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Breast Imaging Flashcards

1
Q

Where is the breast base?

A

2nd to 6th ribs, midclavicular line

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2
Q

Where is the breast located in relation to the deep pectoral and superficial fascia, and serratus anterior?

A

Anterior to deep pectora fascia, and enclosed in superficial

Lower part overlies serratus anterior

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3
Q

When is breast imaging needed?

A

Symptomatic patients or screening:
Lumps
Unilateral or blood-stained nipple discharge
Skin tethering or dimpling
Signs of inflammation
Axillary lumps
Not for pain, tenderness, symmetrical nodularity

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4
Q

What is the 1-5 grading in the triple assessment?

A 
1 Normal
2 Benign
3 Atypical, probably benign
4 Suspicious
5 Malignant
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5
Q

When would breast pain be imaged?

A

Only if associated focal asymmetric nodularity, to exclude underlying mass
Mammography, US or both

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6
Q

What imaging should be used to initially investigate a mass?

A

US <40yo

XRM +- US >40yo

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7
Q

Why is mammography used?

A

Cost effective, non invasive
Reproducible, easy to document
Only technique that reliably visualises microcalcifications (<0.5mm)- assoc. with approx 30% of invasive cancer, almost all screen detected DCIS

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8
Q

When is digital mammography used?

A

Replaces film/screen combination
Various image detectors
Excellent contrast resolution
Better in dense breasts, younger women

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9
Q

What do LNs look like on the normal mammogram?

A

Oval/horseshoe with a fatty hilum

25% have intramammary nodes (UOQ)

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10
Q

What do calcifications look like on the normal mammogram?

A

Bright white

Can be arterial, sebaceous glands (polo mints), oil cysts (eggshell curvilinear)

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11
Q

What are the views in a mammogram?

A

Mediolateral oblique (MLO)
Craniocaudal (CC)
Extended CC
Others

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12
Q

What is the best single view, with the last foreshortening?

A

MLO (45’ off vertical, xray bean perpendicular to long axis of breast)

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13
Q

What does a CC view show?

A

Nipple in profile
Shows medial and most of lateral tissue, not axillary tail
Visualisation of retromammary fat

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14
Q

Describe paddle (localised compression) views

A

Very film localised compression
Less scatter, more contrast
Demonstration of borders of mass
Harder to differentiate between lesion and shadow

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15
Q

What are magnified views good for?

A

Microcalcification

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16
Q

What views can be magnified?

A

CC and lateral

x1.2-2.0

17
Q

What are BIRADS parenchymal patterns?

A

A: nearly all fat
B: scattered fibroglandular densities (25-50%)
C: heterogeneously dense (51-75%)
D: extremely dense (>75% glandular)

18
Q

What are the features of malignant calcification?

A

Distribution- cluster or segmental vs scattered of diffuse (benign)
Cluster shape/size- rhomboid forms
Individual particle shape- linear/branching/Y shaped forms
Pleomorphic nature- size/density

19
Q

What are the indications for US?

A

Characterisation of mammographic findings- cystic/solid lesions
Palpable lesions- women <40yo
Nipple discharge
Breast implants or augmentation
Other- inflammatory conditions (abscesses)
Evaluation of response to chemo

20
Q

What are the radiological characteristics of benign nodules?

A 
Circumscribed
Hypoechoic/hyperechoic
Wider than tall
Homogenous
Peripheral/no vascularity
Often multipe
21
Q

What are the radiological characteristics of malignant nodules?

A 
Poorly circumscribed
Hypoechoic
Heterogenous
Taller than wide
Spiculate
Oedema/peritumoral fat
22
Q

What can be used in vacuum assisted biopsy?

A

Mammotome
SUROS- hand held, light weight, adaptable for XRM/US/MRI
EnCor- hand held with offset needle, different cutting prevents blunting

23
Q

Why is MRI very accurate in breast imaging?

A

Visualisation of morphological and temporal pattern

24
Q

What can MRIs allow you to assess to aid in diagnosis?

A

Enhancement, and rate of enhancement (ROIs)

25
Q

What are the absolute and relative contraindications of MRI in breast imaging?

A

As for any MRI- pacemaker, renal impairment etc

Pregnancy, lactation (contrast effect, increased background breast enhancement)

26
Q

What are the indications for MRI in benign disease?

A 
Implants (integrity)
Problem solving (lesion characterisation)
27
Q

What are the indications for MRI in malignant disease?

A 
Diagnosis (occult 1' breast cancer)
Staging and treatment planning
Residual disease post WLE
Response assessment- chemo
Recurrent disease- breast, reconstructed breast, axilla
Screening- high risk groups
28
Q

What is MRI more accurate for than XRM/US in breast imaging?

A

Tumour size, chest wall involvement
m/f and m/c disease
Occult contralateral disease

29
Q

What are the high risk groups that require screening?

A

Previous irradiation (HL, mantle XRT)
BRCA 1,2 or TP53 mutations (Li Fraumeni)- >60% lifetime risk
PHx of breast cancer

Reproduction (40 decks)

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