Cara's Mammo cards Flashcards
When I say “The calcifications don t change configuration on CC and MLO views”
dermal calcifications (“tattoo sign”)
next step for possible skin calcs
tangential views
secretory calcifications: pre or post menopause?
post - don t call them secretory on a premenopausal
if they show you an ML view of calcifications
think of milk of calcium/tea cupping
what happens with skin thickening and trabecular thickening over time?
improves - otherwise it s recurrent disease
When I say “shrinking breast,” you say
ILC
When I say “thick coopers ligaments,” you say
edema
When I say “thick fuzzy coopers ligaments - with normal skin,” you say
blur
When I say “dashes but no dots,” you say
Secretory Calcifications
When I say “cigar shaped calcifications,” you say
Secretory Calcifications
When I say “popcorn calcifications,” you say
degenerated fibroadenoma
When I say “breast within a breast,” you say
hamartoma
When I say “fat-fluid level,” you say
galactocele
When I say “rapid growing fibroadenoma,” you say
Phyllodes
When I say “swollen red breast, not responding to antibiotics,” you say
inflammatory breast ca
When I say “ lines radiating to a single point,” you say
Architectural distortion.
When I say “Architectural distortion + Calcifications,” you say
IDC + DCIS
When I say “Architectural distortion without Calcifications,” you say
ILC/radial scar
When I say “Stepladder Sign,” you say
lntracapsular rupture on US
When I say “Linguine Sign,” you say
lntracapsular rupture on MRI
When I say “Residual Calcs in the Lumpectomy Bed,” you say
local recurrence
When I say “No calcs in the core,” you say
milk of calcium (requires polarized light to be seen)
what s different about mag views
What is the cost of mag view?
no grid, smaller focal spot (0.1 mm), air gap
Cost of mag view is increased radiation.
nipple enhancement on MRI - normal?
yes, normal - don t call it Pagets
which quadrant has most breast cancers?
upper outer (most tissue)
main blood supply to the breast?
(60%) is via the internal mammary
The sternalis muscle can only be seen on which view on Mamms
CC view
Most common location for ectopic breast tissue is in the
axilla
best time in cycle for mammogram (and MRI)
follicular phase (days 7-14)
Breast Tenderness is max around day
27-30.
most comprehensive risk model
Tyrer Cuzick (but does not include density)
level of chest radiation as a child that would prompt screening MRI
20 Gy
Are males more likely to get breast cancer if they have BRCA 1 or 2?
BRCA 2
If triple negative status, more likely to have BRCA 1 or 2?
BRCA 1 is more often a triple negative CA
Mammo: special view to help with kyphosis, pectus excavatum, and to avoid a pacemaker/line
LMO
which mammo calc pattern has highest suspicion for malignancy?
fine pleomorphic (branching)
density of surgical scars related to breast cancer recurrence
Surgical scars should get lighter, if they get denser - think about recurrent cancer.
can you have isolated extracapsular rupture?
nope, always with intra
The number one risk factor for implant rupture is
the age of the implant
affect of Tamoxifen on parenchymal uptake?
Tamoxifen causes a decrease in parenchymal uptake, then a rebound.
Breast MRI: which cancer is T2 bright?
colloid and mucinous cancer
axillary lymph node levels: level 1 - 3
Rotter node
Level 1: lateral to pec minor
2: beneath pec minor
3: medial to pec minor
Rotter node: between pec major and minor
most cancers start in the
TDLU
should you biopsy a prepubescent breast?
no, it can affect breast development
peak age for breast pain/cyst formation
perimenopause - 50s
name the 5 high risk lesions
ADH, ALD, LCIS, Radial Scar, Papilloma
- BRCA 1 chromosome
- BRCA 2 chromosome
- Triple negative cancers more often have which BRCA?
- Males w/ breast cancer more often have which BRCA?
- 17
- 13
- Triple negative: BRCA 1
- Males: BRCA 2
4 non-BRCA syndromes associated with breast ca
Li Fraumeni, Cowden, Bannayan-Riley Ruvalcaba, NF-1
oldest and most validated breast cancer risk model
Gail - doesn t use genetics
things that increase your estrogen exposure, do what to your breast ca risk?
increase it (Early Menstruation, Late Menopause, late age of first pregnancy I or no kids, being fat, Being a Drunk, hormone Replacement (with estrogen))
all current risk models under or overestimate risk?
underestimate life-time risk
when do you start screening kids who get 20 Gy of chest radiation
age 25 or 8 years after exposure (whichever is longer)
what drugs reduce breast cancer incidence of ER/PR
Tamoxifen and Raloxifenc (SERMs)
BIRADS: multiple bilateral well circumscribed similar appearing masses
2 - don t even ultrasound, unless one is palpable
BIRADS: multiple foci on MRI
2 (I guess you can think of it as Background parenchymal enhancement..)
3 artifacts that cause calcifications on mammo
deodorant, zinc oxide, metallic fragements
treatment for Mondor disease?
thrombosed vein - no anticoagulation, just NSAIDS
most common invasive breast cancer
IDC - 80-85%
most common subtype of IDC
NOS - 65%
IDC subtypes (besides NOS, 4)
tubular, mucinous, medullary, papillary
- IDC subtype associated with radial scar or spiculated mass
- 2 IDC subtypes that present as round/oval masses
- IDC subtype associated with complex cystic and solid mass
- Tubular
- mucinous and medullary
- Papillary
multifocal vs. multicentric breast cancer
multifocal = multiple primaries, same quadrant; multicentric = multiple primaries different quadrants
which type of DCIS histology is more aggressive?
comedo type
when I say “shadowing without a mass on ultrasound”, you say
ILC
Breast Pagets is associated with
high grade DCIS
3 patterns of gynecomastia
nodular, dendritic, diffuse glandular
should trans guys who get boobs from hormone therapy be screened?
no, not high enough risk
Breast MRI: how to tell apart normal radial folds vs. linguine sign?
radial folds - all lines connect to periphery of implant
timing of breast MRI kinetics
initial upslope occurs over 2 min, then washout 2-6 min-ish
grading breast MRI kinetics washout
continued rise (type 1), plateau (type 2), rapid washout (type 3)
mammo recall rate should be less than
10% (target range of 5-7%)
Mammo: required resolution of line pairs is
13 lp/mm in anode-cathode direction and 11 lp/mm in left-right direction
describe the mammo dose phantom
50% glandularity, 4.2 cm thick
Mammo typical patient doses
2 mGy per view - but no limits! that s just for the phantom
dose limit for mammo phantom
3 mGy/view
typical patient breast compression and glandularity
6 cm, 15-20% glandularity
Mammo: target range for cancers/1000 screened
3-8 people with cancer
Mammo: target range for PPV for biopsy recs
15-35%
Cowden Syndrome
breast cancer, bowel hamartoma, follicular thyroid, Lhermitte Duclos (brain hamartoma)
