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REPRODUCTION & GYNAECOLOGY > Breast Imaging > Flashcards

Breast Imaging Flashcards

1
Q

What types of imaging are part of the Triple Assessment in the Breast Clinic?

A

Mammography and US

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2
Q

How is the appearance of a lesion classified on imaging in the Triple Assessment?

A

1-5

5 being malignant

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3
Q

What is mammography?

A
  • low density X-Rays
  • breast is compressed to allow these to easily pass through
  • provides contrast between tumour and fat
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4
Q

HOw many projections are used in mammography?

A

2 projections

  • oblique
  • craniocaudal (CC) => looking from top to bottom of pt
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5
Q

Describe what white and dark tissue represents on a mammogram

A

white - fibroglandular tissue

dark - adipose tissue

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6
Q

Where is most fibroglandular tissue (white on mammogram) found in the breast?

A

Mostly in lateral part of breast

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7
Q

Describe the sensitivity of mammography in a very fatty breast vs in a very dense breast

A

Fatty breast = HIGH

Dense breast = LOW (poor contrast)

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8
Q

Breast density increases with age. TRUE/FALSE?

A

FALSE

  • breast density decreases with age
  • this is not related to the menopause
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9
Q

What factors can change the rate at which breast density decreases?

A
  • weight
  • HRT use
  • Tamoxifen use
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10
Q

Patients with a higher density breast are at higher risk of breast cancer in their lifetime. TRUE/FALSE?

A

TRUE

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11
Q

What are the advantages of mammography?

A
  • images the whole breast at once
  • high sensitivity for DCIS and invasive cancers
  • has shown to decrease population mortality through its use in screening
  • high reattendance rates to screening
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12
Q

What are the disadvantages of mammography?

A
  • false positives
  • overdiagnosis (cancer may be slow growing and not life threatening)
  • ionising radiation
  • uncomfortable for some women
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13
Q

Calcification may be identified on mammography at screening. What conditions can cause this?

A
  • Duct ectasia

- DCIS

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14
Q

Tomosynthesis is a feature of mammography. What does it do?

A

Allows slices of breast to be imaged (like CT)

=> increases sensitivity

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15
Q

How can lesions be enhanced on mammography?

A
  • Contrast
  • Given IV
  • Usually iodinated
  • 2 images taken - 1 before and after contrast for comparison
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16
Q

What is US used for in the breast clinic?

A
  • Confirm lumps seen on mammography
  • If patient is symptomatic (e.g. palpable lump)
  • image guided biopsy
  • inflammation
  • breast problems in pregnancy (mammogram not helpful here as breast is too dense)
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17
Q

What are the advantages and disadvantages of using US in the Breast Clinic?

A

Adv:

  • not uncomfortable
  • detects invasive cancer well
  • can distinguish cyst from solid lump

Disadv:
- doesnt pick up DCIS as well as mammography

18
Q

Contrast enhanced US is often used in the Breast Clinic. TRUE/FALSE?

A

FALSE not used very often

19
Q

What is the purpose of elastography?

A
  • measures stiffness of tissue
  • cancers and their surrounding tissue are more likely to be stiff
  • benign lesions (e.g. fibroadenoma) = very soft
20
Q

What are the different probes used for elastography?

A

Strain Elastography (probe should be moved to assess lesion)

Shear Wave (probe remains still when assessing lesion)

21
Q

Why are cancers usually stiff in comparison to benign pathology?

A

collagen in stroma becomes:

  • disorganised
  • poorly aligned
  • lots of cross linking occurs
22
Q

The interaction between the tumour and surrounding stroma is important in predicting spread and patient outcome. TRUE/FALSE?

A

TRUE

23
Q

Tumours with what characteristics are usually stiffer than others?

A
  • Node positive tumours
  • Large tumours
  • Tumours of high grade
  • Lobular cancers
24
Q

What are the advantages and disadvantages of MRI in braest cancer?

A

ADV:
- Most sensitive and accurate for sizing of lesion

DISADV:
- Shows tiny foci of cancers away from main lesion that prompt patients to have a mastectomy instead of wide local excision

25
Q

Having a mastectomy as opposed to breast conservation and radiotherapy does NOT reduce the risk of recurrence. TRUE/FALSE?

A

TRUE

- Conservation and Radio is just as good if not better than mastectomy

26
Q

What can MRI be used to investigate?

A
  • Lobular cancer
  • Cancer not picked up on mammography
  • Pagets disease of the nipple (investigate underlying DCIS)
  • Shrinking of cancer following neoadjuvant chemotherapy
  • Imaging of positive axillary lymph nodes following normal mammogram/US
  • Shows implant integrity (intra/extracapsular rupture)
27
Q

Describe how a contrast activity/time graph shows a lesion is malignant rather than benign?

A
  • Graph shows tumour rapidly filling with contrast and then “washing out” after a couple of mins
  • benign or normal tissue has a slower increase in tking up contrast
28
Q

What types of biopsy may be used in the Breast clinic?

A
  • Core biopsy
  • Vacuum biopsy
  • FNA (not widely used now)
29
Q

Why must a core biopsy be as large as a 14G needle?

A

breast tissue is friable

=> this size of needle allows a large enough intact sample

30
Q

Core biopsy can be mammogram or US assisted. TRUE/FALSE?

A

TRUE

31
Q

Describe how a Mammogram Assisted Core Biopsy takes place?

A

2 views used on mammogram to plan injection site
X marks the spot
XRay the biopsy sample afterwards to check the right bit has been taken

32
Q

How large is a vacuum biopsy needle and what does this mean can be offered clinically?

A

11G needle
=> can offer to remove some lumps with this needle
=> e.g. papilloma as this can progress to cancer

33
Q

What is the commonest breast cancer lump by age?

A

<30 fibroadenoma
30-50 simple cyst
>50 breast cancer

34
Q

Why are cysts uncommon after the age of 50

A

women are post-menopausal => not going through the horomonal changes that would create a cyst

35
Q

Describe the appearance of a cyst on US and how this would be treated

A

black - fluid

Tx = fluid drainage and reassurance

36
Q

Describe the appearance of cancer on mammography?

A
  • spiculated
  • irregular margin
  • lesion is taller than it is wide (benign lesions are the opposite as they are compressable by the US probe)
37
Q

How is US used to assess axillary lymph nodes?

A

Used to measure cortical thickness and shape

- If over 3mm then biopsy

38
Q

How should staging be carried out for breast cancer and where do metastases normally appear?

A
  • local staging if disease appears to be operable
  • CT chest, abdo, pelvis if worried about systemic spread
  • Normal spread pattern: bone, lung, pleura, liver, brain
39
Q

What breast conditions cause nipple discharge?

A

benign - duct ectasia

malignant - DCIS

40
Q

What are the main causes of abscesses and inflammation in the breast? Which group of women are most at risk?

A 
breastfeeding
duct ectasia (older women)

women who smoke are most at risk due to poor healing

41
Q

How is a breast abscess treated?

A

US guided drainage

antibiotics

42
Q

What takes place during breast screening?

A
  • Mammography alone
  • for women aged 50-70 (extended trial elsewhere in UK)
  • screened every 3 years
  • Annual screening offered from age 40 if Moderate Family risk
  • Annual MRI offered if HIGH risk (e.g. BRCA)

REPRODUCTION & GYNAECOLOGY (58 decks)

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