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