Invasive Procedures

Question 1

Pneumothorax is associated with which bx type?

Answer 1

Core needle bx

Question 2

Pneumocystogram

Answer 2

mammo image taken after doctor injects air into a cyst cavity, post aspiration

Question 3

Indications for bx after aspiration: (4)

Answer 3

1. thickened wall, difficult needle penetration
2. abnormal tissue remains within cyst after fluid drained
3. immediate recurrence of cyst
4. bloody aspirate

Question 4

Least traumatic bx procedure:

Answer 4

fine needle aspiration bx (FNAB) - cytology analysis

Question 5

Core BX Device

Answer 5

14-18 g

Question 6

During a bx, when is the needle best seen?

Answer 6

when beam is perpendicular to long axis of needle

Question 7

Which procedure is done to avoid lumpectomy?

Answer 7

Core Needle Bx

Question 8

Directional Vacuum Assisted Core BX (DVAB)

Answer 8

CNB performed with special needle and suction (ie Mammotome)

Question 9

Mammotome:

Answer 9

can completely remove small tumors with rotating cutting instrument with 11g needle that removes tissue and vacuums it out for histology

Question 10

Advanced Breast Biopsy Instrument (ABBI)

Answer 10

• stereotactic bx
• mammo and computer guid device
• large core bx(2 cm)
• prone position
• local anestesia

Question 11

Surgical BX

Answer 11

Gold-Standard bx method

Question 12

Incisional bx

Answer 12

removes section of tumor

Question 13

Excisional bx

Answer 13

removes entire tumor and surrounding tissue

Question 14

What localization is used for non-palpable lesions?

Answer 14

pre-opperative needle/dye localization

Question 15

Axillary Lymph Node Dissection ( ALND)

Answer 15

removal of lymph nodes in the axilla for eval of mets from breast primary

Question 16

Most common complication of ALND

Answer 16

lymphedema

Question 17

Sentinel Lymph Node Dissection (SLND)

Answer 17

SNL removed or biopsied

Question 18

Mammographic appearance of hematoma

Answer 18

• varies with age of hematoma

- may see mild increased density or distinct opaque mass or mass of varied density and retracted appearance

Question 19

Sonographic appearance of hematoma

Answer 19

• round or oval
• wall thickening common
• fluid/debris levels common
• posterior enhancement varies with echogenicity of internal debris

Question 20

Sonographic appearance of seroma

Answer 20

• irregular, as the fluid fills the surgical cavity
• debris and septations
• posterior enhancement varies

Question 21

Lymphocele

Answer 21

collection of lymphatic fluid, usually related to surgery or interventional procedures

Question 22

Irradiated breast tissue changes (6)

Answer 22

• skin thickening
• architectural distortion
• increased echogenicity of subcutaneous fat
• highly echogenic parenchyma
• fat necrosis
• edema

Question 23

Fat necrosis

Answer 23

-uncommon inflammatory and ischemic process related to breast trauma…fat may turn into fibrous mass or oil cyst

Question 24

Oil cyst on mammo:

Answer 24

round/oval radiolucent mass; varied fat/water density within cyst, eggshell calcification (radiodense capsule)

Question 25

Mammo appearance of scarring

Answer 25

size and density decreases in time

Question 26

Surgical Intervention (4)

Answer 26

1. Lumpectomy
2. Simple Mastectomy
3. Radical Mastectomy
4. Modified Radical Mastectomy**** most common

Question 27

TRAM Flap Procedure

Answer 27

Transverse Rectus Abdominis Myocutaneous Flap…reconstructive surgery post-mastectomy

Question 28

Systemic Therapy

Answer 28

Chemotherapy or hormone therapy

Question 29

Neoadjuvant Chemotherapy

Answer 29

medications given before surgery to reduce size of tumor

Question 30

Whole breast radiation therapy

Answer 30

4-6 weeks following lumpectomy

Question 31

Brachytherapy

Answer 31

type of accelerated partial breast irradiation (APBI) or breast conservation therapy…treatment time is 5-7 days