Breast Imaging Flashcards
Name three methods of breast imaging
Mammogram
Ultrasound
MRI
What are the two types of view of mammogram?
Oblique
Cranial - caudal
What tissues appear white/grey on mammogram?
White - fibroglandular tissue and clacfication
Grey - fat
At what density is there a higher risk of breast cancer?
76-100%
Why does a breast need to be compressed on mammogram?
To allow uniform thickness
When are women screened for breast cancer?
50-70 years old
Name two different types of mammogram
Tomosynthesis
Contrast enhanced
Describe tomosynthesis
3D mammogram, multiple images with the slices reconnected helpful in dense tissue
Describe a contrast enhanced mammogram
Iodine contrast used, low and high energy image. High energy is sensitive to contrast. Subtraction image means only enhanced lesions are visible
Why do tumours enhance with contrast?
Neoangiogenesis - increased vascularity and leaky vessels
State the indications for ultrasound
Palpable mass - solid or fluid Post-mammogram Guided biopsy <40 years old Breast inflammation - cellulitis or abscess Problems during pregnancy
What are the advantages of ultrasound?
No radiation
Not uncomfortable
Sensitive and specific
Quick if directed to one area and easy to biopsy
What are the disadvantages of ultrasound?
Low specificity when used for screening and low sensitivity for DCIS. <10% of lumps found are cancerous
Name four types of ultrasound
Strain elastography
3D ultrasound
Contrast enhanced
Shear wave elastography
Describe strain elastography
Difference in stiffness shown by colour map
What causes stiffness in malignancy?
Collagen disorganisation and crosslinks
Describe shear wave elastography
Quantitative and good reproducibility - produced by probe regarding how fast the waves travel. Shown on colour map
Describe contrast enhanced US
Iv contrast in the form of micro bubbles can identify solid vs cystic masses, assess treatment effectiveness, view axillary nodes and differentiate between benign/malignant
What is the disadvantage of using an MRI?
Increase mastectomy rate - pick up small tumour foci which would have been treated with radio/chemotherapy
State the indications for MRI
Lobular cancer Mammographically occult Chemo effectiveness Paget's disease of the nipple Positive nodes Implant integrity High risk screening
Why is an MRI used in paget’s disease of the nipple?
Central excision can be used but if DCIS is widely spread then mastectomy is required
How often are high risk women screened?
Annually
Name the two types of commonly used biopsy
Core
Vacuum
How can a biopsy be guided radiologically?
US
Sterotactic
MRI
What diseases can be removed by vacuum biopsy?
Benign lumps with malignant potential
- papilloma
- radial scar
As long as there is no cellular atypia
What is the most likely diagnosis of a breast lump in
<30 yo
30-50yo
>50yo?
<30yo - fibroadenoma
30-50yo - cyst
>50yo - cancer
Elderly can also get fat necrosis from falls
What about the dimentions would suggest a lump is a fibroadenoma?
Wider than it is tall - only held loosely by surrounding tissue
What signifies an abnormal lymph node on imaging?
Cortical thickness >3mm
Shape
When is radiological staging of breast cancer indicated?
Invasive tumour >5cm
>4 abnormal nodes
Inflammatory cancer
Recurrent breast cancer
How is staging done radiologically?
CT - chest abdomen pelvis
Where does breast cancer spread to?
Bone, lung, pleura, liver, brain
What type of nipple discharge is concerning?
Unilateral
