Breast Imaging

Question 1

Where is the breast base?

Answer 1

Over ribs 2-6

Midclavicular line

Question 2

What is the breast anterior to?

Answer 2

Deep pectoral muscle facia

Question 3

What does the lowest part of the breast overlie?

Answer 3

Serratus anterior

Question 4

What extends towards the axilla?

Answer 4

Axillary tail of Spence

Question 5

What are common breast complaints that require imaging?

Answer 5

Lumps
Unilateral or blood stained discharge
Skin tethering or dimpling
Inflammation
Axillary lumps

Question 6

What is the triple assessment of breast problems?

Answer 6

Clinical exam
Imaging
Pathology (histol/cytology)

Question 7

What is the 1-5 grading?

Answer 7

1 - Normal
2 - Benign
3 - Atypical, probs benign
4 - Suspicious
5 - malignant

Question 8

When would you image someone with breast pain?

Answer 8

Associated focal / asymmetrical nodularity to exclude underlying mass

Question 9

What imaging would someone <40y with a mass get?

Answer 9

U/S

Question 10

What imaging would someone >40y with a mass get?

Answer 10

XRM +/- U/S

Question 11

What is Mammography?

Answer 11

A low dose xray designed to specifically maximise contrast between breast tissues

Question 12

Why Mammography?

Answer 12

Cost effective
Non-invasive
Can visualise microcalcifications

Question 13

When would you offer mammography?

Answer 13

Screening
All women with a palpable mass over 40
To exclude malignancy & assess contralateral breast

Question 14

Describe a normal Mammogram

Answer 14

Skin and pores
Low density fat
Glandular tissue - higher density
Thin, sharply defined trabeculae
Blood vessels +/- blood calcifications
Lymph nodes

Question 15

How do the lymph nodes look on mammogram?

Answer 15

Oval/horseshoe

Fatty hilum

Question 16

How do clcifications appear on mammogram?

Answer 16

Bright white
arterial
Sebaceous glands (polomints)
Eggshell curvilinear (oil cysts)

Question 17

What is the best imaging view of the breast?

Answer 17

Mediolateral oblique

Question 18

What is another valuable imaging view?

Answer 18

Craniocaudal

Question 19

What re BIRADS paraencchymal patterns?

Answer 19

a) Nearly all fat
b) Scattered fibroglandular densities
c) heterogeneously dense
d) Extremely dense

Question 20

What are features of a calcification malignancy?

Answer 20

Distribution - cluster or segmental
Cluster shape/size - rhomboid forms
Pleomorphic nature - size/density

Question 21

Why would you consider not doing an MRI after a mammography and an USS?

Answer 21

If you can biopsy it

Question 22

What are indications for an ultrasound scan?

Answer 22

Differentiation between cystic and solid lesions
Palpable lesion (>40's)
Nipple discharge
Breast implants or augmentation
Inflam conditions i.e. abscesses 
Evaluation of response to chemo

Question 23

Describe what is looked for with a cyst?

Answer 23

A fluid collection
The shape
Its contents
Internal echoes
Clustered cysts
Complex cysts
Aspiration

Question 24

Describe benign solid nodules of the breast?

Answer 24

Circumscribed
Hypoechoic / hyperechoic
Wider than tall
Homogenous
Peripheral / no vascularity
Often multiple

Question 25

Describe malignant solid nodules of the breast?

Answer 25

Poorly circumscribed
Hypoechoic
Heterogenous
Taller than wide
Spiculate
Oedema / peritumoral fat

Question 26

Name some US guided procedures

Answer 26

Aspirations
Drains
Cutting needle biopsy
Vacuum - assisted biopsy
Sentinel lymph node analyses

Question 27

What are used in a vacuum assisted biopsy?

Answer 27

Mammotome
SUROS
EnCor

Question 28

What feature of a breast may limit a mammogram?

Answer 28

Dense breasts

Question 29

What contrast can be given in an MRI?

Answer 29

I.v. gabolinium

Question 30

Name some absolute contraindications for an MRI?

Answer 30

Pacemakers
Ferromagnetic aneurysm clips
Cochlear implants
Renal impairement