Lecture 81 Flashcards
4 modalities used to dx BC?
Clinical breast exam
Mammography
Breast Ultrasound
Breast MRI
only screening method that has decreased mortality?
mammography
Mortality from breast cancer is decreased by 20-40% in women who are screened
at what age do screening mammographies begin?
for whom are there exceptions, and what are they?
asymptomatic 40 yo women
If family history in first degree relative - Begin 5-10 years prior to age of first degree relative (not before age 25)
If personal or family history of BRCA 1 or BRCA 2 gene mutations
After chest radiation for lymphoma for example- Begin 8 years after treatment (not before age 25)
what are the two views of the standard screening mammography?
Medio-lateral Oblique (MLO)
Craniocaudal (CC)
a 30 yo patient presents with a breast lump, how should you proceed with diagnostics?
30yo = Diagnostic mammography + Ultrasound if indicated
what is the classic mammographic appearance of invasive ductal carcinoma ?
DCIS?
Spiculated mass
DCIS: Pleomorphic microcalcifications
what special imaging method is best for dense breast tissue?
Tomosynthesis
Limitations of mammography sensitivity ?
what is the sensitivity of mammography for breast cancer?
Sensitivity = 40 to 80%
dense breast
Some cancers are occult
Poor quality interpretation
Poor quality of the mammography
lack of comparison studies
Indications for breast ultrasound
first line study for whom?
first line :
Indications for breast MRI
Screening of high risk patients/Diagnostic exam
Newly diagnosed or history of breast cancer – evaluating for extent of disease
Breast implant rupture
Axillary metastatic adenopathy of unknown primary
who should be screened with Breast MRI?
BRCA 1 or BRCA 2 gene mutation carrier
1st degree relative with BRCA 1 or BRCA 2 – even if patient has not been tested
History of radiation to the chest between ages 10-30
Certain syndromes – Cowden, Li-Fraumeni
what is the most sensitivity test for breast cancer identification?
MRI
but this is never the first line exam
Indications for breast MRI
Screening of high risk patients/
Diagnostic exam
Newly diagnosed or history of breast cancer – evaluating for extent of disease
Breast implant rupture
Axillary metastatic adenopathy of unknown primary
who should be high risk patients and therefore what exam should they get ?
Breast MRI — after mammography and US
BRCA 1 or BRCA 2 gene mutation carrier
1st degree relative with BRCA 1 or BRCA 2 – even if patient has not been tested
History of radiation to the chest between ages 10-30
Certain syndromes – Cowden, Li-Fraumeni
if a lesion is visible only on mammography but no US what type of interventional bx is obtained?
Stereotactic bx
