CORE Breast Flashcards
when to use US
when a felt lump not seen on mammogram
MRi indications include
high risk patients
evaluation of diangosed diseased
chemo response
residual disease
recurrene
occult breast cancer with axillary mets
assessment of breast implants
what is the pathogenesis pathway of breast cancer
Normal
Flat epithelial atypia
atypical ductal hyperplasia
DCIS
IDC
what is upstaging
cancer i supstaged after excision
an increase from the core biospy
what does BRCA1 / BRCA2 mutation cause
increase lifetime risk of breast cancer
80% by 80
other risk factors for breast cancner
age, female
1st degree relative
prior chest radiatin
long term estrogen exposure
most common subtype of breast cancer is
IDC
IDC apperance
felt lump
irregular mass spiculated margins and ax pleomorphic clacifications
what are the other types of breast cancer
Tubular
Mucinous
Medullary
encapsulated papillary / solid papillary
adenoid cystic carcinoma
mucinous carcinom more common
in old women
Medullary carcinoma is found in
younger women with BRCA1 gene mutation
Appearanc3e of an encapuslated papillary carcinoma
discharge.
round oval mass.
circumscrbied margins.
US complex cystic solid mass.
inflammatroy carcinoma will appear as
skin distortion
edema
mammo - large, dense, trabecular thickening.
what is pagets disease of the nipple
DCIS that infiltrates the nipple epidermis
erythema of the nipple
non metastatic disease most important prognostic factor
axillary lymph nodes
when to do lymph node dissection vs sentinal biopsy
dissection is done if sentinel lymph node is positive
or not identified
is Er and Pr a good thing
Yes
longer survival
if have HER2 what can you give
trastuzamab - herceptin
Tk inhibitor like lapatinib
triple negative is
bad
common with BRCA1 mutation
What does BIRADS 0 mean
more imaging required
only used in screening
BIRADS 1
normal
BIRADS 2
definitely benign
vacsular, bening calc
simple breast csts, inflammatory lymph nodes
BIRADS 3
probably benign. Leave no stone untunred to diagnose this
therefore, not used in screening#
circumnscribed solid mass
focal asymmetry
single group punctate calcifications
BRIADS 3 f/ u
6 , 12, 24 months
BIRADS 4
suspicious
biopsy needed
4A-C
BIRADS 5
highly likely cancer
BIRADS 6
known cancer
nipple should be in profile view….
in at least one view
what type of breasts have increased risk of cancer
fibroglandular
asymmetry vs mass
mass is two views
asymmetry is only 1 view
margins lexicon
circumscribed
microlobulated
obscured
indistinct
sapiculated
density lexicon
fat containing
low density
equal density
high density
shape lexicon
round
oval
irregular
inversion vs retration of nipple
inversion may be congenital and not necessarily a sign of malignancy
causes of trabecular thickening
edema
radiation therapy
popcorn calc
hyalinising fibroadenoma
milk of calcium exists in
CYSTS
ROUND CALC ISA
BENIGN
RIM calc is from
calc on a sphere.
egg shell / lucent centred
fat necrosis or a cyst
what to do with amorphous calc?
grouped, reginonal or segmental distribution are needing a biopsy as more concerniing
otherwise its a benig nfeature
coarse heterogenous calc
biopsy as may be malignant
pleomorphic has what apperaance
dot and dashes
pleomorphic often seen in
DCIS or IDC
biopsy needed
fine linear
highly concerning
birads 5.
filling of ducts
differential for architectural distoriton
invasive malignancy
complex sclerosing lesions/radial scar
post-biospy scar
fibrocystic change like sclerosing adneitis.
all palpable masses are given
US
breast fat vs other fat
hypoechoic
lipoma, fat necrosis, lymph node hilum: there are hyperechoic
small calc better seen on MRI or mammo
mammo
breast MRI
which sequences are important
both breast at same time
pre and post contrast with kinetic acquisitions
multicentric cancer results in
mastectomy
MRI can be used for what kind of breast implants
silicone
saline implants are done by examinaton, mamo and US
MRi
bunch of grapes on NME internal enhancement pattern
DCIS
oil cyst vs lipoma
oil cyst has peripheral calc
dark internal septations on MRi are specific for
fibroadenoma
