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Breast Block > Core Radiology Breast > Flashcards

Core Radiology Breast Flashcards

1
Q

Indications for breast ultrasound

A
  1. Critical adjunct to diagnostic mammography
  2. Further evaluation of symptomatic patent when mammography is negative
  3. Supplemental to mammo in screening
  4. Characterization of palpable mammographic lesions
  5. First line evaluation of breast abnormality in young patient under 30
  6. Pregnant or lactating women
  7. Guidance for interventional procedures
  8. Evaluation of breast implants
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2
Q

Indications of breast MRI

A
  1. Screening high risk patients
  2. Evaluation of extent of disease in patient newly diagnosed with breast cancer
  3. Evaluation of neoadjuvant chemo response
  4. Assessment for residual disease after positive surgical margins
  5. Tumor recurrence after breast conserving treatment
  6. Evaluation for occult breast cancer in patient with axillary metastases
  7. Breast implants; most sensitive, and most definitive in implant integrity
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3
Q

Risk Factors for developing breast cancer

A
  1. Most imp risk factors; Female sex, advanced age
  2. BRCA1 or BRCA2 mutation
  3. First degree relative with breast cancer in young age
  4. Prior chest radiation for lymphoma
  5. Prior biopsy result for high risk lesion; ALH, LCIS, FEA, Radical scar, intraductal papilloma, atypical papilloma
  6. Long term estrogen; early menarche, late menopause, late first pregnancy, nulliparity, obesity.
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4
Q

DCIS typical presentation and mammography findings

A

Typically asymptomatic
Mammo; calcifications

Note: This is variable, this is the MOST common.

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5
Q

Most common subtype of breast cancer and how does it present?
Findings on mammo

A

Invasive ductal carcinoma

Presentation; palpable breast mass
Mammo; irregular mass with spiculated margins and associated calcifications

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6
Q

Which cancer is difficult to diagnose on imaging and clinically and why

A

irregular mass with spiculated margins and associated calcifications

Reason: Spreads without discrete mass

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7
Q

Inflammatory breast cancer
Presentation
Prognosis
DDx

A

Breast cancer with tumor invasion to the dermal lymphatics (aggressive)
Clinically; breast erythema, edema, firmess, peu d’orange
DDx Mastitis

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8
Q

Mammography findings in inflammatory breast cancer

A

Affected breast is larger and denser, trabecular thickening, skin thickening, mass may or may not be present.

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9
Q

What is Paget’s disease of the nipple?
Clinical presentation
How is it diagnosed?

A

 DCIS that infiltrates the epidermis of the nipple
 Clinically; nipple erythema, ulceration, eczematoid changes of the nipple.
 This is diagnosed by skin punch biopsy not by radiologists

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10
Q

What’s the most important prognostic factor in breast cancer?

A

Axillary lymph node status is most important prognostic factor

Increase number of lymph nodes involved equals to worse prognosis

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11
Q

Majority of breast cancer in BRCA1 mutation is

A

Triple negative.

Triple negative may show features of benign lesions although malignant

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12
Q

BIRADs 0

A

Only appropriate for screening.
Patient is brought back for additional views or adjunct/complementary ultraosund

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13
Q

BIRAD 1

A

Normal breasts with no findings

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14
Q

BIRAD 2

A

Benign and no additional follow up is required.
Examples
1. Vascular or other typically benign calcifications
2. Simple breast cysts
3. Intra-mammary lymph nodes
4. Accessory breasts

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15
Q

BIRAD 3
Defintion
Malignancy Potential
Never appropriate for ________
Follow up recommendation

A

Probably benign
<2% chance of malignancy.
Never appropriate for screening mammogram.
FU recommendation: 6m,12m,24m if stable then BIRAD 2.
Any change => biopsy.

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16
Q

BIRAD 4

A

Suspicious, 2-95% change of malignancy
Next step: Biopsy

17
Q

BIRAD 5

A

> 95% of malignancy
Action; biopsy any other pathological result other than cancer would be discordant

18
Q

BIRAD 6

A

Biopsy proven malignancy

19
Q

Role of screening mammogram?

A

To detect preclinical breast cancer in asymmptomatic patients.

20
Q

Why is mammogram recommended at the age of 40?

A

Greatest reduction in breast cancer specific mortality

21
Q

If lesion only seen on
MLO
CC

next step

A

MLO > true lateral
CC > preform roll view

22
Q

Indications for diagnostic mammogram

A
  1. Breast problem
  2. Annual mammography in asymptomatic woman with past history of breast cancer
  3. Short term follow up (BIRAD 3)
  4. Abnormality on screening US
23
Q

If on CC view, the inferior nipple fold or the pectorals cannot be visualized

A

Draw the posterior nipple line and it should be within 1cm to be considered adequate.

24
Q

State the 4 breast density types

A
  1. Almost entirely fatty
  2. Scattered areas of fibro-glandular tissue
  3. Heterogeneously dense; which may obscure small masses
  4. Extremely dense; lowers sensitivity for mammography
25
Q

Benign causes of breast skin thickening

A
  1. Acute mastitis (or inflammation)
  2. Radiation therapy.
  3. Fluid Overload
26
Q

What is a poor indicator of malignancy?

What does it contribute in TNM staging?

A

Size

Gives us the T!

27
Q

Benign calcifications

A
  1. Skin calcifications
  2. Vascular calcifications
  3. Large rod-like calcifications
  4. Coarse/Pop-corn like calcification
  5. Milk of calcium
  6. Suture calcifications
  7. Dystropic
  8. Round and punctate calcifications
  9. Rim calcifications
28
Q

Skin calcifications

A

Usually punctate or lucent-centered, medially where the concentration of sweat glands is higher.

29
Q

Vascular calcifications
When is it mentioned?

A

Extensive or patient very young.

30
Q

Large rod-like secretory calcifications
Caused by
Demographic
Differentiated from DCIS

A

Plasma cell mastitis/ periductal mastitis.
Demo; postmenopausal women

DCIS; dot-dash appearance.

31
Q

Coarse or “popcorn-like” calcifications
Caused by
Zoning

A

Hyalinizing/Involuting fibroadenoma
Zoning; peripheral then central

32
Q

Milk of calcium
CC and MLO view

A

CC view:
indistinct, fuzzy, amorphous deposits.

90-degree lateral semilunar or crescent- shaped in morphology due to dependent layering (tea cup)

33
Q

Suture calcifications are especially deposited after

A

Radiation therapy

34
Q

Dystrophic calcifications causes

A

Surgery, biopsy, trauma, or irradiation.

35
Q

Round and punctate calcification
Punctate defintion
When are they considered benign

A

Smaller than 0.5 mm, the term “punctate” is preferred.

 When diffusely or randomly distributed, round and punctate calcifications are considered benign.

36
Q

Isolated group of punctate calcifications on a baseline mammogram BIRAD

A

BIRAD 3

37
Q

Rim calcifications

A

Fat necrosis or a cyst with calcified walls.

38
Q

Suspicious morphology calcifications (BIRAD 4)

A
  1. Amorphous calcifications
  2. Coarse heterogeneous calcifications
  3. Fine pleomorphic calcifications
  4. Fine linear or fine-linear branching calcifications

Breast Block (3 decks)

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