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Reproduction > Breast: Radiology and Cytology > Flashcards

Breast: Radiology and Cytology Flashcards

1
Q

What imaging techniques are used to look at the breast?

A
  • Mammography -Ultrasound
  • Image guided techniques
  • MRI
  • Nuclear Medicine
  • Breast Screening Programme
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2
Q

What view are used in mammography?

A

-ML oblique and craniocaudal mainly

Additional views

  • Coned view
  • Magnification view
  • True lateral
  • Extended CC
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3
Q

Who undergoes mammography?

A
  • Over age 40

- Under 40 if strong suspicion of cancer or family history risk greater than 40%

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4
Q

What is the radiation dose in mammography?

A

1mSv

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5
Q

What are signs of breast disease of mammography?

A
  • Dominant mass
  • Asymmetry
  • Architectural distortion
  • Calcifications
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6
Q

What are the features of malignant soft tissue masses on mammography?

A
  • Irregular, ill-defined
  • Spiculated
  • Dense
  • Distortion of architecture
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7
Q

What are the features of benign soft tissue masses on mammography?

A
  • Smooth or lobulated
  • Normal density
  • Halo
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8
Q

What is US used for in the breast?

A

Differentiate

  • Solid from cystic mass
  • Solid benign from malignant
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9
Q

What is the first line imaging used in the <40s?

A

US

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10
Q

What are the advantages of US?

A
  • No ionising radiation

- Improves specificity of imaging

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11
Q

How do solid benign lesions appear on ultrasound?

A
  • Smooth outline
  • Oval shape
  • Acoustic enhancement
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12
Q

How do malignant lesions appear on US?

A
  • Irregular outline
  • Interrupting breast architecture
  • Acoustic shadowing and anterior halo
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13
Q

What is the triple assessment for breast pathology?

A
  • Clinical examination
  • Imaging
  • FNA cytology
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14
Q

What is the sensitivity and specificity of the triple assessment for breast cancer?

A
  • Sensitivity 97-100%

- Specificity 98-100%

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15
Q

What are the 2 basic types of image guided biopsy?

A
  • FNA

- Core biopsy

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16
Q

How can image guided biopsy be carried out?

A

Stereotactic
-Upright or prone table

Ultrasound 
-Guided or freehand

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17
Q

What are the indications for MRI of the breast?

A

-Recurrent disease -Implants -Indeterminate lesion following triple assessment -Screening high risk women

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18
Q

What is the sensitivity and specificity of MRI?

A
  • Sensitivity 94-98% for all breast density

- Specificity is poor

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19
Q

What are the disadvantages of MRI?

A
  • Claustrophobic
  • Noisy
  • Lengthy
  • IV contrast
  • Expensive
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20
Q

How is sentinel node sampling performed?

A
  • Peritumoral injection of 99m Tc sulphur colloid ± isosulphan blue dye
  • Lymphoscintigraphy
  • Intraoperative Gamma probe
  • Single Lymph node removal
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21
Q

How accurate is sentinel node sampling?

A

97% accurate at identifying the sentinel node

22
Q

What is the breast screening programme?

A
  • Women 50-70 invited every 3 years for mammography -Mammograms detect 5 cancers/1000 screened
  • Uptake is 80%
  • Recall for further investigations is 5-10%
23
Q

What is the aim of the breast screening programme?

A

To detect cancers at DCIS stage or less than 15 mm is size while still impalpable

24
Q

What is cytology?

A

Microscopic examination of a thin layer of cells on a slide?

25
Q

How can cells be obtained for cytology in breast disease?

A
  • Fine Needle Aspiration
  • Direct smear from nipple discharge
  • Scrape of nipple with scalpel
26
Q

What is the role of cytology in the symptomatic clinic?

A

Patient presents with symptoms and undergoes “triple assessment” by surgeon, radiologist and cytopathologist

27
Q

What is the role of cytology in breast screening?

A

-Asymptomatic women invited for mammographic examination mostly get core biopsy and FNA of axillary nodes/ satellite lesions)

28
Q

What may be palpable in someone who is symptomatic?

A

Discrete mass

  • Cystic
  • Solid

Diffuse thickening

Nipple lesion

  • Discharge
  • Eczematous skin
29
Q

What equipment is needed for FNA?

A
  • 23G needle
  • 10ml syringe +/- Cameco holder
  • Alcohol swab
  • Cotton wool, sticking plaster
  • Glass slides, pencil
  • +/-Vial with saline for needle washings
30
Q

What is the technique for FNA?

A
  • Ensure patient comfortable
  • Examine to locate lump
  • Swab area
  • Localise lump between fingers
  • Insert needle (45o) and aspirate using in and out action applying negative pressure on syringe
  • Release pressure and remove needle (nb. Non- aspiration technique)
  • Apply cotton wool to ensure haemostasis
  • Spread material onto glass slides - fix, air dry
31
Q

What patient considerations are there for FNA?

A
  • Informed of procedure
  • Comfort
  • Chaperone
32
Q

What safety considerations are there for FNA?

A
  • Wear gloves/ handwashing
  • Dispose of needle
  • Care handling fresh material/ infection risk
33
Q

How do benign lesions appear on cytology?

A
  • Low/moderate cellularity
  • Cohesive groups of cells
  • Flat sheets of cells
  • Bipolar nuclei in background
  • Cells of uniform size
  • Uniform chromatin pattern
34
Q

How doe malignant lesions appear on cytology?

A
  • High cellularity
  • Loss of cohesion
  • Crowding/overlapping of cells
  • Nuclear pleomorphism
  • Hyperchromasia
  • Absence of bipolar nuclei
35
Q

What type of malignant diagnosis does cytology usually provide?

A

Usually non specific e.g. adenocarcinoma NOS

Occasional feature may suggest

  • Cytoplasmic vacuoles (lobular carcinoma)
  • Cells arranged in tubes (tubular carcinoma)
36
Q

What is the cytology scoring system?

A
  • C1 Unsatisfactory
  • C2 Benign
  • C3 Atypia (probably benign)
  • C4 Suspicious (probably malignant)
  • C5 Malignant
37
Q

What is the curative treatment for cysts?

A

Aspiration

38
Q

Fluid from cysts is discarded unless..

A
  • Fluid is bloodstained

- There is residual mass

39
Q

What are the advantages of FNA cytology?

A
  • Simple procedure - can be done at clinic
  • Well tolerated by patients
  • Inexpensive
  • Immediate results
40
Q

What are the disadvantages of FNA cytology?

A

ACCURACY NOT 100%

  • False Negatives
  • False Positives
  • Invasion cannot be assessed
  • Grading cannot be done
41
Q

What sampling limitations of FNA cytology are there?

A
  • Small lesions

- Small tumour in a larger area of thickening

42
Q

What technical limitations of FNA cytology are there?

A
  • Difficult to examine cells

- Suboptimal smears (blood, thick, cells smeared)

43
Q

What are the possible complications of FNA?

A
  • Pain
  • Haematoma
  • Fainting
  • Infection
  • Rare (pneumothorax)
44
Q

What is indicative of a nipple lesion?

A

Bloody discharge from single duct

45
Q

What can be seen on cystoscopy of nipple discharge of duct ectasia?

A

Macrophages only

46
Q

What can be seen on cystoscopy of nipple discharge intraduct papilloma?

A

Benign cells in papillary groups

47
Q

What can be seen on cystoscopy of nipple discharge intraduct carcinoma (DCIS)?

A

Malignant cells

48
Q

What can be seen on cystoscopy of a nipple scrape of Paget’s disease?

A

Squamous cells and malignant cells

49
Q

What can be seen on cystoscopy of a nipple scrape of eczema?

A

Squamous cells from epidermis only

50
Q

When is core biopsy carried out?

A
  • All cases with clinical OR radiological OR cytological suspicion
  • Breast screening – especially architectural distortion and microcalcification
  • Pre-operative classification
51
Q

How is a core biopsy obtained?

A
  • Using a 14G needle to extract an intact tissue strand

- Fixed in formalin

52
Q

What is core biopsy used for?

A
  • Confirm invasion
  • Tumour typing and grading
  • Immunohistochemistry – receptor status

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