Breast Imaging Flashcards
Where is the breast base?
Over ribs 2-6
Midclavicular line
What is the breast anterior to?
Deep pectoral muscle facia
What does the lowest part of the breast overlie?
Serratus anterior
What extends towards the axilla?
Axillary tail of Spence
What are common breast complaints that require imaging?
Lumps Unilateral or blood stained discharge Skin tethering or dimpling Inflammation Axillary lumps
What is the triple assessment of breast problems?
Clinical exam
Imaging
Pathology (histol/cytology)
What is the 1-5 grading?
1 - Normal 2 - Benign 3 - Atypical, probs benign 4 - Suspicious 5 - malignant
When would you image someone with breast pain?
Associated focal / asymmetrical nodularity to exclude underlying mass
What imaging would someone <40y with a mass get?
U/S
What imaging would someone >40y with a mass get?
XRM +/- U/S
What is Mammography?
A low dose xray designed to specifically maximise contrast between breast tissues
Why Mammography?
Cost effective
Non-invasive
Can visualise microcalcifications
When would you offer mammography?
Screening
All women with a palpable mass over 40
To exclude malignancy & assess contralateral breast
Describe a normal Mammogram
Skin and pores Low density fat Glandular tissue - higher density Thin, sharply defined trabeculae Blood vessels +/- blood calcifications Lymph nodes
How do the lymph nodes look on mammogram?
Oval/horseshoe
Fatty hilum
How do clcifications appear on mammogram?
Bright white
arterial
Sebaceous glands (polomints)
Eggshell curvilinear (oil cysts)
What is the best imaging view of the breast?
Mediolateral oblique
What is another valuable imaging view?
Craniocaudal
What re BIRADS paraencchymal patterns?
a) Nearly all fat
b) Scattered fibroglandular densities
c) heterogeneously dense
d) Extremely dense
What are features of a calcification malignancy?
Distribution - cluster or segmental
Cluster shape/size - rhomboid forms
Pleomorphic nature - size/density
Why would you consider not doing an MRI after a mammography and an USS?
If you can biopsy it
What are indications for an ultrasound scan?
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
Describe what is looked for with a cyst?
A fluid collection The shape Its contents Internal echoes Clustered cysts Complex cysts Aspiration
Describe benign solid nodules of the breast?
Circumscribed Hypoechoic / hyperechoic Wider than tall Homogenous Peripheral / no vascularity Often multiple
Describe malignant solid nodules of the breast?
Poorly circumscribed Hypoechoic Heterogenous Taller than wide Spiculate Oedema / peritumoral fat
Name some US guided procedures
Aspirations Drains Cutting needle biopsy Vacuum - assisted biopsy Sentinel lymph node analyses
What are used in a vacuum assisted biopsy?
Mammotome
SUROS
EnCor
What feature of a breast may limit a mammogram?
Dense breasts
What contrast can be given in an MRI?
I.v. gabolinium
Name some absolute contraindications for an MRI?
Pacemakers
Ferromagnetic aneurysm clips
Cochlear implants
Renal impairement
