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Women's Health 1 > Breast Imaging > Flashcards

Breast Imaging Flashcards

1
Q

what are the 4 ways to image breasts

A
  1. Mammography (standard digital xray or 3D)
  2. Breast US
  3. Breast MRI
  4. PET/CT - tool for staging cancer
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2
Q

At what age does annual breast cancer screening start for patients with normal risk

A

40

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3
Q

At what age does annual breast cancer screening start for patients with first degree relatives dx with cancer before 40

A

10 years younger than relative’s diagnosis

*typically no mammogram done before age 30

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4
Q

What is screening mammogram for?

A

patients without breast complaints or findings

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5
Q

What is a call back?

A
  • When a finding is noted on screening mammogram that needs further imaging
  • pt is recommended to come back for dx workup
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6
Q

Diagnostic mammography is used when?

A
  • abnormal finding on screening mammography

- patient has a breast complaint (lump, nipple inversion or discharge, skin changes, focal breast pain)

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7
Q

What does diagnostic imaging of the breasts consist of?

A
  • mammogram
  • US (usually after mammogram)
  • MRI

*this is different than a screening mammogram, pts might be confused why need a second mammogram when get a callback from a screening mammogram

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8
Q

2D mammogram

  • how does it work
  • what are the views
A
  • x-ray to obtain 2 static pictures of each breast

- craniocaudal (CC) and mediolateral obliquie (MLO)

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9
Q

Tomosynthesis 3D mammography

- describe

A
  • X-rays at multiple angles to create a cine imagine of breast tissue
  • better for dense breasts and breast lesions
  • overall results in fewer callbacks: can isolate layers to better analyze tissue
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10
Q

Breast US

A
  • used as starting for w/u on pts <30 yo
  • used in conjunction with mammography to w/u abnormality on screening mamm/pt complaint
  • evaluates axilla for abnormal lymph nodes
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11
Q

Breast MRI

  • when used
  • what is evaluated
A
  • used as screening to evaluate high risk patients
  • used for women dx with cancer or who have unresolved findings
  • looks for add’l suspicious lesions
  • evaluates contralateral breast
  • evaluates lymph nodes
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12
Q

Breast MRI

  • two downsides
  • one pro
A
  • downside: uses contrast, problem with kidney issues. Also can’t use with a heart pacer
  • pro: can evaluate implants
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13
Q

Two main tissues in the breast (dumbed down)

A
  • fat

- glandular “working” tissue: where cancers arise

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14
Q

What are the two most common types of breast cancer

A
  1. DCIS: ductal carcinoma in situ

2. IDC: invasive ductal carcinoma

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15
Q

What are two additional (less common) types of breast cancer

A
  1. LCIS: lobar carcinoma in situ

2. ILC: invasive lobar carcinoma

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16
Q

DCIS

A
  • non-invasive cancer precurser. “respects” the boundary of the duct walls.
  • can be aggressive “high grade” or non-aggressive “low grade”
  • picked up on mammogram
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17
Q

IDC

A
  • cancer cells break through duct and can infiltrate lymphatics and vasculature.
  • does not “respect” boundary of duct walls,
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18
Q

LCIS

A

Not a true premalignant lesion but associated with cancer

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19
Q

ILC

A

invasive cancer which originated from lobule

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20
Q

Three additional types of cancer

A
  1. Paget’s disease
  2. Inflammatory breast cancer
  3. Phyllodes (not as important to know well)
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21
Q

Paget’s disease

A

Skin changes of areola and/or nipple with underlying DCIS and IDC
(dont’ just call it eczema!!) (and be wary of too much Frankincense)

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22
Q

Inflammatory breast cancer

A
  • erythematous, edematous, warmth of skin
  • looks like mastitis
  • secondary to aggressive fast growing ca that back up the lymphatic system of the breast
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23
Q

Non-malignant breast pathology

- 2 findings

A
  • Benign, no further w/u needed

- Benign but still needs to be removed

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24
Q

Examples of non-malignant breast pathology that needs no further workup

A
  • ductal hyperplasia
  • columnar cell changes
  • fibrocystic change
  • adenosis
  • sclerosis
  • apocrine metaplasia
25
Q

Examples of non-malignant breast pathology that need further workup

A
  • atypical ductal hyperplasia
  • flat epithelia atypia
  • radial scars
  • LCIS

**the risk of these things becoming cancer or harboring cancer is high enough to warrant removal

26
Q

Benign breast lesions (4)

A
  1. Mastitis: nursing women. Erythematous, edematous, tender, warm. Usually with fever
  2. Fibroadenoma: benign, in young women
  3. Fibrocystic change: monthly pain and cysts. approx 50% of women have this
  4. Cysts
27
Q

Where do breast cancers most commonly spread?

A

lymph nodes of the chest:

  • axilla
  • internal mammary chain
  • intramammary lymph nodes

Distant mets:

  • bone
  • liver
  • lung
  • brain
28
Q

How do phyllodes tumors spread?

A

hematogenously

29
Q

Genetics of breast cancer

  • percentage hereditary vs. sporadic
  • what two populations at greater risk
A
  • 20% hereditary
  • 80% sporadic
  • ashkenazi jews and AA
30
Q

Known breast cancer genes

A
  • BRCA 1 and BRCA2

- PALB2, BARD1, etc. etc.

31
Q

what other cancers are BRCA1 and 2 associate with?

A
  • melanoma
  • ovarian ca
  • pancreatic ca
  • prostate ca
  • GI ca
32
Q

Does absence of BRCA1/2 gene on 23ANDme test mean there is not a BRCA mutation?

A

no - just tests for 3 of the many snips

33
Q

What are the breast cancer risk factors

A
  • Age (greatest factor)
  • Hormonal state in early life (onset of menstruation, children, breast feeding, onset of menopause)
  • Fam hx
  • breast density
34
Q

What should you make suspicious about breast cancer

A
  • relative dx with breast or ovarian cx younger than 50
  • multiple breast and/or ovarian ca on one side of family
  • fam hx of bilateral breast ca
  • fam hx of triple negative breast ca
  • fam hx of male breast cancer
35
Q

What are current breast health recommendations for women >35 with normal breast cancer risk?

A
  • Clinical encounter 6-12 months
  • Annual screening mammogram (consider 3D)
  • Breast awareness: be aware of breasts and promptly report changes
36
Q

What are current breast health recommendations for women with a lifetime risk >20% of breast cancer

A
  • clinical encounter 6-12 months
  • annual screening mammogram (starting 10 years prior to youngest fam member’s dx age but no earlier than 30)
  • Consider annual breast MRI
  • breast awareness
  • most high risk programs alternate mammogram with MRI/US every 6 months
37
Q

What is effect of chest radiation? Who is at risk

A
  • pts treated as child or teenager with radiation for lymphoproliferative disorders like lymphoma
  • “mantle radiation”
  • considered high risk breast cancer
  • start screening 8 years after radiation or by age 25, whichever is later
38
Q

What sort of clinical breast findings are there?

A

lumps
change in skin
change in nipple
nipple discharge

39
Q

How to workup a breast lump

A
  • <30 yo: breast US and possible mammogram
  • > 30 yo: dx mammogram and US
  • not always cancer, esp if young!
  • always work up, believe the patient
40
Q

How to workup a nipple retraction

A
  • Is it congenital: is it new or old?
  • If new, always work it up!
  • less concerning if it is intermittently retracted
41
Q

What causes nipple retraction in cancer

A

Cancer pulls on cooper ligaments and pulls nipple into breast

42
Q

Peau d’orange

  • describe
  • when to workup
A
  • skin dimpling
  • sign of edema
  • unilateral or bilateral
  • unilateral: concern for cancer
  • bilateral: more likely systemic cause like renal, liver failure or heart dysfunction
  • always workup!!
43
Q

Nipple discharge

  • describe poss findings
  • when is it concerning for cancer
A
  • uni or bilateral
  • multiple or single duct
  • ca risk: spontaneous, unilateral, single duct discharge that is bloody or clear = aways work up
44
Q

Workup of redness/rash

  • causes
  • when to be suspicious
A
  • Paget’s of areola or nipple
  • infection
  • inflammatory breast cancer
  • Beware of young women not lactating who has what looks like mastitis! If not gone in 1 week of abx, send to breast imaging!!
45
Q

Breast pain workup

A
  • common
  • But not common presentation of cancer
  • diffuse, cyclic pain is almost never associated with breast cancer
  • if uncomfortable, send to breast imager
46
Q

What are the 7 BI-RADS findings

A

0: need more w/u, “call back”
1: negative
2: benign
3: probably benign =< 2% cancer
4: suspicious
5: highly suspicious
6: known cancer

47
Q

What three BI-RADS can screening mammography be assigned?

A

0: more workup needed
1: negative
2: benign

48
Q

Why might screening mammography get a 0

A
  • waiting on prior comparisons

- suspicious finding was found, pt needs to come in for add’l mammography views or US

49
Q

BI-RADS 0

  • the patient experience
  • how often need a biopsy?
A
  • scary!!! Remind pt that breast imagers are cautious, just want to ensure it is ok
  • most will be benign
  • 20% will need a biopsy but only 20% of those will be cancerous
50
Q

Examples of BI-RADS 2 findings

A

(benign)

  • vascular calcification
  • dystrophic calcification
  • Fat necrosis
  • oil cyst
  • secretory calcification
51
Q

BI-RADS 3

  • ca risk
  • f/u protocol
A

(probably benign)

  • <2% risk of ca
  • f/u imaging in 6, 12, 24 months if there is not a change at each visit
  • if there is a change, biopsy
52
Q

BI-RADS 4

  • ca risk
  • f/u
A

(suspicious)

  • 2-95% cancer risk
  • biopsy always recommended
  • if pathology is benign, return to routine or high risk screening as before
53
Q

BI-RADS 5

  • ca risk
  • f/u
A

(highly suspicious)

  • > 95% risk
  • even if pathology shows benign, lesion should be sx excised

*would still biopsy to determine what type of ca which will help determine what to excise - lymph nodes, etc.

54
Q

BI-RADS 6

A

This is for post-biopsy proven cancer

55
Q

Other concerning finding on mammography

A

Unilateral skin thickening

- need to know what caused it if it is new

56
Q

Does estrogen cause breast cancer??

A

NO. It might add some fuel to the fire but that ca was there regardless of hormone therapy

Estrogen receptor positive just means cell still has E receptor! Not that the E caused the cancer

57
Q

What hormone is given as hormone replacement therapy for breast cancer survivors?

A

testosterone

58
Q

Do you give breast cancer survivors estrogen therapy?

A

NO, never. Testosterone is prob ok though

59
Q

What are the three receptors on teh cancer cell that are referred to in “triple negative”

A
  • E
  • P
  • Her2neu (a gene actually not a receptor)

Women's Health 1 (17 decks)

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