Imaging in Breast Disease Flashcards
types of breast imaging
mammography USS image guided techniques MRI nuclear medicine screening
traditional mammography views
oblique
craniocaudal
additional mamography views
coned view
magnification view
true lateral
extended CC
mammography may be performed in the under 40 if:
strong suspicion of cancer
FHx is > 40%
radiation dose in mamorgraphy
1mSV
signs of breast disease on mammography?
dominant mass
asymmetry
architectural distortion
calcifications
soft tissue mass mammography findings: malignant
irregular, illdefined
spiculated
dense
distortion of architecture
soft tissue mass mammography findings: benign
smooth or lobulated
normal density
halo
breast USS can be used to differentiate
solid from cystic mass
solid benign from malignant
breast USS is first line in what age?
<40
breast USS findings: solid benign
smooth outline
oval shape
acoustic enhancement
breast USS findings: malignant
irregular outline
interrupting breast architecture
acoustic shadowing and anterior halo
triple assessment in breast Ca
clinical exam
imaging
FNA cytology
MRI of the breast: indications
recurrent disease
implants
indeterminate lesion following triple assessment
screening high risk women
sentinel node sampling in breast ca
- Peritumoral injection of 99m Tc sulphur colloid ± isosulphan blue dye
- Lymphoscintigraphy
- Intraoperative Gamma probe
- Single Lymph node removal
- 97% accurate in identifying sentinel node
breast screening programme
►Women 50-70 invited every 3 years for mammography
►Mammograms detect 5 cancers/1000 screened
►Uptake is 80%
►Recall for further investigations is 5-10%
►Static centres in urban areas, mobile vans for rural areas
►Assessments in static centre with breast team-radiologist, radiographer, breast clinician, nurse, cytologist and surgeon
►Additional views, clinical exam, ultrasound, FNAC or core biopsy
►Aim to detect cancers at DCIS stage or less than 15mm in size ie impalpable
what is cytology?
microscopic examination of a thin layer of cells on a slide
name 3 ways of obtaining cells for cytology
Fine needle aspiration
direct smear from nipple discharge
scrape of nipple with scalpel
role of cytology in symptomatic clinical breast ca
Patient presents with symptoms and undergoes “triple assessment” by surgeon, radiologist and cytopathologist
breast benign cytology
- low/ moderate cellularity
- cohesive groups of cells
- flat sheets of cells
- bipolar nuclei in background
- cells of uniform size
- uniform chromatin pattern
breast malignant cytology
- high cellularity
- loss of cohesion
- crowding/overlapping of cells
- nuclear pleomorphism
- hyperchromasia
- absence of bipolar nuclei
malignant breast cytology usually gives a non-specific diagnosis i.e. adenocardinoma. occassionaly features may suggest:
lobular carcinoma
cytoplasmic vacuoles
tubular carcinoma
cells arranged in tubes
fluid from breast cysts is discarded, unless:
blood stained
residual mass
advantages of breast cytology
- Simple procedure - can be done at clinic
- Well tolerated by patients
- Inexpensive
- Immediate results
limitations of breast cytology
• False Negatives • False Positives • Invasion cannot be assessed • Grading cannot be done • Sampling (lesion missed) – small lesions – small tumour in larger area of thickening • Technical (difficult to examine cells) – suboptimal smears (blood, thick, cells smeared) • Interpretation (features similar)
complications of FNA
- Pain
- Haematoma
- Fainting
- Infection, Pneumothorax –rare
nipple discharge: duct ectasia
macrophages
nipple discharge: intraduct papilloma
benign cells in papillary groups
nipple discharge: intraduct carcinoma
malignant cells
nipple scrape can differentiate between two conditions. name and how can you determine?
– Paget’s Disease (squamous cells and malignant cells ) v
– Eczema (squamous cells from epidermis only)
when would you carry out a core biopsy on a breast?
- All cases with clinical OR radiological OR cytological suspicion
- Breast screening – especially architectural distortion and microcalcification
- Pre-operative classification
- Rarely open biopsy
