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Year 3 > Imaging in Breast Disease > Flashcards

Imaging in Breast Disease Flashcards

1
Q

types of breast imaging

A 
mammography
USS
image guided techniques
MRI
nuclear medicine
screening
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2
Q

traditional mammography views

A

oblique

craniocaudal

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3
Q

additional mamography views

A

coned view
magnification view
true lateral
extended CC

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4
Q

mammography may be performed in the under 40 if:

A

strong suspicion of cancer

FHx is > 40%

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5
Q

radiation dose in mamorgraphy

A

1mSV

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6
Q

signs of breast disease on mammography?

A

dominant mass
asymmetry
architectural distortion
calcifications

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7
Q

soft tissue mass mammography findings: malignant

A

irregular, illdefined
spiculated
dense
distortion of architecture

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8
Q

soft tissue mass mammography findings: benign

A

smooth or lobulated
normal density
halo

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9
Q

breast USS can be used to differentiate

A

solid from cystic mass

solid benign from malignant

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10
Q

breast USS is first line in what age?

A

<40

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11
Q

breast USS findings: solid benign

A

smooth outline
oval shape
acoustic enhancement

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12
Q

breast USS findings: malignant

A

irregular outline
interrupting breast architecture
acoustic shadowing and anterior halo

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13
Q

triple assessment in breast Ca

A

clinical exam
imaging
FNA cytology

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14
Q

MRI of the breast: indications

A

recurrent disease
implants
indeterminate lesion following triple assessment
screening high risk women

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15
Q

sentinel node sampling in breast ca

A
  • Peritumoral injection of 99m Tc sulphur colloid ± isosulphan blue dye
  • Lymphoscintigraphy
  • Intraoperative Gamma probe
  • Single Lymph node removal
  • 97% accurate in identifying sentinel node
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16
Q

breast screening programme

A

►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

17
Q

what is cytology?

A

microscopic examination of a thin layer of cells on a slide

18
Q

name 3 ways of obtaining cells for cytology

A

Fine needle aspiration
direct smear from nipple discharge
scrape of nipple with scalpel

19
Q

role of cytology in symptomatic clinical breast ca

A

Patient presents with symptoms and undergoes “triple assessment” by surgeon, radiologist and cytopathologist

20
Q

breast benign cytology

A
  • low/ moderate cellularity
  • cohesive groups of cells
  • flat sheets of cells
  • bipolar nuclei in background
  • cells of uniform size
  • uniform chromatin pattern
21
Q

breast malignant cytology

A
  • high cellularity
  • loss of cohesion
  • crowding/overlapping of cells
  • nuclear pleomorphism
  • hyperchromasia
  • absence of bipolar nuclei
22
Q

malignant breast cytology usually gives a non-specific diagnosis i.e. adenocardinoma. occassionaly features may suggest:

A

lobular carcinoma
cytoplasmic vacuoles
tubular carcinoma
cells arranged in tubes

23
Q

fluid from breast cysts is discarded, unless:

A

blood stained

residual mass

24
Q

advantages of breast cytology

A
  • Simple procedure - can be done at clinic
  • Well tolerated by patients
  • Inexpensive
  • Immediate results
25
Q

limitations of breast cytology

A 
• 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)
26
Q

complications of FNA

A
  • Pain
  • Haematoma
  • Fainting
  • Infection, Pneumothorax –rare
27
Q

nipple discharge: duct ectasia

A

macrophages

28
Q

nipple discharge: intraduct papilloma

A

benign cells in papillary groups

29
Q

nipple discharge: intraduct carcinoma

A

malignant cells

30
Q

nipple scrape can differentiate between two conditions. name and how can you determine?

A

– Paget’s Disease (squamous cells and malignant cells ) v

– Eczema (squamous cells from epidermis only)

31
Q

when would you carry out a core biopsy on a breast?

A
  • All cases with clinical OR radiological OR cytological suspicion
  • Breast screening – especially architectural distortion and microcalcification
  • Pre-operative classification
  • Rarely open biopsy

Year 3 (164 decks)

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