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Mammography > Breast Review > Flashcards

Breast Review Flashcards

1
Q

What structures comprise the TDLU?

A

Terminal Duct Lobule Unit - Lobule is the exocrine gland

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2
Q

What does MQSA of 1998 stand for and mean?

A

Mamo. Quality Standard Act. Applies to docs, physicists, rads technologists

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3
Q

ACS guidelines for breast screening?

A

Qyear at age 40

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4
Q

ACS guidelines for breast BSE and CBE

A

CBE should be done at 20-39 q3 years. BSE should be taught about BSE and limitations but can start at 20yo.

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5
Q

What is screening mamo for?

A

Healthy adult with no symptoms of BC

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6
Q

What is a diagnostic mamo for?

A

Done under supervision of radiologist for patient with signs or symptoms related to breast. Lump, focal, discharge, etc.

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7
Q

What is the sens/spec of mammography for detection?

A

Sens 80-90, spec 80-95%

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8
Q

What are the two standard views?

A

MLO, CC

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9
Q

What are 8 special views, additionally?

A

Spot compression, mag views, true lateral, axillary tail, cleaavage view, rolled, exaggerated CC, implant displaced.

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10
Q

How old should a comparison mammo study be?

A

2 years old! Because good to evaluate slow growing tumors.

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11
Q

Indications for BUS?

A

solid/cystic? biopsy planning. Evaluation of mass in woman under 30 years old. Staging.

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12
Q

What is ultrasound NOT good for detecting?

A

Calcifications

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13
Q

What two nuclear medicine studies detect breast cancer?

A

Tc-99m sestamibi, FDG PET

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14
Q

Four methods for getting samples of a breast lesion?

A

CNB, needle loc with surg bx, FNA, surgical excision of palpable mass.

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15
Q

What are the indications for a CNB?

A

Birads 5 and 4, and 3 if patient is anxious.

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16
Q

BIRADS

A

0 - needs additional imaging
1 - negative
2 - Benign - stable mass, cyst, calcs, 0% chance of malig
3 - Probably benign - round calcs, 90% chance
4 - Suspicious abnormality - 2%-90% chance of malig (35% biopsy positive)
5 - Highly suggestive of malig - >90% chance (99% biopsy positive)
6 - Known active malignancy

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17
Q

What are the three terms used to describe a mass in BIRADS lexicon?

A

Shape, Margin, density

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18
Q

What are the three most common palpable masses?

A

Fibroadenoma (young), cyst, carcinoma (older)

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19
Q

Lexicon words to describe benign lesions?

A

Round, oval, macrolobulated, circumscribed margin, radiolucent, or low dencity.

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20
Q

Lexicon words to describe malignant lesions?

A

Irregular mass shape, spiculated margin, high density, architectural distortion, enlargement over time

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21
Q

List a differential for a well defined mass

A

Cyst, fibroadenoma, phylloides, carcinoma, mets, papilloma, hematoma, hamartoma, lipoma, lymph node (intramammary), abcess, oil cyst, galactocele.

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22
Q

List a differential for a ill defined mass

A

Carcinoma, abcess, hematoma, radial scar, fibrocystic change, myoblastoma

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23
Q

List a differential for a lucent lesions

A

lymph node, lipoma, hamartoma, oil cyst, galactocele

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24
Q

What are DIRECT signs of malignancy?

A

Mass, spiculated, malignant calcs, assymetry, neodensity, architectural distortion

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25
Q

What are INDIRECT signs of malignancy?

A

Architectural distortion, skin thickening, nipple retration, lymphadenopathy, breast edema

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26
Q

What is “taller than wide” a sign of?

A

Bad sign

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27
Q

BUS sign of cystic lesion?

A

Anechoic, parallel orientation, increase through transmission

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28
Q

BUS sign of fibroadenoma?

A

Oval or macrolobulated, parallel, circumscried, iso/hypo echoic

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29
Q

BUS sign of carcinoma?

A

Irregular, spiculated, hypoechoic, NONPARALLEL

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30
Q

What are the stages of enhancement on MRI?

A

Type1a: persistent (likely benign), Type1b: bowing (typically benign), Type2: plateau (intermediate), Type 3: washout (bad sign)

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31
Q

What type of cancer only enhances 50% of the time?

A

DCIS

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32
Q

What calcifications are typically benign?

A

Diffuse/scattered, large, popcornlike, rodlike, smooth, round, stable

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33
Q

What calcifications are typically malignant?

A

Grouped/clustered, linear, micro (<0.5mm), pleomorphic/heterogeneous, increasing in number

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34
Q

What are ductal casts?

A

Can be a sign of malignany - these are necrotic debris or secretions that calcify in the ducts. They cand be sandlie or granular

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35
Q

What are two lesions that are almost always associated with calcifications?

A

DCIS and IDC

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36
Q

What causes PLEOMORPHIC or HETEROGENOUS calcs?

A

DCIS, fibrocystic change, fibroadenoma, papilloma

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37
Q

What causes AMORPHOUS calcs?

A

DCIS, fibrocystic change, sclerosing adenitis

38
Q

What causes LINEAR BRANCHING calcs?

A

DCIS, VASCULAR, secretory

39
Q

What causes LUCENT calcifications

A

fat necrosis, skin cals

40
Q

What does a vascular calcification look like?

A

Tram-track

41
Q

Appearance of fibroadenoma calc?

A

Popcornlike

42
Q

Appearance of fibrocystic change calc?

A

scattered round or amorphous

43
Q

Appearance of oil cyst calc?

A

lucent centereed

44
Q

Appearance of plasma cell mastitis?

A

needle like calcs along orientation of ducts

45
Q

Appearance of vascular calc?

A

tram tracks

46
Q

Appearance of artifactual calcs of deodorant, talc?

A

distribution

47
Q

Appearance of silicone, or foreign body calcs?

A

bizarre…

48
Q

Milk of magnesium calcs?

A

Looks like tea cups on laterals and pearls on CC.

49
Q

What can cause benign skin thickening?

A

Inadequate compression, irradiation or surgery, mastitis, cardiac failure, renal failure, liver or hypoalbuminemia, Mondor’s disease, SVC thrombus

50
Q

What can cause malignant thickening?

A

Locally advanced cancer, recurrent cancer, lymph obstruction, inflammatory breast cancer

51
Q

What can cause a dialted duct?

A

Obstruction: DCIS, papilloma, adenoma, debris, duct ectasia

52
Q

Risk factors for developing breast cancer?

A

Female, family history, previous BC, early menarche and late menopause, nulliparity, BRCA, prior radiation therapy

53
Q

What are the histologic types of breast cancer?

A

Invasive ductal (65), DCIS (15), invasic lobular (10), medullary (3), mucinous (3), tubular (1), phyloides, pagets, inflammatory, papillary.

54
Q

Keys for ductal carcinoma

A

could be palpable or discrete, usually spiculated in mammo

55
Q

Keys for lobular carcinoma

A

Usually spiculated, usually mammographically occult, which is bad!

56
Q

Keys for inflammatory carcinoma

A

Red swollen painful, peau d’orange.

57
Q

Keys for phylloides tumor

A

Usually 70 or older, can be round, circumscribed, and look like fibroadenoma, BUT you have to be very suspicious in an old woman.

58
Q

Keys for Paget’s disease of the breast

A

Thickening of the nipple, can look normal

59
Q

TNM staging

A

0: DCIS (nearly 100% survival)
I: Invasive tumor less than 2cm, no nodes. (96% survival)
II: Invasive tumor less than 5cm, not fixed to chest wall and w/wo local nodes (81% survival)
III: Invasive tumor of any size, fixed to chest wall, with nodes, but NO distant (52% survival)
IV: Distant mets (18% survival)

60
Q

What is the most prognostic factor in patients with primary breast cancer?

A

Axillary nodes

61
Q

Levels of lymph nodes related to what muscle

A

All in relation to pec minor

62
Q

What are the levels?

A

I is lateral, II is over the muscle, III is medial to the muscle

63
Q

Does ER positive status portend favorable or bad outcome?

A

Better outcome

64
Q

What does a Halstead radical remove?

A

All breast tissue, pect major/minor, all lymph nodes

65
Q

What does a modified radical remove?

A

Everything that the Halstead does minus the musclulature.

66
Q

What does the total (simple) remove?

A

Modified minus the nodes

67
Q

What does a subcutaneous mastectomy remove?

A

removal of most of the tissue but preservation of nipple, etc.

68
Q

What is the difference between LCIS and DCIS?

A

LCIS is being debated to whether it is the precursor to ICS. Whereas 35% of DCIS progresses.

69
Q

What is a cause of bloody discharge?

A

Papilloma

70
Q

How could you try to diagnose this?

A

Ductogram

71
Q

What does a radial scar look like radiographically?

A

Usually spiculated, may have black star (central lucency) appearance, whereas malignancy usually looks like a white star.

72
Q

Are radial scars associated with cancers?

A

Yes. Tubular carcinoma. There is often atypia associated so excision is recommended.

73
Q

How does a simple breast cyst develop?

A

Dilation of the TDLU!

74
Q

What gives the appearace of a breast within a breast?

A

Hamartoma

75
Q

What appears well circumscribed and entirely radiolucent?

A

Lipoma

76
Q

What cystic lesion is caused by a sudden cessation of breast feeding?

A

galactocele

77
Q

What is Mondor’s disease?

A

Superficial thrombophlebitis of the veins of the breast.

78
Q

What does fibrocystic change look like?

A

Mammo: increased glandular tissue, microcalcifications that are scattered or milk of calcium.

79
Q

What does fibrcystic change look like on US?

A

macrocysts or microcyst <3 mm.

80
Q

What would an abnormal lymph node look like?

A

dense, not fatty hilum.

81
Q

When is nipple discharge worrysome?

A

Blood or serous.

82
Q

When is nipple discharge not worrysome?

A

Bilateral, brown, green, milky

83
Q

What is a study that’s useful for evaluating discharge?

A

Galactogram (ductogram)

84
Q

What are the two types of rupture?

A

Intracapsular, extracapsular

85
Q

How does a breast react to an implant?

A

Fibrous capsule

86
Q

What is the best method for evaluating breast implant rupture?

A

MRI

87
Q

What is the linguine sign?

A

Lines in an implant may represent collapse of the capsule

88
Q

What are radial folds?

A

NORMAL reduntant retaining capsule

89
Q

What do crenelated margins indicate?

A

capsular contracture

90
Q

What does a focal bulge in implant represent?

A

Possible herniation through a defect in the fibrous capsule

91
Q

Breast density categories

A

Fatty, scattered, heterogenous, dense

Mammography (1 decks)

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