breast imaging Flashcards
when is imaging needed?
- if presenting with pain?
- if presenting with Mass?
-in symptomatic patients with: Lumps Unilateral or blood-stained nipple discharge Skin tethering or dimpling Signs of inflammation Axillary lumps
As screening
-only if assoc with focal/asymmetric nodularity, US and/or Mammogram
-US if <40
Mammogram
+/- US if >40
what is the triple assessment approach in breast cancer
Clinical examination
imaging- mammogram/US
pathology- i.e biopsy
name the 3 main imaging modalities in breast?
Mammography- film or digital
US
MRI?
Mammography
-why is it the primary form of imaging?
-cost effective & non invasive
reproducible
reliably visualises micro calcifications
where is digital mammography an advantage?
-adv?
-in dense breasts and younger women, gives excellent contrast resolution
-better contrast shorter exam time fewer technical repeats fewer films easier image storage and transfer
What do you look for on a normal mammogram?
skin and pores Fat-low density (dark) glandular density (appears lighter) blood vessels and vascular calcifications Lymph nodes (oval/horseshoe) Calcifications- appear bright white
List the 3 main mammography views
Mediolateral oblique (MLO)- table at a 45 deg angle off vertical
Craniocaudal (CC)- table horizontal
Extended CC
What is the BIRADS classification for?
give the 4 categories
A measure of breast density
a: nearly all fat
b: scattered fibroglandular densities (25-50%)
c: heterogeneously dense (51-75% glandular)
d: extremely dense (> 75% glandular)
features of malignant calcification?
distribution
cluster/size shape individual particle shape
Pleomorphic nature
- cluster or segmental is suspicious Vs scattered or diffuse (benign)
- rhomboid forms, worry if looks like it follows ductal system
- linear/brnaching/Y-shaped
- size, density
effect of HRT on breast tissue?
causes the tissue to become more dense
indications for US?
-area scanned?
for the characterisation of mammography lesions- lesions cystic or solid? palpable lesions in women <40 nipple discharge breast implant inflammatory conditions to evaluate response to chemo
-scan along the ductal system and perpendicular to it
features of a benign lesion on US?
malignant lesion?
-circumscribed hypo/hyperechoic wider than tall homogeneous peripheral/no vascularity often multiple
-poorly circumscribed Hypoechioc Heterogeneous Taller than wide Speculate Oedema/peritumoral fat
Vacuum assisted biopsy
- describe
- what might need to be done after biopsy?
- tissue is sucked into a chamber and then cut and sucked into a collecting pot.
- the whole tumour might be removed in which case you need to deploy a marker
why is MRI effective?
Excellent intrinsic tissue contrast multiplayer tomographic capacity No compression No ionising radiation Accuracy independent of breast density can use IV gadolinium based contrast
interpretation of breast MRI:
- what to look for?
- 6 morphological features?
- indications?
- contraindications?
- diasadv?
-any enhancement? does it show a mass or not?
Morphology?
Rate of enhancement
-smooth mass non enhancing internal septations ductal enhancement Rim enhancement irregular mass Speculated mass
-benign: implants, ,lesion characterisation
Malignant: dx, staging an treatment plan, residual disease, asses response, recurrent disease, screening in high risk groups
-absolute:
pacemakers, cochlear implants, renal impairment etc
Relative:
Pregnancy, lactation
the effect of the gadolinium based contrast and increased background breast enhancement
-patient acceptability/tolerance
over diagnosis
hard to localise and biopsy lesions seen on MR only
cost and access in appropriate time frame
