Early Breast CA

Question 1

Ddx of early breast cancer

Answer 1

Fibroadenoma breast
Antibioma
Chronic abscess
Tuberculosis of breast 
Traumatic fat necrosis 
Fibroadenosis of breast with nodularity

Question 2

Investigation to confirm diagnosis of Early breast cancer

Answer 2

Breast imaging with mammography

Core needle biopsy

Question 3

How does mammography help in diagnosis of carcinoma breast

Answer 3

Essential in evaluation of breast lump as a part of triple assessment, as imaging with mammography in patients older than 40 years.

Shows characteristic lesion suggestive of malignancy

Can detect multicentric breast cancer which will preclude breast conservation surgery

May detect an impalpable lesion in opposite breast

Digital mammography is superior to traditional film mammography

Question 4

Characteristics of malignant lesion in mammography

Answer 4

Architectural distortion of breast tissue
Duct dilatation
Dense Stellate soft tissue mass with irregular margin and spiky projection
Microcalcification
Stippled calcification is characteristic
Increased thickness of skin due to lymphedema
Nipple retraction may be seen

Question 5

Which views are essential for mammography

Answer 5

Craniocaudal view and mediolateral views

Question 6

How reliable is mammography for evaluation of breast malignancy

Answer 6

Sensitivity is 90%
False positive -10%
False negative - 6-8%

Question 7

What is BIRADS category for breast imaging reporting?

Answer 7

BIRADS CATEGORY AND DEFINITION
BIRADS 0- incomplete assessment -needs additional imaging
BIRADS 1- Negative - nothing to comment
BIRADS 2- Benign finding
BIRADS 3- Probably benign finding - follow up study required
BIRADS 4- Suspicious for malignancy - consider biopsy
BIRADS 5- Highly suggestive of malignancy
BIRADS 6 - Biopsy proven malignancy

Question 8

BIRADS full form

Answer 8

Breast Imaging Reporting And Data System

Question 9

What is digital mammography ?

Answer 9

Images are obtained in computer which are then magnified so that computer aided diagnosis is obtained.

Question 10

What are the currently recommended screening methods ?

Answer 10

Clinical breast examination’
Mammography screening
Breast self-examination

Question 11

Imaging of choice for recurrence in breast

Answer 11

Magnetic resonance imaging

Question 12

Advantages of MRI

Answer 12

Can differentiate scar from recurrence
Imaging of choice in breasts with implants
Abnormal enhancement is seen after radiotherapy, therefore it is not used within 9 months of radiotherapy.

Question 13

How much percentage of breast cancers can be missed on mammography ?

Answer 13

About 5% of breast cancers can be missed on mammography.

Question 14

What is the frequency of screening mammography?

Answer 14

Optimum frequency is 2 yearly.

Annual screening is certainly too frequent.

Question 15

What are the disadvantages of mammography?

Answer 15

Painful
Expensive
Requires  high technology equipments
Requires special film and processing
Requires highly trained radiologists

Question 16

What are the mammography findings in a benign lesion?

Answer 16

Well circumscribed mass
Relatively low density 
No architectural distortion
Asymmetric density maybe present
Scattered and rounded calcification

Question 17

Indications of mammography

Answer 17

Screening women above 45 years of age
Screening asymptomatic women above 35 years who have high risk of cancer
Women with previously diagnosed atypical ductal hyperplasia
To differentiate benign and malignant lesion
To identify multicentricity when carcinoma is diagnosed
For assessment of size before chemotherapy, so that response of the lesion can be assessed.
For assessment of contralateral breast
Surveillance of breast following breast conservation therapy
Evaluation of breast following augmentation mammoplasty
Investigation of suspicious breast lump in males