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Year 3 Repro (JK) > Breast lecture 2 - radiology and cytology > Flashcards

Breast lecture 2 - radiology and cytology Flashcards

1
Q

List 6 breast imaging modalities

A 
mammogram 
USS
Breast screening programme 
nuclear medicine 
MRI 
Image guided techniques
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2
Q

Age for mammography and why

A

over 40 -radiation

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3
Q

2 reasons for offering a mammogram under 40

A

strong suspicion of cancer

FH risk >40%

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4
Q

Radiation dose of mammogram

A

1mSV

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5
Q

4 signs of disease on mammography

A

dominant mass
asymmetry
architectural distortion
calcifications

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6
Q

Malignant mass appearance on mammography

A

irregular, illdefined
spiculated
dense
distorted architecture

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7
Q

benign mass appearance on mammography

A

smooth or lobulated
normal density
halo

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8
Q

What can USS help to differentiate between?

A

solid vs cystic and benign vs malignant

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9
Q

1s line for under 40’s

A

USS

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10
Q

Solid benign on USS

A

smooth outline, oval, acoustic enhancement

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11
Q

Solid malignant on USS

A

irregular outline, interrupting architecture, acoustic shadowing, anterior halo

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12
Q

Triple assessment

A

clinical examination
Imaging
FNA cytology

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13
Q

2 basic types of needle biopsy

A

FNA and core

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14
Q

Indications for MRI of breast

A

recurrent disease
implants
high risk screening
indeterminate lesions after triple assessment

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15
Q

Sensitivity or specificity of MRI poor?

A

specificity

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16
Q

Disadvantages of MRI

A

claustrophobic - noisy - IV contrast - time - expense

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17
Q

What probe is used in sentinel LN biopsy?

A

intra-operative gamma probe

18
Q

Breast screening programme

A

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

19
Q

Aim of breast screening programme

A

detect cancers at DCIS or 15mm or less

20
Q

Breast team

A

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

21
Q

cytology

A

Microscopic examination of a thin layer of cells on a slide

22
Q

3 ways a sample for cytology can be obtained

A

FNA
direct smear from nipple discharge
scrape of nipple with scalpel

23
Q

Role of cytology in symptomatic women

A

part of triple assessment

24
Q

Roel of cytology in breast screening

A

usually core biopsy, FNA of axillary LN, satellite lesions

25
Q

Briefly describe the FNA technique

A

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

26
Q

3 important patient considerations for FNA

A

comfort, informed, chaperone

27
Q

3 important safety considerations for FNA

A

gloves/handwashing
disposal of needle
care with handling - infection

28
Q

benign cytology

A

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

29
Q

Malignant cytology

A

high cellularity
loss of bipolar nuclei
hyperchromasia
nuclear pleomorphism

30
Q

Cytology scoring system

A 
C1 - unsatisfactory 
C2 - benign 
C3 - atypia 
C4 - suspicious 
C5 - malignant
31
Q

What is aspiration curative for?

A

cysts

32
Q

When would cyst fluid not be discarded?

A

blood stained

residual mass

33
Q

Advantages of FNA

A

well tolerated and inexpensive

simple and immediate results

34
Q

Limitations of FNA

A

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

35
Q

Sampling limitations of FNA

A

lesions missed - small or in large thickening

36
Q

technical limitations of FNA

A

difficult to examine - blood, necrosis, smear

37
Q

4 complications of FNA

A

pain
haematoma
infection, pneumothorax - rare
fainting

38
Q

CI of FNA

A

none

39
Q

3 cytology results from nipple discharge

A

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

40
Q

Difference in cytology between pagets and eczema

A

eczema - squamous cells from epidermis

pagets - squamous and malignant cells

41
Q

Why would you do a core biopsy?

A

all cases with suspicion

breast screening - architectural disruption and calcification

42
Q

What can you confirm from core biopsy?

A

immunochemistry eg hormone receptors
confirm invasion
type and grade tumour

Year 3 Repro (JK) (33 decks)

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