Indications for Breast Imaging Flashcards
What is the gold standard in breast cancer screening?
mammography
3 main categories of breast imaging:
- screening
- diagnostic
- interventional
When should a normal female get her baseline mammogram?
35-40 years
At what age should a woman begin having annual mammograms?
40
Women at high risk for breast cancer should have what done every year after 30?
mammogram AND MRI
___% of women with breast cancer have no risk factors apart from being female and over 50?
70%
When evaluating a palpable mass, women under 30 years should have which performed first, u/s or mammo?
u./s first due to breast density
Galactorrhea:
milk discharge in a non-pregnant, non-lactating female, bilateral
What causes galactorrhea? (2)
medicine or pituitary adenoma
Which pt position best relates to cranio-caudal mammograms?
sitting upright
Which pt position relates best to MLO mammograms?
posterior oblique.. LPO for right breast, RPO for left breast
High frequency transducers have elevational focus of
1-2 cm
Sonographically, fat should appear how on breast exams?
medium gray
T/F: Malignancies can change shape with compression?
false, they do not change shape
If a mass can be compressed by >30%, it is likely a
fatty lesion (lipoma)
Ballottement:
alternating compression and release to help demonstrate the mobility of echoes in ducts or cysts
What size stand-off pad is best for evaluating the breast (Specifically the nipple)?
1 cm, this raises the elevational focus to 1.5 cm
Radial scanning is used for ___________.
Screening
Anti-Radial scanning is used for _____________.
documenting pathology
Letters used in labeling refer to
depth of mass in tissue A-C
Numbers used in labeling refer to
distance from nipple (1-3)
Fremitis is
the vibration of the chest during speech, or humming. Normal, soft breast tissue will vibrate with color, while malignant masses will not vibrate, and will not have color.
How do malignant lesions look on elastography?
the harder the lesion, the more blue
What is the most important mammogram view?
Medial-Lateral Oblique (MLO)
Which view is used in mammogram for biopsies?
True Lateral View
Eklund View in mammogram refers to:
tissue pulled forward for compression while implant is left out
Name the four classifications of Breast Malignancy:
- Ductal
- Lobular
- Stromal
- Metastasis
Name the nine tumors with ductal origin:
- Invasive Ductal Carcinoma **
- Ductal Carcinoma In Situ
- Paget Disease
- In Situ Intracystic Papillary Carcinoma
- Tubular Carcinoma
- Medullary Carcinoma
- Colloid AKA Mucinous Carcinoma
- Invasive Papillary Carcinoma
- Inflammatory AKA Diffuse Carcinoma
What is desmoplasia?
host response (halo) around tumor, common with scirrhous tumors
What is the most common non-invasive breast malignancy?
DCIS
Describe DCIS:
malignant cells form a mass from ductal epithelium, this mass is confined to the duct
*usually asymptomatic
Most common form of DCIS
Comedo (High Nuclear Grade), agressive, central necrosis
Which malignancy is most often associated with Paget’s Disease?
DCIS
How does DCIS appear on mammogram?
clusters of calcifications, linear branch calcifications
How does In Situ Intracystic Papillary Carcinoma appear sonographically?
thick-walled cyst with a mural nodule, color flow within mass, no posterior shadowing, dilated ducts
Which breast malignancy has the worst prognosis?
Invasive Ductal Carcinoma (IDC)
How does Invasive Ductal Carcinoma occur?
maligant cells originate in duct, and then tumor extends oustide of the duct
Symptoms of Invasive Ductal Carcinoma (7)
- papable mass
- rigid
- firm
- nipple discharge
- nipple retraction
- disrupted skin
Which Malignancy is associated with benign radial scar?
Tubular Carcinoma
How does tubular carcinoma occur?
rigid, spiculated lesions originate in duct, invade breast in multicentric, satellite tumors
How does tubular carcinoma appear on mammogram?
microcalcifications, central density within small spiculated mas (white star), multicentric
Which malignancy is most common in Asian and Black women under 50?
Medullary carcinoma
Symptoms of Medullary Carcinoma:
soft, palpable , mobile mass, rapid increase in size, distorted breast contour
Sonographic appearance of Medullary Carcinoma
-may appear similar to fibroadenoma..round, well defined, lobulations, central necrosis, posterior enhancement, prominent vascularity
Symptoms of Colloid Carcinoma
smooth, soft, palpable mass in late 50’s
How does Colloid Carcinoma appear on mammography?
low-density, well defined lobular mass
How does Colloid Carcinoma appear sonographically?
similar to fibroadenoma, may have microlobulations and posterior enhancement, non-scirrhous
Symptoms of Invasive Papillary Carcinoma:
- bloody nipple discharge
- palpable mass
- skin dimpling
- . nipple retraction
Sonographic features of Invasive Papillary Carcinoma
nodule formation within dilated ducts, esp papillomas over 1.5 cm, no shadowing
Inflammatory Carcinoma AKA
Diffuse Carcinoma
Which malignancy invades the lymphatics of the skin?
Inflammatory Carcinoma
Which malignancy may result in Peau de Orange?
Inflammatory Carcinoma
