Breast Imaging Flashcards
what is a mammogram?
X ray
mainstay of breast imaging
views on mammogram?
oblique and Craniocaudal (CC)
where do most cancers occur?
upper outer quadrant
how does breast density change across lifetime?
density reduces as you get older
how does density affect risk of breast cancer?
more dense = higher risk?
advantages of mammography?
images whole of both breasts
sensitive for detecting DCIS and invasive cancer
only screening known to reduce population mortality
calcification on mammogram?
fine bright white specks
drawbacks of mammography?
ionising radiation (can induce a cancer) can be uncomfortable
what is tomosynthesis?
3D mammography (many slices, almost like a CT of the breast) increased sensitivity
conrast enhanced spectral mammography?
shows contrast enhancement in the breast after IV iodine contrast
low energy image
high energy image
subtraction image (take 1 away from the other so only the parts that are enhancing are left behind)
breast US is best used in which cases?
symptomatic cancer (palpable lump)
can further investigate lesion shown on mammogram
image guided biopsy
breast inflammation/abscesses (can be used in draining)
breast problems in pregnancy
advanatages of US?
no ionising radiation not uncomfortable good sensitivity and specificity for invasive cancer cant show DCIS quick can differentiate cystic from solid cheap and easy
advanced US technologies?
contrast enhanced
elastography?
medical imaging modality that maps the elastic properties and stiffness of soft tissue. The main idea is that whether the tissue is hard or soft
problems with strain elastography?
non-quantitive
poor reproducibility
shear wave elastography?
strain produced by the US probe (shear waves)
….
why are breast cancers stiff?
collagen in stroma around the tumour
- organised in normal
- disorganised and poorly aligned in cancerous
stiffness in types of breast cancer from most to least?
lobular > ductal > papillary > tubular
MRI in breast cancer?
most sensitive imaging for breast cancer diagnosis and sizing
(contrast enhanced = 95% sensitive)
problems with MRI?
almost too good
will show tiny foci away from main lesion which will have to be biopsied and will result in a mastectomy when a wide local incision would otherwise be sufficient (other systemic cancer treatments would actually mop up these tiny foci but if they’re seen they have to be taken out)
when is MRI used?
lobular cancers
if cancer cant be seen on mammography
if cancer is thought to be bigger than shown on other imaging
pagets disease of the nipple
down sizing of tumour with neoadjuvant chemotherapy (before surgery)
good at showing that the tumour is gone
positive axillary node biopsy but normal mammogram and US
breast implant integrity (intracapsular rupture etc)
screening in very high risk women
pagets?
invasion of the nipple by DCIS
which type of curve on MRI enhancement (Kuhl enhancement) indicates cancer?
type 3 “washout pattern”
has a relatively rapid uptake and shows reduction in enhancement towards the latter part of the study
types of biopsy?
FNA (rarely used anymore)
core needle (most common)
vacuum
stereotactic biopsy (mammogram guided, type of core?)
commonest causes of breast lump by age?
<30 = fibroadenoma 30-50 = cyst >50 = cancer
why cant menopausal women get cysts?
need oestrogen in system to form cysts
best imaging modality to assess breast mass?
US
- greyish = solid
- black hole = cyst
spiculate masses are likely to be what?
cancer
when is axillary US done?
can show metastases in breast cancer
abnormal nodes identified by cortical thickness and shape
how is breast cancer staged?
only local staging for operable breast cancer use CT (chest, abdo and pelvis) to look for mets in locally advanced disease
when is nipple discharge worrying?
unilateral single duct
bloody etc
what can cause breast abscess/infection?
lactation
duct ectasia
when is screening done?
every 3 years in women aged 50-70
who gets screening?
annual mammogram in women over 40 who have a moderate family history
MRI done in people with BRCA gene or with risk equal to BRCA gene
