L81/L82 - Mammography and BC treatment Flashcards
Screening Mammorgraphy is for who? When do women get them? When do you get them earlier?
ASYMPTOMATIC PATIENTS
Annual screening begins at age 40 for asymptomatic women w/ average rate of breast cancer
Results sent in a letter to patient and physician
Earlier screening if:
Familty Hx 1st degree relative - 5-10 yrs before age of their dx
BRCA1/2 Start at 30
After Mantle Radiation - 8 years after treatment but not before age 25
What are the 2 standard mammorgram views for a Screening mammorgram of each breast?
MLO view - Medio-lateral-oblique
- pectoral muscle to nipple - good for inf/sup lesions
- gets inframammillary fold and axilla
- might midd medial breast
CC view - Cranio-Caudal
- gets medial breast tissue
What is/who gets a diagnostic mammogram?
SYMPTOMATIC PATIENTS > 30 yo
anyone w/ new symptoms, history, or followup abnormal screening or benign lesions
Uses different views - 4 standard instead of 2 - spot compression and magnification for calcifications
INTERPRETED IN REAL TIME at the time of exam
What if you see calcifications or other findings but they are non-palpable?
then use the SAME imaging modality to biopsy lesion!!!!
When do you do a breast ultrasound?
US for EVERY patient w/ a clinical problem
and for under age 30!!!!
ex. 30 yo with lump then order US
Suspicous findings on mammography?
Spiculated masses
Pleomorphic microcalcifciations w/ linear or branching patterns (linear implies necrotic tissue in ducts…bad!) MUST biopsy
Neodensities and architectural distortions
Ill-defined margins
What are the official indications for a braeast ultrasound?
All palpable breast and axillary lumps
eval of new mammograpphic findings (masses, asymmetries, distortions, calficications)
Nipple discharge - serous or blood, unilateral or spontaneous
Focal Pain
*STUDY OF CHOICE in women < 30 yo, PRegnant/lactating for eval of lumps
Screening breat US in women w/ dense breasts on mammography or intermediate risk for BC
Sonographic features of bresat cancer?
irreulgar margins, ill-defined masses - most are hypoechoic
Posterior acoustic shadowing
*Taller - than - wide or antiparallel orientation
Increased vascularity
Cyst w/ mural nodule
Unilateral axillary adenopathy
Indications for BReast MRI?
Screening for HIGH RISK Patients
Diagnostic Exam for:
- newly diagnosed or history of BC
- breast implant rupture - SILICONE IMPLANTS
MRI is MOST sensitive TEST!!!
Indications for breast MRI in newly diagnosed BC?
to get extent of disease in young patients/dense breasts
Screen for Contralateral Brest cancer
Status post-lumpectomy
Response to neo-adjuvant CTX
VERY sensitive - Angiogenesis!!!
3 facts TO KNOW ABOUT MRI?
1) should BEVER be first line diagnostic imaging
2) must be read in conjunction w/ mammography
3) most problems solved w/out MRI
RF for breast cancer?
Reproductive - estrogens etc
Breast feeding protective!!!
High breast tissue density
Confirmed hyperplasia
BRCA and family history
Prior radiation therapy
Obseity, Lack of exercise, ETOH
Treatment options for early stage BC?
Local therapy - surgery or radiation to breast + axilla LN
Systemic Adjuvant therapy - CTX, hormonal, Abs, etc
what LN are not sampled surgically?
Internal Mammillary LN
What are the different levels of LN - matters for Sentinel LN biopsy?
Level 1: Lateral to Pec minor
Level 2: deep to pec minor
Level 3: Medial to Pec Minor
Level 4: Interpectora/Rotter’s nodes
