Imaging

Question 1

Disadvatage of mammography

Answer 1

Young women with dense breast

Question 2

BIRADS assessment and recommendation

Answer 2

• 0 – Incomplete
• 1 – Negative
  
  • Continue routine screenings
• 2 – Normal
  
  • Continue routine screening
• 3 – Probably bening (≈2% chance of cancer)
  
  • Follow-up with a repeat mammogram in six months
• 4 – Suspicious (≈20 - 35% percent chance of breast cancer)
  
  • Biopsy, preferable needle
• 5 – Highy suspicious (≈95% percent chance of breast cancer)
• 6 – Pathologist has confirmed the diagnosis

Question 3

Mammographic feature suggestive of a diagnosis of breast cancer

Answer 3

• Solid mass ± stellate features
• Asymmetric thickening of tissues
• Clustered microcalcifications

Question 4

Primary indication is nipple discharge particularly when the fluid contains blood

Question 5

Seen as small filling defects surrounded by contrast media in ductography

Answer 5

Intraductal papilloma

Question 6

Screening recommendation in women with BRCA mutation

Answer 6

MRI

Question 7

A 35-year-old premenopausal woman whose mother had breast cancer comes into your office and has been told that she has fibrocystic breasts. On examination she has multiple areas of thickening but no discrete mass. Of the following diagnostic tests, which should be performed?

1. Re-examination in 6 months
2. Bilateral breast ultrasound
3. Thermography
4. Bilateral breast magnetic resonance imaging (MRI) with gadolinium
5. Spot compression views if an area of discrete asymmetry or concerning calcifications is seen

Answer 7

Answer: 5

• Spot compression views if an area of discrete asymmetry or concerning calcifications is seen

Rationale:

• Patients who present with fibrocystic mastopathy at this age should undergo routine screening mammography, either regular film or digital, and ultrasound if no obvious benign etiology is seen on mammography
• Spot compression mammography is done for any questionable abnormality
• Routine use of screening MRI is not indicated at this time

Question 8

During a routine screening mammography, a 62-year-old teacher is informed that she has changes on her mammography, and she should consult her physician. She can be reassured that the findings that indicate a benign condition are which of the following?

1. Discrete, stellate mass
2. Fine, clustered calcifictions
3. Coarse calcifications
4. Solid, clearly defined mass with irregular edges
5. Discrete, nonpalpable mass that has enlarged when compared with a mass shown on a mammogram taken 1 year previously

Answer 8

Answer: 3

• Coarse calcifications
• Rationale:*
• Coarse calicifications are usually benign
• Fine, clustered califications are often milignant and require biopsy
• Solid tumors of the breast, especially those that have increased in size or have changed in appearance, are suspicious for carcinoma and require biopsy