FM Radiology Case - Mammography

Question 1

Glandular tissue and cancerous lesions appear ___ on a mammogram, whereas fat appears ___.

Answer 1

White; black

Question 2

Why is it easier to identify cancer on mammography as patients age?

Answer 2

In young women, with dense glandular breast tissue, it is very difficult to distinguish cancer from normal glandular tissue. As women age, there is a fatty infiltration of the breast, which appears dark on imaging, making it easier to identify cancerous lesions.

Question 3

What is the most specific mammographic feature of malignancy?

Answer 3

Spiculated focal mass

Question 4

There is a high correlation between a ___ density mass lesion and malignancy.

Answer 4

High

Question 5

List some calcification that are NOT suspicious for malignancy.

Answer 5

1. Vascular and skin calcifications
2. Rim-like calcifications
3. Large coarse calcifications
4. Smooth round or oval calcifications

Question 6

Describe two types of calcification that are more predictive of malignancy.

Answer 6

1. Clustered microcalcifications measuring between 0.1 to 1 mm in diameter and numbering more than 4 to 5 per cubic cm are seen in 60% o cancers detected by mammography.
2. Linear branching microcalcifications have a higher predictive value for malignancy than do granular microcalcifications, especially for high grade DCIS.

Question 7

What is the incidence of breast cancer corrected for age?

Answer 7

Under 20 - rare
Under 30 - <2% of total cases
Risk gradually increases after age 40
Incidence of 300 cases per 100,000 in 8th decade

Question 8

After which age does the risk of developing breast cancer steadily increase in women?

Answer 8

After the age of 40

Question 9

What risk factors are associated with an increased chance of developing breast cancer?

Answer 9

1. Gender (less than 1% of incidence occurs in males)
2. Age (>40 y/o)
3. History of cancer in one breast (3-4x increase)
4. Family history (2-3x increase if first degree relatives had breast cancer)
5. Non-invasive carcinoma (DCIS or LCIS)
6. Early menarche
7. Late menopause
8. Nulliparity
9. Late first full-term pregnancy
10. Low dose radiation
11. Japan - surviving women exposed to high doses of radiation from the atomic bomb

Question 10

Estimate the accuracy (sensitivity and specificity) of mammography as a screening test for women aged 50-70 y/o.

Answer 10

Sensitivity - 75-94%

Specificity - 83-98%

Question 11

What decreases sensitivity of screening mammography?

Answer 11

F < 50 y/o
Denser breasts
Taking hormone replacement therapy

Question 12

What increases specificity?

Answer 12

Shorter screening intervals

Availability of prior mammograms

Question 13

What conditions give rise to false positive suspicion for breast cancer?

Answer 13

Several benign conditions can produce a spiculated density, including:

1. Post-biopsy scarring
2. Traumatic fat necrosis
3. Breast abscess
4. Sclerosing adenosis
5. Radial scar

Question 14

What are some potential disadvantages for screening mammography?

Answer 14

1. Low specificity (false-positives)
2. Overdiagnosis of DCIS, leading to unnecessary major procedures
3. Radiation-induced breast cancer

Question 15

___% of abnormal screening mammograms or CBEs are false positives.

Answer 15

80-90%

Question 16

What factors contribute to the annual cost of performing screening mammograms for women as indicated?

Answer 16

1. Number of women over the age of 40
2. Average cost for screening mammogram
3. Annual cost

Question 17

Studies have demonstrated that regular screening mammograms among women aged 50-69 years can reduce mortality from breast cancer by ___%.

Answer 17

30%

Question 18

Screening mammogram reveals a suspicious lesion - no mass is palpable - how do you proceed?

Answer 18

1. Core biopsy with stereotactic or U/S guidance or

2. Needle localization procedure (biopsy)

Question 19

Screening for detection of early breast cancer is not indicated for women below ___ years of age.

Answer 19

40

Question 20

What are some potential disadvantages to screening mammography?

Answer 20

1. Low specificity
2. Concerns for potential overdiagnosis of DCIS, leading to major procedures such as mastectomy or lumpectomy and radiation for lesions that may not require such aggressive intervention
3. Radiation induced breast cancer

Question 21

Cumulative risk of a false-positive result after 10 mammograms is ~___%.

Answer 21

49

Question 22

USPSTF recommendation regarding screening mammography?

Answer 22

Biennial screening for women aged 50-74 (Grade B)

-Women 40-49 - individual decision (Grade C)