Breast Imaging Flashcards
what is the triple breast assessment
clinical
radiological (mgm, USS)
pathology (image guided core biopsy)
where do most breast cancer occur
in upper outer quadrant (more fibroglandular tissue in outer breast)
why is breast density important
high breast density increases cancer risk and also makes them harder to see on mgm
density decreases with age
what are the pros and cons of mammograms
pros- images whole breast, 2-3 views, high sensitivity for DCIS and invasive cancer, screening reduces population mortality
cons -screening overdiagnosis and false positives (1 in 5 +ves will have cancer), small radiation dose, can be uncomfortable (breast compressed),
what can cause calcification
duct ectasia
DCIS (cell necrosis)
what is tomosynthesis
3D mgm (increases sensitivity)
what is contrast enhanced spectral mgm
identifies contrast enhancement in the breast with Iv injection of iodinated material, low energy image and high energy image, subtract these from each other to show what contrast is enhancing- good for removing density of breast from image
when is USS better than mgm
if patient symptomatic
better for seeing lumo
what are the indications for USS
palpable mass, mmg detected lesion, image guided biopsy, breast inflammation, breast problems during pregnancy (have very dense mammograms when pregnant)
what are the pros of USS
Doesn’t use radiation, not uncomfortable. good sensitivity for invasive cancer, can differentiate cystic from solid, cheap, image guided biopsy, quick and tailored to one area.
what are the advanced forms of breast USS
shear wave elastography (assessment of anatomical structures, measures the stiffness of the tissue, strain produced by waves in USS probes probe measures how fast is goes through tissue- soft faster, red stiff yellow soft), contrast enhanced (allows assessment of perfusion, IV agents, 2d or 3d), strain elastography (same as shear wave except strain created by pressure of probe)
why is shear wave elastography good
measures the stiffness of the tissue- benign lumps are soft, cancer and the surrounding stroma are stiff
good at differentiating masses seen on greyscale USS
what makes breast cancers stiff
due to the collagen in the stroma- poorly aligned, varies in size, cross links
why is tumour stiffness important
Turmour stroma important in predicting prognosis, why stiffness is important to know. Higher the grade more stiff
what USS is good at detecting lobular breast cancer
elastography
loses cell adhesion molecule E-cadherin= harder to detect on other methods
what is the most sensitive test for breast cancer
MRI
what are the pros and cons of MRI
pros- very sensitive, most accurate in sizing
cons- increases mastectomy rate without decreasing mortality rate and recurrence or increasing +ve margins
when is MRI used
screening for very high risk lobular cancers those that dont show on mgm uncertainty of size of tumour when aim is breast conserving Tx and nees size and focality assessment- pagets disease, lobular cancer, mgm occult cancer, downsizing with neo ad chemo
+ve axillary node but normal mgm and US
implant integrity
what are the breast biopsy method
core
vacuum (MRI, mhm or USS guided)
FNA (not done these days)
what is a stereotactic biopsy
mgm guided
what are the commonest causes of breast lump by age
<30 fibroadenoma
30-50 cysts (need oestrogen to get cysts)
>50 cancer
breast cancer under 25 is very rare
what lumps can a vacuum biopsy remove
fibroadenoma
papillomas
radial scars
what Ix to see if mass solid or cystic
USS
when do you do mgm under 40
when red flags for cancer
do you need to biopsy a cyst
no
what does a spiculate mass on imaging suggest
malignancy
what can axillary USS detect
40% of lymph mets by cortical thickness and shape of nodes
how is breast cancer staged
operable- only local staging needed
locally advanced/ recurrent- CT chest abdo and pelvis
what are common breast met sites
bone, lung, pleura, liver and brain
when is nipple discharge worrying
unilateral single duct only
if bloody
persistent
new in development over 50
what can cause nipple discharge
invasive cancer
breast abscess
duct ectasia
papillomas
what causes breast abscesses
breast feeding
duct ectasia
what is the management of breast asbcess
US guided drainage and Abx
summarise breast screening
done by mammography alone
Every 3 years aged 50-70.
If moderate FHx get it yearly from age 40.
If very high risk for cancer then get offered MRI screening (BRCA carriers/ similar risk)
