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Women's Imaging > Breast Imaging PBRE 2 > Flashcards

Breast Imaging PBRE 2 Flashcards

1
Q

Breast cancer survival is influence by what factors of the tumor?

A

Size of tumor
and
lymph node status

At the time of diagnosis

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2
Q

What is the goal of screening asymptomatic women?

A

Find breast cancer in its earliest stages

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3
Q

Defined as those that are noninvasive or invasive but less than 1 cm in size with negative nodes

A

Minimal cancers

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4
Q

Starting age of annual screening?

A

40 - American College of Radiology and Society of Breast Imaging

45 - American Cancer Society

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5
Q

Factors known to increase a woman’s risk for breast cancer

A
  1. History of breast or ovarian cancer
  2. Laboratory evidence (carrier of BRCA1 or BRCA2 genetic mutation)
  3. Having a mother, sister, or daughter with breast cancer
  4. Atypical ductal hyperplasia or lobular neoplasia diagnosed on a previous breast biopsy
  5. History of chest irradiation received between the ages of 10 and 30 years
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6
Q

In addition to mammographic screening - women who are at high risk should undergo what screening modality?

A

Screening MR

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7
Q

If patient cannot undergo MR screening, what modality can be used?

A

Screening with US can be considered in high-risk women who cannot undergo MR screening

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8
Q

Is screening mammography required for:

Women with reconstructed breast without native breast tissue after mastectomy

A

No

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9
Q

Is screening mammography required for:

Women with implants for breast augmentation

A

Yes

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10
Q

How many mammographic views are performed per breast in patients with implants?

A

Four

Standard CC and MLO plus two implant-displaced views

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11
Q

What are the two most widely used materials in breast implants?

A

Silicone and Saline

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12
Q

These implants appear uniformly hyperdense on mammography

A

Silicone implants

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13
Q

These implants appear less dense than silicone, where the x-ray beam is able to penetrate the filling material

A

Saline implants

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14
Q

What is the body’s reaction after implants are placed?

A

Generates a fibrous capsule

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15
Q

Locations of implants

A

Subglandular
and
Subpectoral

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16
Q

Location of implant that is less associated with capsular contracture

A

Subpectoral implants

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17
Q

This is a clinical diagnosis where there is abnormal constriction of the fibrous capsule on the implant

Patient states the implant feels abnormally spherical and firm

A

Capsular contracture

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18
Q

What implant, when ruptured, will be decompressed and retracted against the chest wall?

A

Saline implants

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19
Q

Why is silicone implants rupture more difficult to evaluate on MR?

A

Because of the density of the silicone filling

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20
Q

What imaging study is most sensitive for evaluation of silicone implant rupture?

A

MR imaging

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21
Q

Bonus question:
Linguine sign:

A. Intracapsular rupture
B. Extracapsular rupture

A

A. Intracapsular rupture

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22
Q

Also referred to as three-dimensional mammography?

A

Digital breast tomosynthesis

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23
Q

In DBT patient is positioned exactly as standard digital mammography during DBT

What is the difference?

A

Image acquisition:
The x-ray tube pivots in an arc while the patient and the breast remain stationary

*Images consist of multiple thin (1 mm) “slices” of breast after reconstruction

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24
Q

Advantages of of DBT?

A

Differentiating true masses from superimposing breast tissues

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25
Q

Classic mammographic signs of malignancy?

A

Spiculated masses or pleomorphic clusters of microcalcifications

*Only 40% of all breast carcinoma presents in these ways

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26
Q

Composition of breast (regarding breast density)

A

Radiopaque breast parenchyma
and
Radiolucent fatty elements

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27
Q

Four mammographic density categories (BI-RADS)

A

a. Almost entirely fatty (<25%)
b. Scattered areas of fibroglandular densities (25% to 50%)
c. Heterogeneously dense, which may obscure small masses (50% to 75%)
d. Extremely dense, which lowers sensitivity of mammography (>75%)

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28
Q

Imaging modality that has proven to reduce breast cancer mortality

A

Mammography

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29
Q

Examples of functional imaging of the breast

A

Contrast-enhanced spectral mammography

Breast-specific gamma imaging

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30
Q

Imaging modality that aids in the detection of increased blood flow associated with breast cancer

A

Contrast-enhanced spectral mammography

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31
Q

Imaging modality that employs the use of technetium-99m sestamibi to detect malignancy

A

Breast-specific gamma imaging

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32
Q

Indications for diagnostic mammography

A
  1. Recent abnormal screening mammogram
  2. Current sign or symptom of malignancy
  3. Being followed for a probably benign finding
  4. Have a personal history of breast cancer
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33
Q

In diagnostic mammography:

This is used to evaluate equivocal findings seen on full-field mammographic views

A

Spot compression views

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34
Q

Some benefits of compression (mammography)

A
  1. Decreases breast thickness to improve contrast
  2. Reduces blurriness of the image
  3. Displaces glandular tissue
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35
Q

Characteristic of breast cancers in contrast to glandular tissue (during compression)

A

Breast cancers tend to be firm and not easily compressible - Less displacement

Glandular tissue is easily displace

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36
Q

Why is breast cancers firm and not easily compressible?

A

Due to desmoplastic response initiated by some tumors

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37
Q

Any indeterminate mammographic finding the persists after spot compression views should further be evaluated with what modality?

A

Ultrasound

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38
Q

Most microcalcifications recommended for biopsy result in:

Benign or malignant?

A

Benign (70 to 80% of cases)

Can be a sign of underlying malignancy- Most commonly = ductal carcinoma in situ

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39
Q

View to evaluate milk of calcium

A

Lateral projection (instead of MLO)

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40
Q

Diagnostic mammographic view:

Use to determine whether lesion is real or is a summation shadow

A

Spot compression

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41
Q

Diagnostic mammographic view:

Use for better definition of margins of masses and morphology calcifications

A

Spot compression with magnification

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42
Q

Diagnostic mammographic view:

Use to show lesions in outera aspect of breast and axillary trail not seen in CC view

A

Exaggerated craniocaudal

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43
Q

Diagnostic mammographic view:

Use to show lesions in in postermedial breast not seen in CC

A

Cleavage view

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44
Q

Diagnostic mammographic view:

Use verify true lesions and show palpable lesions obscured by dense tissues

A

Tangential view

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45
Q

Diagnostic mammographic view:

Use verify true lesions and determine location of lesion seen in one view by seeing how location changes

A

Rolled views

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46
Q

Diagnostic mammographic view:

Use to improve visualization of superomedial tissue

It also improve tissue visualization and comfort for women with pectus excavatum, recent sternotomy, and prominent pacemaker

A

Lateromedial oblique

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47
Q

Ultrasound appearance of a cyst

A

Circumscribed, anehoic masses, usually with posterior acoustic enhancement

48
Q

Ultrasound apperance of fibroadenomas

A

Circumscribed, oval, and homogeneously hypoechoic

49
Q

BI-RADS category of fibroadenoma

A

BI-RADS 3: Probably benign

50
Q

Initial imaging modality is based on age

What are the initial imaging recommendation for a palpable breast mass?

A

<30 years - US
30-39 - Mammography or US
> 40 - Mammography

51
Q

Mastalgia can be divided into two types of pain

A

Cyclic breast pain

Noncyclic breast pain

52
Q

This is defined by intermittent breast pain the spikes during the luteal phase, right before the menses, and is thought to be primarily hormonal in etiology due to its relatioship to the menstrual cycle

A

Cyclic breast pain

Pain or tenderness is also associated with swelling in the breasts

Usually, no imaging evaluation of cyclic breastis necessary (likelihood of malignancy is low)

53
Q

Breast pain that tends to be unilateral and more focal than cyclical breast pain

A

Noncyclical breast pain

54
Q

Imaging used for evaluation of noncyclical breast pain

A

Mammography is usually performed for women older than 40
Ultrasound - younger than 30
Mammo/US - between 30-39

Similar to palpable breast mass recommendation

55
Q

Preferred imaging modality in young and pregnant women

A

Ultrasound

56
Q

Categories of nipple discharge

A
  1. Pathologic nipple discharge

2. Physiologic nipple discharge

57
Q

Nipple discharge that present as serous or bloody in color, spontaneous, unilateral, and arising from a single duct

A

Pathologic

58
Q

Nipple discharge that can be green, yellow, or milky in color, spontaneous, bilateral, and usually from multiple ducts

A

Physiologic

59
Q

Most common cause of pathologic nipple

A

Intraductal papilloma

60
Q

Region in the breast - where most lesions cause nipple discharge

A

Retroareolar region

61
Q

Next step if mammography and ultrasound are negative

A

Galactography (AKA ductography) and breast MR imaging - have been demonstrated to be useful in the evaluation of pathologic nipple discharge

62
Q

Modality of choice of initial evaluation of breast inflammation

A

Ultrasound

Patients cannot tolerate the compression of mammography

63
Q

Ultrasound characteristic of mastitis

A
  1. An area of heterogeneous altered echotexture from the edema within the parenchyma
  2. Skin thickening
  3. Increased vascularity
64
Q

Ultrasound characteristic of abscess

A

An irregular, indistict, heterogeneously hypoechoic collection

Sometimes with multiple loculations

65
Q

Important mimicker of infection mastitis

A

Inflammatory breast cancer

66
Q

When is inflammatory breast cancer considered?

A

If the patient is older and antibiotics do not provide complete resolution within 1 to 2 weeks

67
Q

Imaging findings of inflammatory breast carcinoma

A
  1. Diffuse breast enlargement
  2. Diffuse increased density
  3. Skin thickening
  4. Enlarged axillary lymph nodes
68
Q

Paget disease should be considered in what clinical presentation?

A

Itching, eczema, or ulceration of the nipple

69
Q

Disease that is characterized pathologically as invasion of the epidermis of the nipple by malignant cells

A

Paget’s disease

70
Q

Diagnostic standard for the diagnosis of Paget’s disease

A

Biopsy

71
Q

Axillary lymph nodes are visualized on what mammographic view?

A

MLO

72
Q

Mammographic appearance of pathologic axillary nodes

A

Homogeneously dense and enlarged

73
Q

Coarse calcifications in axillary nodes may reflect what disease?

A

Granulomatous disease

74
Q

On ultrasound

Benign or normal lymph nodes have a hyperechoic hilum with a thin hypoechoic cortical rim

What is the upper limit of normal cortical thickness?

A

It ranges from 2.3 to 3 mm

75
Q

Deposits in the lymph nodes that create focal hypoechoic cortical thickening or complete replacement of the lymph node

A

Metastatic deposits

Results in absence of fatty hilum

76
Q

Appearance of a normal male breast on mammography

A

It appears as a mound of subcutaneous fat without glandular tissue

77
Q

Most common indication for imaging the male breast

A

Gynecomastia

78
Q

Benign proliferation of ductal and stromal tissue in men

A

Gynecomastia

79
Q

Etiologies of gynecomastia

A 
Idiopathic
Drugs
Cirrhosis
Hypogonadism
Hormone-secreting neoplasms
Hyperthyroidism
Chronic renal disease
80
Q

Drugs that can cause gynecomastia

A 
Anabolic steroids
Leuprolide acetate
Thiazide
Spinorolactone
Digitalis
Marijuana
81
Q

Initial imaging recommendation for palpable male breast mass

A

<25 is ultrasound

> or = to 25 is Mammography

82
Q

Mammographic finding of gynecomastia

A

Appears as a triangular or flame-shaped area of subareolar glandular tissue that points toward the nipple with fat interspersed within the parenchymal elements

83
Q

What are the three patterns of gynecomastia?

A

Nodular
Dendritic
Diffuse glandular

84
Q

Accounts for about 80% of the breast cancer types in men

A

Invasive ductal carcinoma

85
Q

Any palpable abnormality on the mastectomy side should be assessed with what modality?

A

Ultrasound

To evaluate for possible recurrence

86
Q

What modality should still be performed for women who underwent breast conservation therapy?

A

Annual mammography with either 2D or DBT

To detect any evidence of recurrence

87
Q

These are common findings within the first year of surgery

A

Mass-like postoperative fluid collections

88
Q

Lumpectomy site is commonly associated with what findings?

A

Scar formation and dystrophic or fat necrosis calcification

Instead of mass

89
Q

Appearance of scar formation on mammography?

A

Architectural distortion

Which either stabilizes or diminishes in conspicuity over the years

90
Q

These are common findings if the patient receives radiation treatment

A

Breast edema and skin thickening

91
Q

What are the mammographic evidence of recurrence?

A
  1. Enlarging masses
  2. Developing asymmetries
  3. New or increasing suspicious calcifications within or adjacent to the lumpectomy bed
92
Q

Indications for breast MRI

A
  1. Breast cancer screening of high-risk patient
  2. Preoperative staging of breast cancer
  3. Postoperative evaluation in women with positive margins after lumpectomy
  4. Monitoring response to neoadjuvant chemotherapy
  5. Detection of mammographically occult malignancy in patients with axillary nodal metastasis
  6. Work-up of nipple discharge (selective)
  7. Evaluation of silicone implants
93
Q

Imaging modality that can distinguish scar and fibrosis from recurrence in women status post breast conservation therapy

A

MRI

94
Q

MR imaging can visualize structures outside the breast parenchyma

What are these structures?

A
  1. Axilla
  2. Dome of the liver
  3. Mediastinum
  4. Bones of the ribcage and sternum
95
Q

Most common sites for breast cancer metastases

A 
Bone - MC
Lung
Brain
Liver 
Lymph nodes

*In descending order

96
Q

Diagnosis of saline implant rupture does not require MR

True or False?

A

True

It can be diagnosed clinically by rapid breast shrinking and can be seen as collapsed or absent implant on mammography or US

97
Q

It comes from the collapsed implant membrane (dark signal) layering dependently in the silicone (bright T2)

A

Linguine appearance

98
Q

Silicone signal is seen outside the dark fibrous capsule

A

Extracapsular rupture

99
Q

Screening breast MR shoud be performed when?

A

During the first half of the menstrual cycle

days 3 to 14

100
Q

Features of a focus that re more typical of malignancy

A
  1. Dominant or single focus, one that does not have features suggestive of a lymph node (no fatty hilum)
  2. Change from prior examination
  3. Associated suspicios kinents (washout delayed pattern)
101
Q

If a focus is hyperintense on T2, it is more likely malignant

A

False
It is more likely benign

Especially if it is stable and have a fatty hilum or persistent delayed kinetics

102
Q

Differential diagnosis of a focus on breast MRI

A
  1. Intramammary lymph node
  2. Papilloma
  3. Small fibroadenoma
  4. Fibrocystic changes
  5. Usual ductal hyperplasia
  6. Atypical ductal hyperplasia
  7. Invasive ductal hyperplasia
  8. Ductal carcinoma
103
Q

Defined as a unique punctate enhancing dot, usually < 5 mm that lacks features of a mass

A

Focus

104
Q

It describes shape, margin, and internal enhancement characteristic

Needs to be 3- dimensional with convex outward margins

A

Mass

105
Q

Most concerning internal enhancement pattern

A

Rim-enhancement

106
Q

Most concerning shape

A

Irregular

107
Q

Defined as enhancement that is not a mass nor a focus and stand out compared to BPE

A

Nonmass enhancement

108
Q

Most common cause of of nonmass enhancement

A

Fibrocystic changes

109
Q

Most common malignancy to present as nonmass enhancement

A

Ductal carcinoma in situ

110
Q

Differential Diagnosis of nonmass enhancement

A
  1. Fibrocystic change
  2. Inflammatory benign lesion
  3. Usual ductal hyperplasia
  4. Atypical ductal hyperplasia
  5. Invasive lobular carcinoma
  6. Ductal carcinoma in situ
111
Q

Complications of image-guided biopsies

A
  1. Hemorrhage
  2. Infection
  3. Pneumothorax (rare)
112
Q

Indications for surgical excision

A
  1. Needle biopsy results
    (Malignant, Benign discordant, Atypia)
  2. Unsuccessful image-guided biopsy
    (Tissue too thin to perform need biopsy, location inaccessible, patient factors)
  3. Patient preference
113
Q

This is indicated for women with spontaneous, unilateral, single duct clear, or bloody nipple discharge

A

Galactography

Often conventional imagings are normal

114
Q

Differential diagnosis for suspicious nipple discharge

A
  1. Ductal carcinoma in situ
  2. Papilloma
  3. Duct ectasia
  4. Mastitis
  5. Fibrocystic changes
115
Q

Reasons why galactography can be unsuccessful

A
  1. Failure to elicit discharge
  2. Failure to cannulate the duct
  3. Extravasation of contrast material through the duct wall
  4. Imaging of the incorrect ductal system
116
Q

A contraindication to galactography

A

Allergy to iodinated contrast material

Women's Imaging (4 decks)

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