Mammo CORE - Sheet1 Flashcards
1
Q
When I say “The calcifications don’t change configuration on CC and MLO views”
A
dermal calcifications (“tattoo sign”)
2
Q
next step for possible skin calcs
A
tangential views
3
Q
secretory calcifications: pre or post menopause?
A
post - don’t call them secretory on a premenopausal
4
Q
if they show you an ML view of calcifications
A
think of milk of calcium/tea cupping
5
Q
3 ways to show DCIS on the exam
A
(1)suspicious calcifications (fine linear branching or fine pleomorphic), (2) non mass like enhancement on MRI, or (3) multiple intraductal masses on galactography.
6
Q
what happens with skin thickening and trabecular thickening over time?
A
improves - otherwise it’s recurrent disease
7
Q
When I say “shrinking breast,” you say
A
ILC
8
Q
When I say “thick coopers ligaments,” you say
A
edema
9
Q
When I say “thick fuzzy coopers ligaments - with normal skin,” you say
A
blur
10
Q
When I say “dashes but no dots,” you say
A
Secretory Calcifications
11
Q
When I say “cigar shaped calcifications,” you say
A
Secretory Calcifications
12
Q
When I say “popcorn calcifications,” you say
A
degenerated fibroadenoma
13
Q
When I say “breast within a breast,” you say
A
hamartoma
14
Q
When I say “fat-fluid level,” you say
A
galactocele
15
Q
When I say “rapid growing fibroadenoma,” you say
A
Phyllodes
16
Q
When I say “swollen red breast, not responding to antibiotics,” you say
A
inflammatory breast ca
17
Q
When I say “ lines radiating to a single point,” you say
A
Architectural distortion.
18
Q
When I say “Architectural distortion + Calcifications,” you say
A
IDC + DCIS
19
Q
When I say “Architectural distortion without Calcifications,” you say
A
ILC
20
Q
When I say “Stepladder Sign,” you say
A
lntracapsular rupture on US
21
Q
When I say “Linguine Sign,” you say
A
lntracapsular rupture on MRI
22
Q
When I say “Residual Calcs in the Lumpectomy Bed,” you say
A
local recurrence
23
Q
When I say “No calcs in the core,” you say
A
milk of calcium (requires polarized light to be seen)
24
Q
what’s different about mag views
A
no grid
25
BIRADS 3 = what % cancer
\< 2% chance of cancer
26
BIRADS 5 = what % cancer
\> 95% chance of cancer
27
nipple enhancement on MRI - normal?
yes, normal - don't call it Pagets
28
which quadrant has most breast cancers?
upper outer (most tissue)
29
main blood supply?
(60%) is via the internal mammary
30
main lymphatic drainage?
(97%) is to the axilla
31
The sternalis muscle can only be seen on
CC view
32
Most common location for ectopic breast tissue is in the
axilla
33
best time in cycle for mammogram (and MRI)
follicular phase (days 7-14)
34
Breast Tenderness is max around day
27-30.
35
most comprehensive risk model
Tyrer Cuzick (but does not include density)
36
level of chest radiation as a child that would prompt screening MRI
20 Gy
37
Are males more likely to get breast cancer if they have BRCA 1 or 2?
BRCA 2
38
If triple negative status, more likely to have BRCA 1 or 2?
BRCA 1 is more often a triple negative CA
39
special view to help with kyphosis, pectus excavatum, and to avoid a pacemaker/line
LMO
40
which calc pattern has highest suspicion for malignancy?
fine pleomorphic
41
density of surgical scars related to recurrence
Surgical scars should get lighter, if they get denser - think about recurrent cancer.
42
can you have isolated extracapsular rupture?
nope, always with intra
43
The number one risk factor for implant rupture is
the age of the implant
44
affect of Tamoxifen on parenchymal uptake?
Tamoxifen causes a decrease in parenchymal uptake, then a rebound.
45
which cancer is T2 bright?
colloid and mucinous cancer
46
axillary lymph node levels: level 1
lateral to pec minor
47
axillary lymph node levels: level 2
under pec minor
48
axillary lymph node levels: level 3
medial to pec minor
49
axillary lymph node levels: rotter node
between pec major and minor
50
most cancers start in the
TDLU
51
should you biopsy a prepubescent breast?
no, it can affect breast development
52
peak time for breast pain/cyst formation
perimenopause - 50s
53
name the 5 high risk lesions
ADH, ALD, LCIS, Radial Scar, Papilloma
54
BRCA 1 chromosome
17 - more common than BRCA 2
55
BRCA 2 chromosome
13
56
4 non-BRCA syndromes associated with breast ca
Li Fraumeni, Cowden, Bannayan-Riley Ruvalcaba, NF-1
57
oldest and most validated breast cancer risk model
Gail - doesn't use genetics
58
things that increase your estrogen exposure, do what to your breast ca risk?
increase it (Early Menstruation, Late Menopause, late age of first pregnancy I or no kids, being fat, Being a Drunk, hormone Replacement (with estrogen))
59
all current risk models under or overestimate risk?
underestimate life-time risk
60
when do you start screening kids who get 20 Gy of chest radiation
age 25 or 8 years after exposure (whichever is longer)
61
what drugs reduce breast cancer incidence of ER/PR
Tamoxifen and Raloxifenc (SERMs)
62
BIRADS: multiple bilateral well circumscribed similar appearing masses
2 - don't even ultrasound, unless one is palpable
63
BIRADS: multiple foci on MRI
2
64
3 things you can BIRADS-3:
1. looks like fibroadenoma, 2. focal asymmetry that becomes less dense on compression, 3. grouped/clustered round calcs
65
Mammo: shapes
round, oval, irregular
66
Mammo: margin
Circumscribed, Microlobulated, Obscured, Indistinct, Spiculated
COMIS
67
Mammo: density
Fat Density (radiolucent), hypodense, lsodense, hyperdense
68
List types of asymmetries
1. asymmetry,
2. global asymmetry
3. focal asymmetry
4. developing asymmetry
69
Mammo: typically benign vs. suspicious calcifications
Benign: Skin, vascular, popcorn, plasmacell mastitis, fat necrosis, milk of calcium, dystrophic, eggshell, suture
Suspicious: amorphous, coarse heterogenous, fine linear, branching, pleomorphic
[https://radiologyassistant.nl/breast/calcifications/differential-of-breast-calcifications](https://radiologyassistant.nl/breast/calcifications/differential-of-breast-calcifications)
70
US: shape
Round ,Oval, Irregular
71
US: orientation
parallel or anti-parallel
72
US: margin
Circumscribed, lndistinct, Angular, Microlobulated, SpicuIated
73
US: echo pattern
Anechoic, hyperechoic, hypoechoic, lsoechoic, complex cystic and solid, heterogeneous
74
US: posterior features
None, Enhancement, Shadowing
75
3 artifacts that cause calcifications
deodorant, zinc oxide, metallic fragements
76
Calcifications: distribution
scattered, regional, grouped/clustered, linear, segmental
77
Calcifications: benign
dermal, vascular, popcorn, secretory, egg-shell, dystrophic, milk of calcium, round
78
Calcifications: suspicious
amorphous, coarse heterogeneous, fine pleomorphic, fine linear/linear branching, near a scar/mass/FA
79
treatment for Mondor
thrombosed vein - no anticoagulation, just NSAIDS
80
5 classic fat containing lesions
oil cyst/fat necrosis, hamartoma, galactocele, lymph nodes, and Iipoma
81
PASH follow-up rec
Pseudoangiomatous Stromal Hyperplasia - 12 month f/u - benign thing with scary sounding name
82
most common invasive breast cancer
IDC - 80-85%
83
most common subtype of IDC
NOS - 65%
84
IDC subtypes (besides NOS, 4)
tubular, mucinous, medullary, papillary
85
IDC subtype associated with radial scar or spiculated mass
[tubular](https://radiopaedia.org/articles/tubular-carcinoma-of-the-breast?lang=us)
86
2 IDC subtypes that present as round/oval masses
mucinous and medullary
87
IDC subtype associated with complex cystic and solid mass
papillary (older, non-white ladies)
88
multifocal vs. multicentric breast cancer
multifocal = multiple primaries, same quadrant; multicentric = multiple primaries different quadrants
89
which type of DCIS histology is more aggressive?
comedo type
90
when I say "shadowing without a mass on ultrasound", you say
ILC
91
Breast Pagets is associated with
high grade DCIS
92
3 patterns of gynecomastia
nodular, dendritic, diffuse glandular
93
should trans guys who get boobs from hormone therapy be screened?
no, not high enough risk
94
how to tell apart normal radial folds vs. liguine sign?
radial folds - all lines connect to periphery of implant
95
timing of breast MRI kinetics
initial upslope occurs over 2 min, then washout 2-6 min-ish
96
grading MRI kinetics upslope
slow, medium, rapid
97
grading MRI kinetics washout
continued rise (type 1), plateau (type 2), rapid washout (type 3)
98
recall rate should be less than
10% (target range of 5-7%)
99
required resolution of line pairs is
13 lp/mm in anode-cathode direction and 11 lp/mm in left-right direction
[https://www.fda.gov/regulatory-information/search-fda-guidance-documents/mammography-facility-surveys-mammography-equipment-evaluations-and-medical-physicist-qualification](https://www.fda.gov/regulatory-information/search-fda-guidance-documents/mammography-facility-surveys-mammography-equipment-evaluations-and-medical-physicist-qualification)
part of the annual survey from FDA
100
describe the dose phantom
50% glandularity, 4.2 cm thick
101
typical patient doses
2 mGy per view - but no limits! that's just for the phantom
102
dose limit for phantom
3 mGy/view
103
typical patient breast compression and glandularity
6 cm, 15-20% glandularity
104
target range for cancers/1000 screened
3-8 people with cancer
105
target range for PPV for biopsy recs
15-35%
106
Cowden Syndrome
breast cancer, bowel hamartoma, follicular thyroid, Lhermitte Duclos (brain hamartoma)
