Breast Imaging Basics

Question 1

How is breast cancer screening performed?

Answer 1

Mammography (DBT-3D; FFDM-2D)
MRI
Ultrasound

Question 2

• x-ray picture of the breast (2 views of each breast
• typically from 2 different angles (MLO, CC)
• mammogram interpreted by radiologist (generally not in “real time”
• letter semt within 30 days pre MQSA
• if abnormality detected, the patient will be recalled for additional imaging

Answer 2

Screening Mammogram

Question 3

Preparation for mammography should include?

Answer 3

• skin should be free of lotions, deodarant, etc
• timing during menstrual cycle
• consider pre-medicating with ibuprofen before exam

Question 3

how are screening mammograms scored?

Answer 3

• BIRADS1: negative, routine screening
• BIRADS2: Benign (post-surgical findings, stable benign masses, typically benign calcs), routine screening
• BIRADS0: Additional imaging needed; Diagnostic Mammo +/- U/S

Question 4

• focused X-ray picutres of the area of concern
• first mammogram status post lumpectomy or mastectomy with reconstruction ;follow-up of a high risk biopsy that did not undergo surgical excision, implant concern
• impant concern
• mammo interpreted by radiologist in real time
• often followed by targeted ultrasound

Answer 4

Diagnostic mammogram

Question 5

What breast imaging is recommended based on age?

Answer 5

• If < 30 years, targeted US
• if > 30, Diagnostic mammogram followed by U/S

Question 6

What algorithms decide what imaging to go for?

Answer 6

• Calcifications –> diagnostic mammogram
• masses–> diagnostic mammogram + targeted U/S
• Architectural distortion–> diagnostic mammogram + targeted U/S
• Asymmetries/focal asymmetries–> diagnostic mammogram + possible targeted U/S

Question 7

Benefits of DBT?

Answer 7

• Improves sensitivity and specificity
• technically a CT and mammography- puts the images in slices so there is less overlap
• increase cancer detection ration
• conspicuity of lesions
• recall rate

Question 8

how are diangostic mammogram scored?

Answer 8

• BIRADS1: negative, routine screen
• BIRADS2: Benign; routine screening
• BIDRADS3: probably benign (>0% but < 2%) short interval F/U; 6mos, 1yr, 2yr
• BIRADS4: Biopsy (> 2 % but < 95%)
• BIRADS5: Biopsy ( >95%)

Question 9

Who should be screened for breast cancer?

Answer 9

• guidelines differ by society
• patients should be asymptomatic (no palpable abnormality, focal pain, nipple discharge, skin retraction etc,
• if symptomatic—> diagnostic mammo + U/S
• annual screening mammo in 40-84 y.o prevents more deaths from breast cancer