Investigations

Question 1

What are some forms of breast imaging?

Answer 1

Mammography; standard, tomosynthesis, CEMG

US; grayscale, Doppler, elastography, CEUS

MRI

Nuclear Medicine

Image guided techniques

CT, molecular imagine, transillumination, termography

Breast screening programme

Question 2

Describe standard mammography views

Answer 2

Mediolateral oblique (MLO)

Craniocaudal (CC)

Question 3

Describe additional mammography views which can be taken

Answer 3

• Coned view
• Magnification vie
• True lateral
• Extended CC
• Eclund views

Question 4

When is mammography carried out?

Answer 4

Over age 40

Under 40 if

• strong suspicion of cancer
• FH risk >40%

Radiation dose is 1mSv

Question 5

How is cancer seen on a mammogram?

Answer 5

MAACS

• Mass
• Asymmetry
• Architectural distortion
• Calcifications
• Skin changes

Question 6

Describe a malignant soft tissue mass in breast

Answer 6

Irregular and ill-defined

Spiculated

Dense

Distortion of architecture

Question 7

Describe a benign soft tissue mass in breast

Answer 7

Smooth or lobulated

Normal density

Halo

Question 8

Describe US of the breast

Answer 8

Differentiate

• solid from cystic
• benign from malignant

First line under age 40
No radiation

Imrpoves specificity of imaging

Doesn’t provide same info as mammo

Solid benign
- smooth outline, oval, acoustic enhancement, orientation

Malignant
- irregular outline, interrupting architecture, acoustic shadowing, anterior halo

Question 9

What is triple assessment of breast?

Answer 9

• Clinical examination
• Imaging
• FNA cytology

Sensitivity 97-100%, specificity 98-100% for detection of breast cancer

Question 10

Describe image guided needle biopsy of the breast

Answer 10

Stereotactic
- upright or prone table

US
- guided or freehand

FNA and core biopsy

Question 11

What are indications for breast MRI?

Answer 11

• recurrent disease
• implants
• indeterminate lesion following triple assessment
• screening high risk women

Question 12

Describe the pros and cons of breast MRI

Answer 12

Pros; great problem solving tool with high sensitivity

Cons; poor specificity, expensive, can be claustrophobic, noisy and lengthy

Question 13

Describe sentinel node sampling

Answer 13

Preitumoral injection of 99m Tc suphur colloid +/- isosulphan blue dye

Lymphoscintigraphy

Intraoperative gamma probe

Single lymph node removal

97% accurate in identifying sentinel node

Question 14

Describe the breast screening programme

Answer 14

Women 50-70 invited every 3 years for mammography

Mammograms detect 5 cancers / 1000 screened

Uptake is ~84%

Recall for further investigations is 5-10%