Breast - radiology + cytology Flashcards
Understand the use of, and indications for, the common investigative modalities in patients with breast disease (eg, ultrasound, mammography, FNAC, core biopsy).
.
What types of imaging are used for the breast
Mammography US MRI Nuclear medicine Image guided techniques CT Transillumination
Standard views of mammography
Mediolateral oblique (MLO) or Craniocaudal (CC)
Indications for mammography
> 50 for breast screening
<50 if
- strong suspicion of cancer
- FH high risk
What changes to look for on a mammogram for cancer
Mass Asymmetry Architectural distortion Calcifications Skin changes
Features of a malignant soft tissue mass on a mammogram
irregular, ill-defined
Spiculated (spikes or points on the surface) – due to fibrous tissue around the mass
Dense tissue
distortion of architecture
Features of a benign soft tissue mass on a mammogram
smooth or lobulated
normal density
halo
Uses of ultrasound in breast disease
Differentiate
- solid masses from cystic masses
- benign from malignant
Indications for US in breast disease
Part of imaging section of ‘triple assessment’ for breast cancer
Features of a solid benign mass on US
smooth outline
oval shape
acoustic enhancement
orientation
Features of a malignant mass on US
irregular outline
interrupting breast architecture
acoustic shadowing
anterior halo
What does the triple assessment for breast cancer involve
Clinical Examination
Imaging - mammogram + US
FNA cytology
Types of image guided needle biopsy (FNA biopsy or core biopsy [bigger needle + small incision})
X-ray guided stereotactic - upright or prone table
US
Difference between FNAC and a core biopsy
FNAC is same as a FNA biopsy; former just emphasises that any aspiration biopsy involves cytopathology
FNAC only takes out a few cells with a thin needle whereas core biopsy takes out a piece of tissue with a larger needle (requires LA)
Indications for an MRI in breast disease
Recurrent disease
Implants
Indeterminate lesion following triple assessment
Screening high risk women
The breast screening programme invites women aged what to attend + how frequent
50-70, every 3 years
The breast screening programme aims to detect cancers at what stage
DCIS (ductal carcinoma in-situ) or less than 15mm in size
What is cytology
Microscopic examination of a thin layer of cells on a slide
FNAC can be down with what samples
Nipple discharge
Sputum
Urine
Aspirate cysts
Indications for FNAC in breast disease
Triple assessment for those presenting with symptoms
OR
Breast screening - if something suspicious discovered on mammogram
Features on benign v malignant cytology
Low cellularity in benign; high in malignant
Cohesive groups of cells; loss of cohesion in malignant
Flat sheets of cells; overlapping in malignant
Uniform sized cells; pleomorphic cells in malignant
Malignant cytology, although helpful, is …
non-specific to the exact cancer, i.e. may suggest it is a lobular or tubular carcinoma
What is the cytology scoring system
C1 - Unsatisfactory C2 - Benign C3 - Atypia (probably benign) C4 - Suspicious (probably malignant) C5 - Malignant
Advantages v limitations of FNAC
Simple + quick
Well tolerated
Cheap
Immediate results
Not 100% accurate - false +/-ves
Doesn’t provide info on grading
Needle may have missed it if lesion is small
Complications of an FNA
Pain
Haematoma
Fainting
Indications for a core biopsy (different from FNAC)
Clinical/radiological/cytological suspicion
Breast screening
Pre-operative classification of a tumour to confirm grading and staging
2 most important mammography indicators of breast disease
Mass
Microcalcification - majority harmless
