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Year 3 - Reproductive > Breast - radiology + cytology > Flashcards

Breast - radiology + cytology Flashcards

1
Q

Understand the use of, and indications for, the common investigative modalities in patients with breast disease (eg, ultrasound, mammography, FNAC, core biopsy).

A

.

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2
Q

What types of imaging are used for the breast

A 
Mammography
US
MRI 
Nuclear medicine
Image guided techniques
CT
Transillumination
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3
Q

Standard views of mammography

A 
Mediolateral oblique (MLO) or
Craniocaudal (CC)
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4
Q

Indications for mammography

A

> 50 for breast screening

<50 if

  • strong suspicion of cancer
  • FH high risk
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5
Q

What changes to look for on a mammogram for cancer

A 
Mass 
Asymmetry
Architectural distortion 
Calcifications
Skin changes
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6
Q

Features of a malignant soft tissue mass on a mammogram

A

irregular, ill-defined
Spiculated (spikes or points on the surface) – due to fibrous tissue around the mass
Dense tissue
distortion of architecture

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7
Q

Features of a benign soft tissue mass on a mammogram

A

smooth or lobulated
normal density
halo

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8
Q

Uses of ultrasound in breast disease

A

Differentiate

  • solid masses from cystic masses
  • benign from malignant
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9
Q

Indications for US in breast disease

A

Part of imaging section of ‘triple assessment’ for breast cancer

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10
Q

Features of a solid benign mass on US

A

smooth outline
oval shape
acoustic enhancement
orientation

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11
Q

Features of a malignant mass on US

A

irregular outline
interrupting breast architecture
acoustic shadowing
anterior halo

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12
Q

What does the triple assessment for breast cancer involve

A

Clinical Examination
Imaging - mammogram + US
FNA cytology

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13
Q

Types of image guided needle biopsy (FNA biopsy or core biopsy [bigger needle + small incision})

A

X-ray guided stereotactic - upright or prone table

US

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14
Q

Difference between FNAC and a core biopsy

FNAC is same as a FNA biopsy; former just emphasises that any aspiration biopsy involves cytopathology

A

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)

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15
Q

Indications for an MRI in breast disease

A

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

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16
Q

The breast screening programme invites women aged what to attend + how frequent

A

50-70, every 3 years

17
Q

The breast screening programme aims to detect cancers at what stage

A

DCIS (ductal carcinoma in-situ) or less than 15mm in size

18
Q

What is cytology

A

Microscopic examination of a thin layer of cells on a slide

19
Q

FNAC can be down with what samples

A

Nipple discharge
Sputum
Urine
Aspirate cysts

20
Q

Indications for FNAC in breast disease

A

Triple assessment for those presenting with symptoms
OR
Breast screening - if something suspicious discovered on mammogram

21
Q

Features on benign v malignant cytology

A

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

22
Q

Malignant cytology, although helpful, is …

A

non-specific to the exact cancer, i.e. may suggest it is a lobular or tubular carcinoma

23
Q

What is the cytology scoring system

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia (probably benign)
C4 - Suspicious (probably malignant)
C5 - Malignant
24
Q

Advantages v limitations of FNAC

A

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

25
Q

Complications of an FNA

A

Pain
Haematoma
Fainting

26
Q

Indications for a core biopsy (different from FNAC)

A

Clinical/radiological/cytological suspicion

Breast screening

Pre-operative classification of a tumour to confirm grading and staging

27
Q

2 most important mammography indicators of breast disease

A

Mass

Microcalcification - majority harmless

Year 3 - Reproductive (18 decks)

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