From Q book Flashcards
Screening recs
American cancer society
Annual 45 to 54
option for annual 40-44
biennial at 55 with option to continue annual
(MOST COMPLICATED)
Screening recs
ACR and SBI
annual starting at 40
(most simple)
Screening recs
US Preventative Services Task Force
Biennial aged 50-74
(option to start earlier)
MOST lenient
Factors that make a woman high risk?
>20% lifetime risk
BRCA carrier
first degree BRCA, themselves untested
Radiated between 10 and 30
other mutations like Li-Fraumeni
When to start screening w/ h/o RT
8 years after RT
earliest age 25
Differential for a malignant fat containing breast lesion
Liposarc
phyllodes
IDC
ILC
(belieft is that tumors can engulf fat as they grow)
Additional study indicated in new Dx of inflammatory cancer?
PET/CT
bone mets mc
Breast MRI and preggos
breast feeding
Gad not safe to fetus so NO
OK during breast feeding
Preg associated breast cancer
how common?
MC type?
10% of all new dx in patients <40
MC HISTOLOGY IS high grade, E and P receptor NEGATIVE IDC
Prior RT and breast MRI
Cycle and BPE
DECREASES backgrough parenchymal enhancement
Ideal time with LEAST BPE is during FOLLICULAR phase (days 7-15)
First postcontrast phase acquired when?
First 2 minutes
American cancer society MRI screening rec?
For those with >20% lifetime risk
Required for birads 2 dx of bilateral benign appearing masses
3 masses, at least one in each breast
f/u for man boobs
none
looks like man boob on screener, next step?
diganostic bilat mammo
Patterns of gynecomast
nodular <1 year, reversible
Dendritic >1 year irrev chronic pattern
Diffuse 2/2 exogenous estrogen
Mass (or asymm, focal asymm, arch distort) on screener next step
Calcs?
Dx mammo with spot compression and US
Calcs get mag and US
Terminology shit
Mammo circumscribed margin % ?
other mammo margin descriptors ?
Density mammo terms?
Mammo circumscribed margin 75% sharply defined
(obscured more than 25% not defined)
Other mammo margins- circumscribed, obscured, microlobulated, indistinct, spiculated
Density mammo terms = fat-density, low-density, equal-density, high-density
Shape mammo terms = oval, round, irregular
Breast US terms
US margin terms = circumscribed or not circumsribed
circumscribed = 100% well defined (vs mammo only 75%)
US margin not circumsribed can be further described as
microlobulated, angular, indistinct and spiculated
US breast mass echogenicity described relative to?
Mass echogenicity described relative to FAT, not fibroglandular tissue
Ddx for malignant spiculated?
Invasive ductal
Invasive lobular
tubular
Ddx for benign spiculated ?
Postsurgical scar
fat necrosis
radial scar
sclerosing adenosis
fibromatosis
granular cell tumor
Ddx for malignant round mass
high grade invasive ductal
mucinous carcinoma
medullary carcinoma
mets
Papillary
Phantom pass
four fibers
three masses
three speck groups
Dense breasts target/filter
Rh/Rh
“thick” still mo/mo or mo/rh
birads 4 or 5 ‘attempts to communicate with healthcare provider’ within
3 business days
ACR parameter for ambient light?
approximately equal to average luminance of image
25-40 lux range
radial scar vs complex sclerosing lesion
same histo
differ by size. radial scar <1cm
both central stroma with glands radiating from central stellate lesion
MAMMO famous paper BULLSHIT
ACRIN 6666
documentation of a negative screening breast US exam requirements
one image in each quadrant plus subareolar
5 images per tit
Mammo famous trial BULLSHIT
Digital mammography imaging screening trial
DMIST
compared film screen mammo to?
full field DIGITAL mammo
Mammo famous trial BULLSHIT
DMIST showed full field digital had greater dx accuracy in which subgroups
<50 yo
heterogenous or dense tits
pre or perimenopausal
Mammo famous trial BULLSHIT
First breast cancer screening trial in USA
Health Insurance Plan Randomized Control Trial
25% less mortality in intervention group
Mammo famous trial BULLSHIT
Swedish 2 county trial
? prevented br ca deaths per 1000 women screened every 2 years
8 - 11 prevented br ca deaths per 1000 women screened every 2 years
TIT TRIAL BULLSHIT
Canadian National Breast Screening Study CNBSS
25 year survival was ? in women with br ca detected via mammo and PE vs PE alone
25 year survival was HIGHER in women with br ca detected via mammo and PE vs PE alone
TIT TRIAL BULLSHIT
CNBSS
cumulative mortality over 25 years ? in women dx with br ca over screening period via mammo and PE vs PE alone
cumulative mortality over 25 years SIMILAR in women dx with br ca over screening period via mammo and PE vs PE alone
TIT TRIAL BULLSHIT
Simulation modeling for radiation induced br ca show that annual screening of 100k women projected to induce ? cancers leading to 16 deaths, relative to ? breast cancer deaths prevented by screening
Simulation modeling for radiation induced br ca show that annual screening of 100k women projected to induce 125 cancers leading to 16 deaths, relative to 970 breast cancer deaths prevented by screening
Triple neg br ca mutation
MC in BRCA 1
post lumpectomy mammo recs
q 6 months x 2-3 years
MC mets to breast
other breast (wah)
melanoma, lymphoma
Breast US transducer
LINEAR
center frequency of at least 10 MHz
Differential for T2 bright breast mass
Cyst
fibroadenoma - non enhancing septations
Lymph node - T2 dark fatty hilum central
Necrotic bad or mucinous cancers
DDX for rim enhancement on MRI
Inflamed cyst
Fat necrosis
MUCINOUS cancer
post op seroma
Non mass enhancement
Linear- suspicious - in a duct
Focal - Less than one quadrant single duct system
Segmental - conical - suspicious
Regional - more than one quadrant - more than one ductal system
Archtectural distortion
MC appearance?
US look?
Can be a/w adjacent finding?
distorted parenchyma with lines radiating from lucent center
US - mass, distorted tissue or abnormal Coopers
can have adjacent skin or nipple retraction
Architectural distortion
Benign causes?
a/w malignancy?
what to do if no US correlate?
Benign causes - post-surgical scarring, radial scar, complex sclerosing lesion…. post bx change, fat necrosis, sclerosing adenosis, focal fibrosis
Third MC presentation of Breast cancer
IDC, ILC, Tubular
(medullary and mets are round)
NO US correlate –> stereotactic bx
Workup of nipple DC < or > 30 yo
galactogram contraindx
filling defect =
<30 US
>30 dx mammo and US
contraindx = infection or allergy
0.3 ml
filling defect = air bubble or intraductal lesion
air bubble will move on orthogonal view
Suspicious nipple DC =
bloody, serous or clear
spontaneous = suspicious
uniductal = suspicious
Benign
white, green, yellow
non-spontaneous
bilateral
MC benign and malignant causes of nipple DC
Pagets?
MC benign = INTRADUCTAL PAPILLOMA
MC Malignant = DCIS
Pagest can present with nipple DC, nipple eczema, subareolar mass
Demo, pres prognosis of Papillary carcinoma
complex cystic and solid mass
OVER 60 YO
good prognosis
PAPILLARY = OLD, COMPLEX, CYSTIC
when is a focal assymetry considered benign (how long)
2 years
A focal asymmetry screen detected with no suspicious features on diagnostic w/u = birads 3
When to use rolled view?
asymmetryseen only on CC
opposite of roll = inferior
Solid, wide, circumscribed mass seen on US in 28 year old with palpable
Probably is?
birads?
f/u?
Probably a fibroadenoma
BIRADS 3
f.u 6, 12, 24 months
solitary complicated cyst birads?
complex solid and cystic mass birads?
simple microcysts?
solitary complicated = birads 3
complex solid and cystic mass = birads 4
simple microcysts are benign
simple microcysts too small to characterize or real deep on US = birads 3
BIRADS 3 f/u q’s
mass resolves?
markedly decreases in size?
size increase that warrants bx?
2 years of stability?
Resolves = birads 1
Markedly decreases in size = birads 2
20% increase in 6 months = birads 4 bx
rapidly growing think phyllodes
2 years of stability = birads 2
