Indications for Breast Imaging

Question 1

What is the gold standard in breast cancer screening?

Answer 1

mammography

Question 2

3 main categories of breast imaging:

Answer 2

1. screening
2. diagnostic
3. interventional

Question 3

When should a normal female get her baseline mammogram?

Answer 3

35-40 years

Question 4

At what age should a woman begin having annual mammograms?

Answer 4

40

Question 5

Women at high risk for breast cancer should have what done every year after 30?

Answer 5

mammogram AND MRI

Question 6

___% of women with breast cancer have no risk factors apart from being female and over 50?

Answer 6

70%

Question 7

When evaluating a palpable mass, women under 30 years should have which performed first, u/s or mammo?

Answer 7

u./s first due to breast density

Question 8

Galactorrhea:

Answer 8

milk discharge in a non-pregnant, non-lactating female, bilateral

Question 9

What causes galactorrhea? (2)

Answer 9

medicine or pituitary adenoma

Question 10

Which pt position best relates to cranio-caudal mammograms?

Answer 10

sitting upright

Question 11

Which pt position relates best to MLO mammograms?

Answer 11

posterior oblique.. LPO for right breast, RPO for left breast

Question 12

High frequency transducers have elevational focus of

Answer 12

1-2 cm

Question 13

Sonographically, fat should appear how on breast exams?

Answer 13

medium gray

Question 14

T/F: Malignancies can change shape with compression?

Answer 14

false, they do not change shape

Question 15

If a mass can be compressed by >30%, it is likely a

Answer 15

fatty lesion (lipoma)

Question 16

Ballottement:

Answer 16

alternating compression and release to help demonstrate the mobility of echoes in ducts or cysts

Question 17

What size stand-off pad is best for evaluating the breast (Specifically the nipple)?

Answer 17

1 cm, this raises the elevational focus to 1.5 cm

Question 18

Radial scanning is used for ___________.

Answer 18

Screening

Question 19

Anti-Radial scanning is used for _____________.

Answer 19

documenting pathology

Question 20

Letters used in labeling refer to

Answer 20

depth of mass in tissue A-C

Question 21

Numbers used in labeling refer to

Answer 21

distance from nipple (1-3)

Question 22

Fremitis is

Answer 22

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.

Question 23

How do malignant lesions look on elastography?

Answer 23

the harder the lesion, the more blue

Question 24

What is the most important mammogram view?

Answer 24

Medial-Lateral Oblique (MLO)

Question 25

Which view is used in mammogram for biopsies?

Answer 25

True Lateral View

Question 26

Eklund View in mammogram refers to:

Answer 26

tissue pulled forward for compression while implant is left out

Question 27

Name the four classifications of Breast Malignancy:

Answer 27

1. Ductal 2. Lobular 3. Stromal 4. Metastasis

Question 28

Name the nine tumors with ductal origin:

Answer 28

1. Invasive Ductal Carcinoma ** 2. Ductal Carcinoma In Situ 3. Paget Disease 4. In Situ Intracystic Papillary Carcinoma 5. Tubular Carcinoma 6. Medullary Carcinoma 7. Colloid AKA Mucinous Carcinoma 8. Invasive Papillary Carcinoma 9. Inflammatory AKA Diffuse Carcinoma

Question 29

What is desmoplasia?

Answer 29

host response (halo) around tumor, common with scirrhous tumors

Question 30

What is the most common non-invasive breast malignancy?

Answer 30

DCIS

Question 31

Describe DCIS:

Answer 31

malignant cells form a mass from ductal epithelium, this mass is confined to the duct *usually asymptomatic

Question 32

Most common form of DCIS

Answer 32

Comedo (High Nuclear Grade), agressive, central necrosis

Question 33

Which malignancy is most often associated with Paget's Disease?

Answer 33

DCIS

Question 34

How does DCIS appear on mammogram?

Answer 34

clusters of calcifications, linear branch calcifications

Question 35

How does In Situ Intracystic Papillary Carcinoma appear sonographically?

Answer 35

thick-walled cyst with a mural nodule, color flow within mass, no posterior shadowing, dilated ducts

Question 36

Which breast malignancy has the worst prognosis?

Answer 36

Invasive Ductal Carcinoma (IDC)

Question 37

How does Invasive Ductal Carcinoma occur?

Answer 37

maligant cells originate in duct, and then tumor extends oustide of the duct

Question 38

Symptoms of Invasive Ductal Carcinoma (7)

Answer 38

1. papable mass 2. rigid 3. firm 4. nipple discharge 5. nipple retraction 6. disrupted skin

Question 39

Which Malignancy is associated with benign radial scar?

Answer 39

Tubular Carcinoma

Question 40

How does tubular carcinoma occur?

Answer 40

rigid, spiculated lesions originate in duct, invade breast in multicentric, satellite tumors

Question 41

How does tubular carcinoma appear on mammogram?

Answer 41

microcalcifications, central density within small spiculated mas (white star), multicentric

Question 42

Which malignancy is most common in Asian and Black women under 50?

Answer 42

Medullary carcinoma

Question 43

Symptoms of Medullary Carcinoma:

Answer 43

soft, palpable , mobile mass, rapid increase in size, distorted breast contour

Question 44

Sonographic appearance of Medullary Carcinoma

Answer 44

-may appear similar to fibroadenoma..round, well defined, lobulations, central necrosis, posterior enhancement, prominent vascularity

Question 45

Symptoms of Colloid Carcinoma

Answer 45

smooth, soft, palpable mass in late 50's

Question 46

How does Colloid Carcinoma appear on mammography?

Answer 46

low-density, well defined lobular mass

Question 47

How does Colloid Carcinoma appear sonographically?

Answer 47

similar to fibroadenoma, may have microlobulations and posterior enhancement, non-scirrhous

Question 48

Symptoms of Invasive Papillary Carcinoma:

Answer 48

1. bloody nipple discharge 2. palpable mass 3. skin dimpling 4. . nipple retraction

Question 49

Sonographic features of Invasive Papillary Carcinoma

Answer 49

nodule formation within dilated ducts, esp papillomas over 1.5 cm, no shadowing

Question 50

Inflammatory Carcinoma AKA

Answer 50

Diffuse Carcinoma

Question 51

Which malignancy invades the lymphatics of the skin?

Answer 51

Inflammatory Carcinoma

Question 52

Which malignancy may result in Peau de Orange?

Answer 52

Inflammatory Carcinoma