From CtC Flashcards
Malignant a/w breast asymmetry
‘shrinking breast’ of invasive lobular breast cancer
Titty node levels
1
2
3
R
Relationship to pec minor
1 lateral
2 under
3 above and medial
R between major and minor
period phases
7-14 Follicular/proliferative - Estrogen
15-30 Secretory/luteal - Progesterone
Perimenopausal period hormone change
shorter follicular/proliferative phase
More progesterone
more pain, more fibrocystic change, cyst formation
Menopause changes
lobules go down
fibroadenomas degenerate — > popcorn
Secretory calcs develop —> Cigars
where do most cancers start
TDLU
when boobs most tender?
days 27-30
when to mammo or MRI
proliferative/follicular
7-14
Increased density non-preggo
Prolactinoma
anticrazy meds
When to LMO
kyphosis or pectus or medial wire/line
spot compression collimator change?
Leave collimator open on spot compression
Direction of mag views?
CC and ML
ML or LM on call back if only seen on CC?
ML if lateral
LM if medial
detector closer to lesion
ML if only seen on MLO (70% of cancers lateral)
Blur source
motion or inadequate compression
MLO misses?
CC misses?
MLO misses most medial
CC misses posterior-inferior
how to localize a CC only finding?
Rolled view
CC with boob twisted medial or lateral
BR 3 list
fibroadenoma
focal asymm that looks like breast tissue
Grouped or clustered round calcs
What does BR4 mean about biopsy results
that you would accept a negative
5 means if you call it benign I’m calling surgeon
BIRADS TERMINOLOGY
Shape
ROI
Round
Oval
Irregular
BIRADS TERMINOLOGY
Margin
COMIS
Circ
Obscured
Microlobulated
Indistinct
Spiculated
BIRADS TERMINOLOGY
Density
relative to parenchyma
Fat
Hypodense
Isodense
Hyperdense
Most reliable descriptor for malignancy
MARGIN
BIRADS TERMINOLOGY
US
Margin
US = CAMIS mammO = COMIS
US
Circumscribed
Indistinct
Angular
Microlobulated
Spiculated
MRI
Background Parenchymal Enhancement
which sequence
FIRST post contrast sequence
none, minimal, mild, moderate, marked
MRI lexicon
Shape
ROI
Margin
CIS
Internal enhancement pattern
Homo, hetero, rim, dark internal septations
NO ENHNANCING INTERNAL SEPT’s or CENTRAL Enhancement
NMLE buzzword for DCIS or IDC
“clustered ring”
Demo for secretory calcs
ONLY POSTMENOPAUSAL
involuted ducts
milk of calcium (teacup) are 2/2?
fibrocystic change
trivia = needs to be viewed with polarized light after biopsy
Round calcs thought process
Round calcs are like masses
bilateral, scattered, symmetric ok (fibrocystic change)
clustered, singular or new = workup
Grouped round calcs = BR3 (on first mammo)
Suspicious calcs
3 types
amorphous - can’t count
MC = fibrocystic change DCIS= low grade
Coarse Hetero
bigger than 0.5 mm, no ouch
Low-intermed DCIS or masses (FA or papilloma)
Fine Pleomorphic
ouch, <0.5mm, DCIS high grade
Boob DVT
Mondor disease
looks like you’d expect
don’t anticoagulate
lipoma look
radiolucent with no calcs
enlarging = indication for bx
PASH
look
f/u
Pssshhh they b9
big, solid, oval, well defined
IDC subtype trivia
tubular
Radial scar
10-15% contra involvement
small, spiculated, favorable prog
IDC subtype trivia
Medullary
round, circumscribed, no calcs
a/w big nodes even when not mets
young, good outcome
IDC subtype trivia
Papillary
Old, black, complex (pappy)
complex cystic and solid
elderly, non whites
2nd MC besides IDC-NOS
ILC look
arch distort
US - shadowing with no mass
dark star ddx
(arch distortion with central lucency)
lobular
radial scar (tubular)
IDC - NOS
surgical scar
ILC vs IDC
ILC more often multifocal
fewer axilla mets
more mets to weird places
positive margins more often –> mastectomy
Pagets of boob
Carcinoma in situ of nipple epidermis
a/w high grade DCIS
not T4
most suspicious nipple discharge combo
spontaneous
bloody (serous also suspicious)
single duct
galactography contraindx
mastitis, inability to express DC, allergy, prior surgery to nipple complex
AD with no US/MRI correlate?
gets a bx
male breast cancer and brca
1/4 have it
MC brca 2
recurrence rate and period
6-8%
usually around 4 years
benign calcs occur early, within 2 years, bad calcs around 4 years
skin/trabecular thickening post RT
worst on 1st mammo
Skin thickening late with red plaques post RT
Secondary angiosarcoma
T staging
T1 = <2cm
T2 = 2-5 cm
T3 = >5cm
T4 = chest wall, skin, or inflammatory
biggest predictor of overall survival?
axillary nodal involvment
contraindx’s to breast conservation therapy
inflammatory
large tumor
multi-centric (multiple quadrants)
prior RT to that titty
who gets MRI screener
lifetime risk >20% (don’t use Gail to calculate, Tyrer Cuzick is the best)
20 Gy to chest as a kid
tamoxifen and BPE
will decrease while on it, then cause rebound
BIRADS 3 focus on MRI
solitary with persistent kinetics
bad enhacement
heterogenous or rim
kinetics timing
upslope = first 2 minutes
washout = 2-6 minutes
MRI classic looks
Fibroadenoma
T2 bright (usually means b9 anytime)
non-enhancing septa
type 1 kinetics
MRI classic looks
DCIS
clumped, ductal, linear or segmental NMLE
kinetics don’t matter
DCIS = NMLE
MRI classic looks
IDC
spiculated, irregular
hetero enhancement
type 3 curve
MRI classic looks
ILC
doesnt always enhance
T2 bright but bad
colloid cancer
mucinous cancer
timing for MRI screening post RT to chest
20Gy = threshold
age 25 or 8 years post tx (whichever later)
risk peaks 15 years post RT
Cowden
breast
follicular thyroid
endometrial
lhermitte duclos
BRCA 1 vs 2
1 more common in women
1 = chrom 17 2 = chrom 13
Men bad one = brca 2
male with indeterminate palpable
< 25 US
>25 mammo then US if suspicious
woman >40 with mammo that look like a lipoma, palpable?
no more imaging
woman < 30 US looks b9 or negative?
NO mammo
woman < 30 US BR3 (FA)
q6 month US f/u
US needle used for masses
of passes
14 G spring loaded
5 passes
when is FNA ok
known breast cancer with a node you’re pretty sure is a met
indx for cyst aspiration
anxiety, pain, uncertain dx
NOT SIZE
