Imaging in Breast Disease

Question 1

What are the different types of Mammography?

Answer 1

Standard
Tomosynthesis
CEMG

Question 2

What are the standard views in mammography?

Answer 2

Mediolateral oblique

Craniocaudal

Question 3

What are some additional views used in mammography?

Answer 3

Coned view
Magnification
true lateral
Extended craniocaudal
Eclund

Question 4

When is mammography performed?

Answer 4

Over the age 40yrs

Under the age of 40 if strong suspicion of cancer or there is family hx risk of > 40%.

Question 5

How can cancer be seen on a Mammography?

Answer 5

Mass
Asymmetry
Architectural distortion
Calcifications
Skin changes

Question 6

What is the appearance of a malignant soft tissue mass?

Answer 6

Irregular
Illdefined 
Spiculated (spikes/points of surface)
Dense
Distorted architecture

Question 7

What is the appearance of a benign soft tissue mass?

Answer 7

Smooth
Lobulated
Normal density
Halo

Question 8

Why is ultrasound used to examine breast tissue?

Answer 8

• Used differentiate between solid and cystic and benign and malignant.
• First line imaging in <40yrs
• No radiation
• Improves specificity of imaging.

Question 9

How do solid benign masses appear on ultrasound?

Answer 9

smooth outline
oval shape
acoustic enhancement
orientation

Question 10

How do malignant masses appear on ultrasound?

Answer 10

Irregular outline
interrupting breast architecture.
acoustic shadowing
anterior halo

Question 11

What is meant by triple assessment?

Answer 11

Clinical examination
Imaging
FNA cytology

Question 12

What are some types of image guided needle biopsy?

Answer 12

Sterotactic - upright or prone table.
Ultrasound - guided or freehand.
FNA & Core biopsy

Question 13

What are the indications to MRI breast tissue?

Answer 13

Recurrent disease
Implants
Indeterminate lesion following triple assessment
Screening high risk women.

Question 14

What are some advantages and disadvantages of MRI breast tissue?

Answer 14

Sensitivity 94-98% for all breast density.
Great problem solving tool.

Specificity is poor
Expensive
Claustrophobic, noisy, lengthy, IV contrast.

Question 15

What is involved in sentinel node sampling?

Answer 15

Peritumoral injection of 99m Tc sulphur colloid +/- is-sulphanilamide blue dye.
Lymphoscintigraphy.
Intraoperative gamma probe.
Single lymph node removal.
97% accurate in identifying sentinel node.

Question 16

What is the breast screening programme?

Answer 16

Women ages 50-70yrs invited every 3 years for mammography.
Mammograms detect 5 cancers per 1000 screened.
Uptake is 84%
Recall for further investigations is 5-10%.

Question 17

What is cytology?

Answer 17

Microscopic examination of a thin layer of cells on a slide obtained by fine needle aspiration or direct smear.

Question 18

What are some features of benign cytology?

Answer 18

Low/moderate cellularity
Cohesive groups of cells
Flat sheets of cells
Bipolar nuclei in background
Cells of uniform size
Uniform chromatin pattern

Question 19

What are some features of malignant cytology?

Answer 19

High cellularity
Loss of cohesion
Crowding/overlapping of cells
Nuclear pleomorphism
Hyperchromasia
Absence of bipolar nuclei.

Question 20

What is the cytology scoring system?

Answer 20

C1 = unsatisfactory
C2= benign
C3= atypic (probs benign)
C4= suspicious (probs malignant)
C5 = malignant

Question 21

What are some complications of FNA?

Answer 21

Pain
Haematoma
Fainting
Infection
Pneumothorax

Question 22

What are some examples of nipple lesions?

Answer 22

Duct ectasia (macrophages only)
Intra-duct papilloma (benign cells in papillary groups)
Intra-duct carcinoma (malignant cells)

Question 23

What cells are present on a nipple scrape for Paget’s disease?

Answer 23

Squamous cells and malignant cells.

Question 24

What cells are present on a nipple scrape of Eczema?

Answer 24

Squamous cells from epidermis only.

Question 25

When is a core biopsy performed?

Answer 25

All cases in which there is clinical, radiological or cytological suspicion.

Question 26

What is a core biopsy?

Answer 26

14 G needle used to take an intact tissue strand. The strand of tissue is then formalin fixed.

Question 27

What is a core biopsy used for?

Answer 27

Confirm invasion
Tumour typing and grading
Immunohistochemistry - receptor status.