Breast lecture 2 - radiology and cytology

Question 1

List 6 breast imaging modalities

Answer 1

mammogram 
USS
Breast screening programme 
nuclear medicine 
MRI 
Image guided techniques

Question 2

Age for mammography and why

Answer 2

over 40 -radiation

Question 3

2 reasons for offering a mammogram under 40

Answer 3

strong suspicion of cancer

FH risk >40%

Question 4

Radiation dose of mammogram

Answer 4

1mSV

Question 5

4 signs of disease on mammography

Answer 5

dominant mass
asymmetry
architectural distortion
calcifications

Question 6

Malignant mass appearance on mammography

Answer 6

irregular, illdefined
spiculated
dense
distorted architecture

Question 7

benign mass appearance on mammography

Answer 7

smooth or lobulated
normal density
halo

Question 8

What can USS help to differentiate between?

Answer 8

solid vs cystic and benign vs malignant

Question 9

1s line for under 40’s

Answer 9

USS

Question 10

Solid benign on USS

Answer 10

smooth outline, oval, acoustic enhancement

Question 11

Solid malignant on USS

Answer 11

irregular outline, interrupting architecture, acoustic shadowing, anterior halo

Question 12

Triple assessment

Answer 12

clinical examination
Imaging
FNA cytology

Question 13

2 basic types of needle biopsy

Answer 13

FNA and core

Question 14

Indications for MRI of breast

Answer 14

recurrent disease
implants
high risk screening
indeterminate lesions after triple assessment

Question 15

Sensitivity or specificity of MRI poor?

Answer 15

specificity

Question 16

Disadvantages of MRI

Answer 16

claustrophobic - noisy - IV contrast - time - expense

Question 17

What probe is used in sentinel LN biopsy?

Answer 17

intra-operative gamma probe

Question 18

Breast screening programme

Answer 18

women aged 50-70 invited every 3 years for a mammogram

Question 19

Aim of breast screening programme

Answer 19

detect cancers at DCIS or 15mm or less

Question 20

Breast team

Answer 20

radiologist, breast clinician, cytologist, surgeon, nurse, radiographer

Question 21

cytology

Answer 21

Microscopic examination of a thin layer of cells on a slide

Question 22

3 ways a sample for cytology can be obtained

Answer 22

FNA
direct smear from nipple discharge
scrape of nipple with scalpel

Question 23

Role of cytology in symptomatic women

Answer 23

part of triple assessment

Question 24

Roel of cytology in breast screening

Answer 24

usually core biopsy, FNA of axillary LN, satellite lesions

Question 25

Briefly describe the FNA technique

Answer 25

patient comfortable and locate lump (swab area) insert needle at 45 degrees and aspirate in and out remove and cotton wool - haemostasis

Question 26

3 important patient considerations for FNA

Answer 26

comfort, informed, chaperone

Question 27

3 important safety considerations for FNA

Answer 27

gloves/handwashing disposal of needle care with handling - infection

Question 28

benign cytology

Answer 28

low/moderate cellularity bipolar nuclei uniform size of cells uniform chromatin

Question 29

Malignant cytology

Answer 29

high cellularity loss of bipolar nuclei hyperchromasia nuclear pleomorphism

Question 30

Cytology scoring system

Answer 30

``` C1 - unsatisfactory C2 - benign C3 - atypia C4 - suspicious C5 - malignant ```

Question 31

What is aspiration curative for?

Answer 31

cysts

Question 32

When would cyst fluid not be discarded?

Answer 32

blood stained | residual mass

Question 33

Advantages of FNA

Answer 33

well tolerated and inexpensive | simple and immediate results

Question 34

Limitations of FNA

Answer 34

not 100% accurate false negatives and positives no invasion or grading assessment

Question 35

Sampling limitations of FNA

Answer 35

lesions missed - small or in large thickening

Question 36

technical limitations of FNA

Answer 36

difficult to examine - blood, necrosis, smear

Question 37

4 complications of FNA

Answer 37

pain haematoma infection, pneumothorax - rare fainting

Question 38

CI of FNA

Answer 38

none

Question 39

3 cytology results from nipple discharge

Answer 39

duct ectasia - macrophages intraduct papilloma - benign cells in papillary groups DCIS - malignant cells

Question 40

Difference in cytology between pagets and eczema

Answer 40

eczema - squamous cells from epidermis | pagets - squamous and malignant cells

Question 41

Why would you do a core biopsy?

Answer 41

all cases with suspicion | breast screening - architectural disruption and calcification

Question 42

What can you confirm from core biopsy?

Answer 42

immunochemistry eg hormone receptors confirm invasion type and grade tumour