Imaging in Breast Disease Flashcards
What are the different types of Mammography?
Standard
Tomosynthesis
CEMG
What are the standard views in mammography?
Mediolateral oblique
Craniocaudal
What are some additional views used in mammography?
Coned view Magnification true lateral Extended craniocaudal Eclund
When is mammography performed?
Over the age 40yrs
Under the age of 40 if strong suspicion of cancer or there is family hx risk of > 40%.
How can cancer be seen on a Mammography?
Mass Asymmetry Architectural distortion Calcifications Skin changes
What is the appearance of a malignant soft tissue mass?
Irregular Illdefined Spiculated (spikes/points of surface) Dense Distorted architecture
What is the appearance of a benign soft tissue mass?
Smooth
Lobulated
Normal density
Halo
Why is ultrasound used to examine breast tissue?
- Used differentiate between solid and cystic and benign and malignant.
- First line imaging in <40yrs
- No radiation
- Improves specificity of imaging.
How do solid benign masses appear on ultrasound?
smooth outline
oval shape
acoustic enhancement
orientation
How do malignant masses appear on ultrasound?
Irregular outline
interrupting breast architecture.
acoustic shadowing
anterior halo
What is meant by triple assessment?
Clinical examination
Imaging
FNA cytology
What are some types of image guided needle biopsy?
Sterotactic - upright or prone table.
Ultrasound - guided or freehand.
FNA & Core biopsy
What are the indications to MRI breast tissue?
Recurrent disease
Implants
Indeterminate lesion following triple assessment
Screening high risk women.
What are some advantages and disadvantages of MRI breast tissue?
Sensitivity 94-98% for all breast density.
Great problem solving tool.
Specificity is poor
Expensive
Claustrophobic, noisy, lengthy, IV contrast.
What is involved in sentinel node sampling?
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.
What is the breast screening programme?
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%.
What is cytology?
Microscopic examination of a thin layer of cells on a slide obtained by fine needle aspiration or direct smear.
What are some features of benign cytology?
Low/moderate cellularity Cohesive groups of cells Flat sheets of cells Bipolar nuclei in background Cells of uniform size Uniform chromatin pattern
What are some features of malignant cytology?
High cellularity Loss of cohesion Crowding/overlapping of cells Nuclear pleomorphism Hyperchromasia Absence of bipolar nuclei.
What is the cytology scoring system?
C1 = unsatisfactory C2= benign C3= atypic (probs benign) C4= suspicious (probs malignant) C5 = malignant
What are some complications of FNA?
Pain Haematoma Fainting Infection Pneumothorax
What are some examples of nipple lesions?
Duct ectasia (macrophages only)
Intra-duct papilloma (benign cells in papillary groups)
Intra-duct carcinoma (malignant cells)
What cells are present on a nipple scrape for Paget’s disease?
Squamous cells and malignant cells.
What cells are present on a nipple scrape of Eczema?
Squamous cells from epidermis only.
When is a core biopsy performed?
All cases in which there is clinical, radiological or cytological suspicion.
What is a core biopsy?
14 G needle used to take an intact tissue strand. The strand of tissue is then formalin fixed.
What is a core biopsy used for?
Confirm invasion
Tumour typing and grading
Immunohistochemistry - receptor status.
