Breast lecture 2 - radiology and cytology Flashcards
List 6 breast imaging modalities
mammogram USS Breast screening programme nuclear medicine MRI Image guided techniques
Age for mammography and why
over 40 -radiation
2 reasons for offering a mammogram under 40
strong suspicion of cancer
FH risk >40%
Radiation dose of mammogram
1mSV
4 signs of disease on mammography
dominant mass
asymmetry
architectural distortion
calcifications
Malignant mass appearance on mammography
irregular, illdefined
spiculated
dense
distorted architecture
benign mass appearance on mammography
smooth or lobulated
normal density
halo
What can USS help to differentiate between?
solid vs cystic and benign vs malignant
1s line for under 40’s
USS
Solid benign on USS
smooth outline, oval, acoustic enhancement
Solid malignant on USS
irregular outline, interrupting architecture, acoustic shadowing, anterior halo
Triple assessment
clinical examination
Imaging
FNA cytology
2 basic types of needle biopsy
FNA and core
Indications for MRI of breast
recurrent disease
implants
high risk screening
indeterminate lesions after triple assessment
Sensitivity or specificity of MRI poor?
specificity
Disadvantages of MRI
claustrophobic - noisy - IV contrast - time - expense
What probe is used in sentinel LN biopsy?
intra-operative gamma probe
Breast screening programme
women aged 50-70 invited every 3 years for a mammogram
Aim of breast screening programme
detect cancers at DCIS or 15mm or less
Breast team
radiologist, breast clinician, cytologist, surgeon, nurse, radiographer
cytology
Microscopic examination of a thin layer of cells on a slide
3 ways a sample for cytology can be obtained
FNA
direct smear from nipple discharge
scrape of nipple with scalpel
Role of cytology in symptomatic women
part of triple assessment
Roel of cytology in breast screening
usually core biopsy, FNA of axillary LN, satellite lesions
Briefly describe the FNA technique
patient comfortable and locate lump (swab area)
insert needle at 45 degrees and aspirate in and out
remove and cotton wool - haemostasis
3 important patient considerations for FNA
comfort, informed, chaperone
3 important safety considerations for FNA
gloves/handwashing
disposal of needle
care with handling - infection
benign cytology
low/moderate cellularity
bipolar nuclei
uniform size of cells
uniform chromatin
Malignant cytology
high cellularity
loss of bipolar nuclei
hyperchromasia
nuclear pleomorphism
Cytology scoring system
C1 - unsatisfactory C2 - benign C3 - atypia C4 - suspicious C5 - malignant
What is aspiration curative for?
cysts
When would cyst fluid not be discarded?
blood stained
residual mass
Advantages of FNA
well tolerated and inexpensive
simple and immediate results
Limitations of FNA
not 100% accurate
false negatives and positives
no invasion or grading assessment
Sampling limitations of FNA
lesions missed - small or in large thickening
technical limitations of FNA
difficult to examine - blood, necrosis, smear
4 complications of FNA
pain
haematoma
infection, pneumothorax - rare
fainting
CI of FNA
none
3 cytology results from nipple discharge
duct ectasia - macrophages
intraduct papilloma - benign cells in papillary groups
DCIS - malignant cells
Difference in cytology between pagets and eczema
eczema - squamous cells from epidermis
pagets - squamous and malignant cells
Why would you do a core biopsy?
all cases with suspicion
breast screening - architectural disruption and calcification
What can you confirm from core biopsy?
immunochemistry eg hormone receptors
confirm invasion
type and grade tumour
