Breast Imaging

Question 1

Where do the majority of breast cancers occur?

Answer 1

Outer upper quadrant; this is because there is increased fibroglandular tissue there

Question 2

Is there a link between breast density and breast cancer?

Answer 2

Yes, those with a high breast density are more likely to get breast cancer

Question 3

Describe the triple assessment?

Answer 3

Clinical
Radiology; MGM and USS
Path; image guided core biopsy

Question 4

What pathologies is mammogram highly specific for?

Answer 4

DCIS

Invasive cancer

Question 5

What can cause calcification within the breast?

Answer 5

Duct ectasia; benign

DCIS; malignant

Question 6

What is the benefit of contrast enhanced spectral MGM?

Answer 6

Identified contrast enhancement in breast after IV injection of iodinated contrast
Removes breast density and only shows tumour that takes up contrast

Question 7

What are the indications for an ultrasound?

Answer 7

Palpable lump
Work up of MGM detected lesion 
Image guided biopsy 
Breast inflammation 
Breast problems during pregnancy

Question 8

Is USS good for detecting DCIS?

Answer 8

No; but VERY good for detecting invasive cancer

Question 9

What is elastography?

Answer 9

Measures stiffness of tissue

Question 10

Why is elastography helpful in breast cancer?

Answer 10

Invasive cancers are stiff

Benign lesions are mobile

Question 11

Why are invasive cancers stiff?

Answer 11

Disorganised collagen in stroma

Disorganisation and stiffness of carcinoma is prognostic

Question 12

Why are lobular carcinomas difficult to detect from mammogram?

Answer 12

Lack of E-cadherin adhesion molecule and therefore instead of forming a solid, single mass they will diffusely spread throughout the lobules

Question 13

What is the most sensitive imaging modality for detection of breast ca?

Answer 13

MRI

Question 14

When should MRI be used in the work of of breast cancer?

Answer 14

Unsure of the size of tumour
Lobular cancer
Cancer that doesn't show up on MGM 
Discrepancy
from USS sizing and clinical examination 
Paget's disease of nipple
Implant integrity 
Screening in v high risk women 
Positive axillary node with normal MGM and USS

Question 15

What are the methods for biopsy of breast ca?

Answer 15

Core biopsy

Vacuum

Question 16

What is a stereotactic biopsy?

Answer 16

Mammogram directed biopsy

Question 17

Do papillomas and radial scars need to be removed?

Answer 17

Yes; have malignant potential

Question 18

In terms of age, describe the commonest causes of breast lump

Answer 18

<30 = fibroadenoma
30-50 = cyst 
>50 = cancer

Question 19

What is the best imaging modality for a breast mass?

Answer 19

US
Can tell you if cystic or solid
Stiffness
If under 40; only use mammogram if you suspect cancer

Question 20

On mammogram, what is a buzzword for a carcinoma?

Answer 20

Spiculate/ stellate mass

Question 21

How are abnormal axillary nodes detected on USS?

Answer 21

Cortical thickness and shape

Question 22

Describe the staging process for breast cancer

Answer 22

If operable; only local staging needed

Locally advanced or recurrence; use CT chest, abdo, pelvis to look for mets

Question 23

Where will breast cancer metastasize to?

Answer 23

Bone
Lung
Pleura
Liver
Brain

Question 24

What indicates worrying nipple discharge?

Answer 24

Unilateral single duct

Question 25

What can cause a unilateral single duct nipple discharge?

Answer 25

Invasive carcinoma
DCIS
Duct ectasia
Paget’s disease of the nipple

Question 26

How are breast abscesses/ infections managed?

Answer 26

US guided drainage and antibiotics

Question 27

Describe the normal screening programme

Answer 27

Mammography in women aged 50-70

Mammogram every 3 years

Question 28

What is the screening programme for women with a moderate family history of breast cancer?

Answer 28

Annual mammography from age 40

Question 29

What is the screening programme for women who are at very high risk for breast cancer (BRCA)

Answer 29

Annual MRI and mammogram from 30-35 years