Breast Radiology Flashcards
When someone has suspected breast disease we approach with Triple Assessment:
- Clinical Exam
- Imaging (Mammography or US)
- Cytology (FNA or Core biopsy)
Sensitivity 97-100%, Specificity 98-100% for detection of breast cancer. Imaging and cytology have been proven to be the two most reliable components.
When would we do a mammograph?
If a patient is symptomatic and > 40yrs.
Under 40yrs the radiation dose is considered more risky than not scanning so we do US instead; Unless there is a strong suspicion of cancer or a strong FH
How do you tell a benign breast mass vs a malignant one (without cytology) on a mammogram?
Benign are smooth or lobulated, normal density and have a halo.
Malignant will be irregular/ill defined, speculated, dense and distort the natural breast architecture.
We can do needle biopsies either image guided or freehand, what imaging do we use to guide?
US
How do we score cytology after a needle biopsy?
C1-5: 1 = Unsatisfactory 2 = Benign 3 = Atypia 4 = Suspicious 5 = Malignant
We can use a Fine Needle Aspiration on both solid masses and cysts, how is it different when used on cysts?
It’s often curative
You only need to actually test the fluid if its bloodstained or there’s a residual mass.
Pros and cons of an FNA?
- Wide available
- Well tolerated
- Cheap
- Quick results.
But it can’t assess grade or invasion
Pros and Cons of a Core biopsy?
Can confirm invasion, assess typing and grading and oestrogen and Progesterone receptor status.
However its less easy to do and more unpleasant.
What are the risks of a FNA?
Pain, haematoma and fainting Very rarely can get infected or cause pneumothorax
When might we do an MRI for breast disease?
- Recurrent Disease
- Implants
- Indeterminate lesion even after triple assessment
- Screening in high risk women
What is sentinal node sampling and how do we do it?
Its so we can test the first lymph node from the tumour to see if it’s spread.
Do it by lymphoscintigraphy, a radioisotope dye (sulphur colloid +- isosuphan blue dye) is injected into lesion and followed to the first node
Single Lymph node removal.
Explain the UK breast cancer screening programme?
Women invited for a mammograph every 3yrs from 50 to 70
Mammograms detect 5 cancers/1000 screened.
Aim to detect cancers at DCIS stage or < 15mm in size (i.e. palpable)
What different types of mammographies can be used for breast imaging?
Standard, tomosynthesis and contrast-enhanced spectral mammography (CEMG)
What different types of ultrasounds are used for breast imaging?
Grayscale, dopler, elastography and CEUS
What are four different imaging modalities used for breast imaging?
Mammograpy US MRI Nuclear medicine
