 components of complex sclerosing adenosis

A

Also called radial scar: mimics IDC on radiology and gross histology. But, NON-PALPABLE! No dilated lymphatics.

Central fibroelastic core

Dilated ducts

Epithelial and myoepithelial cells

28
Q

Name 3 features of juvenile papillomatosis

A

2/3 less than 20 years

Ductal hyperplasia and epithelial proliferation with cyst formation

Benign but marker for familial breast cancer and concurrent breast ca

29
Q

What is Paget disease of the breast?

A

DCIS from ductal system extends into nipple skin without crossing the basement membrane

Tumour cells disrupt nipple epithelial barrier resulting in scaling

Risk of progression to invasive ca is 1% (lumpectomy and XRT)

50-60% have underlying invasive ca (rest have DCIS only)

30
Q

Name 3 features of LCIS on histology

A

Loss of E-cadherin expression

Small, dyscohesive cells

Mucin-positive signet ring cells often present

31
Q

What cancer is more common in women with BRCA 1?

A

Medullary carcinoma (10-15% associated with BRCA)

32
Q

Lymphocytic infiltrate and pushing border (non-infiltrative) border on histology. Dx?

A

Medullary carcinoma

33
Q

Papillary carcinoma vs papilloma

A

Absence of myoepithelial cells

34
Q

3 features of ILC on histology

A

Dyscohesive tumour cells arranged in indian file

Signet ring cells common (mucin)

No tubule formation

35
Q

Name 4 features that affect grading of breast ca

A

Tubule production (glandular differentiation)

Mitotic count

Nuclear pleomorphism

Necrosis

36
Q

Nodal disease and 10 year disease-free survival

A

No nodes: 70-80%

1-3 nodes: 35-40%

More than 10 nodes: 10-15 %

37
Q

What is the significance of ER, PR and HER2/ neu expression?

A

ER and PR positive means better Px

HER2/ neu over-expression has poorer survival

38
Q

Name the top 3 stromal breast tumours

A

Intralobular stroma: phylloides and FA

Interlobular stroma: PASH

39
Q

Describe 3 features of PASH

A

Circumscribed palpable mass

Stromal proliferation of fibroblasts and myofibroblasts

Can mimic phylloides or mucinous tumour on FNA. Core biopsy is diagnostic- conservative management

40
Q

Breast cancer stages

A

Stage I: T1N0 or T0N1mi

Stage II: T1N1 or T2N0 or T3N0

Stage III: T4N0-2 or T3N1-2 or T2N2 or T1N2

Stage IV: any T and any N and M1

41
Q

Apart from breast and ovarian ca, what other tumours do BRCA1 and BRCA2 predispose to?

A

Prostate ca

Colon ca

42
Q

DCIS- micropapillary subtype

A

Extends well beyond mammographic abnormality

43
Q

DCIS- cribriform subtype

A

Neoplastic cells pack the distended duct: cookie-cutter like appearance

44
Q

LCIS pre-malignant?

A

No, indolent lesion which does NOT usually progress to ILC (unlike DCIS).

However, increased risk of ipsilateral and contralateral invasive cancer (both ductal and lobular).

45
Q

Pleomorphic variant of LCIS?

A

More aggressive behaviour- more radical therapeutic approach

46
Q

When would you biopsy a lesion that looks like a fibroadenoma?

A

If more than 25 mm to exclude a phylloides tumour

47
Q

What drug associated with FA?

A

Cyclosporin

48
Q

Digital vs film mammography

A

20-30% increased sensitivity in 40-50 year-old women (dense breasts)

49
Q

Most common presentation of ILC

A

Spiculated mass

50
Q

Is sclerosing adenosis associated with microcalcifications?

A

YES

47% have punctate or amorphous calcifications

51
Q

Edge and shadow artefact in breast US?

A

Edge artefact: cyst

Shadow artefact: fibrous tissue

52
Q

Name 2 appearances of breast papilloma on MMG

A

Dilated ducts or well defined mass

Non specific calcifications

53
Q

Name 2 malignancies associated with radial scar

A

30% associated with DCIS and tubular carcinoma

54
Q

Fibroadenoma on MRI?

A

Slow initial enhancement with persistent delayed enhancement

Non-enhancing septae

55
Q

From MLO to lateral, what happens to a lesion?

A

Lateral lesion goes lower

Medial lesion goes higher

56
Q

Triple negative (ER, PR and HER) breast cancer?

A

Medullary breast cancer (especially BRCA-1 associated)

Poorly differentiated IDC

57
Q

Non proliferative breast disease

A

FCC: cysts, fibrosis and adenosis

58
Q

Name 5 proliferative breast disease without atypia (RR 1.5-2.0)

A

Epithelial hyperplasia

Sclerosing adenosis: acini distorted by fibrosis. Calcifications

Papilloma: growth within dilated duct. Nipple discharge 80%

Juvenile papillomatosis: ductal hyperplasia and cyst formation. Marker for familial and concurrent breast ca

Radial scar

59
Q

Invasive papillary ca vs papilloma

A

Invasive papillary ca: absence of myoepithelial cells

60
Q

Micropapillary ca vs invasive papillary ca

A

Micropapillary has worse Px due to LN involvement

61
Q

Name 2 features of complex FA

A

Cysts more than 3 mm

Mild increased cancer risk

62
Q

Male breast cancer- Px when matched for grade?

A

SAME prognosis when matched for grade

Most cases are IDC

63
Q

What anode and filter for non-obese female?

A

Mo-Mo with 28 kVp filter

Note: Rh anode produces more penetrating radiation for use in dense breasts (Rh-Rh)

Mo-Nb for thin breasts

64
Q

Most common cause of bloody nipple discharge?

A

Papilloma

65
Q

Most common presentation for PASH?

A

Circumscribed mass with NO calcifications

Biopsy needed to distinguish from phylloides

66
Q

Name four B3 (indeterminate lesions)?

A

ADH, ALH, LCIS, radial scar

Radiology (16 decks)

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