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Breast > 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 triple assessment?

A

1-5 (5 being malignant)

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3
Q

what is a 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 breast?

A

mostly in lateral part of breast

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7
Q

describe the sensitivity of mammography in very fatty breast vs very dense breast?

A

fatty = high

dense = low (poor contrast)

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8
Q

breast density increases with age - true or false?

A

false - breast density decreases with age

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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

people with higher breast density are at a higher risk of breast cancer in their lifetime - true or 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
ionising radiation
uncomfortable for some

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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 one after contrast

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16
Q

what is US used for in breast clinic?

A 
confirm lumps seen on mammography 
if patient is symptomatic 
image guided biopsy 
inflammation 
breast problems in pregnancy (mammogram not helpful here as breast too dense)
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17
Q

what are the advantages and disadvantages of using US in 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 breast clinic - true or false?

A

false - not used very often

19
Q

what is the purpose of elastography?

A

measures stiffness of tissue
cancers and their surrounding tissues are more likely to be stiff
benign lesions eg fibroadenomas are 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 or 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 breast 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 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 or false?

A

true

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 the uptake of contrast

28
Q

what types of biopsy may be used in breast clinic?

A

core biopsy
vacuum biopsy
FNA (not really anymore)

29
Q

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

A

breast tissue is friable so this side of needle allows a large enough intact sample

30
Q

core biopsy can be mammogram or US assisted - true or 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 after to check the right bit has been taken

32
Q

how large is a vacuum biopsy needle and what does this means can be offered clinically?

A

11G

  • can offer to remove some lumps with this needle
  • eg papilloma as this can progress to cancer
33
Q

what is the commonest breast cancer lump by age?

A 
<30 = fibroadenoma 
30-50 = breast cyst 
>50 = breast cancer
34
Q

why are cysts uncommon after age 50?

A

women are post-menopausal - not going through the hormonal 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 opposite as they are compressed by 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 mets normally appear?

A

local staging if disease appears to be operable

CT chest, abdo and 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 and who are most at risk?

A 
breast feeding 
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

screened every 3 years

annual screening offered from age 40 if moderate family risk

annual MRI if high risk (eg BRCA)

Breast (6 decks)

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