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CORE: Mammo > Mammographic Masses/Calcifications > Flashcards

Mammographic Masses/Calcifications Flashcards

1
Q

definition of mammographic mass

A

space occupying lesion with convex borders seen on 2 projections

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2
Q

definition of asymmetry

A

seen on a single view

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3
Q

BI-RADS lexicon for margins

A

COMIS

circumscribed, microlobulated, obscured, indistinct, spiculated

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4
Q

Margins: circumscribed

A

75% of margin well-defined, remainder obscured by tissue

generally benign

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5
Q

Margins: microlobulated

A

finely irregular or serrated edge

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6
Q

Margins: obscured

A

25% hidden or superimposed by adjacent normal tissue

mass may be circumscribed but margin hidden by overlying tissue

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7
Q

Margins: indistinct

A

poorly defined margin raises concern that lesion may be infiltrating

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8
Q

Margins: spiculated

A

linear densities radiate from mass

malignant until proved otherwise

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9
Q

BI-RADS lexicon for density

A

radiolucent, low density, equal density, high density

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10
Q

breast cancers typically have ___ density compared to surrounding fibroglandular tissue

A

equal/higher density

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11
Q

BIRADS lexicon for shape

A

round, oval, lobular (undulating contour), irregular

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12
Q

when to use quadrants vs clockface?

A

quadrants: mammography
clockface: ultrasound

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13
Q

Associated features in mammography

A

architectural distortion, microcalcifications (malignant ductal calcifications), skin retraction, nipple retraction, skin thickening, trabecular thickening, axillary adenopathy

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14
Q

pathophysiology of architectural distortion

A

tethering of normal fibroglandular tissue

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15
Q

causes for skin retraction

A

postsurgical; desmoplastic tumor reaction

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16
Q

causes for skin thickenng

A

edema, prior radiation therapy

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17
Q

causes of trabecular thickening

A

edema or prior radiation therapy

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18
Q

when to perform spot compression magnification

A

characterize indeterminate/suspicious calcifications

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19
Q

mammogram technique for magnification

A

air-gap technique and small focal spot (0.1 mm)

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20
Q

skin calcifications finding

A

BIRADS 2

punctate/lucent centered, medially located

may need tangential view to delineate

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21
Q

vascular calcification findings

A

BIRADS 2

large rod like calcifications

early/incomplete vascular calcifications may appear suspicious

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22
Q

popcorn/coars calcifications

A

BIRADS 2

involuting/hyalinizing fibroadenoma
typically pripheral –> chunky popcorn appearance

23
Q

large rod-like calcifications

A

BIRADS 2

secretory disease/plasma cell mastitis/duct ectasia (postmenopausal females)

ductal distribution similar to DCIS but large and rod-like

24
Q

milk of calcium calcifications

A

BIRADS 2

free-floating calcium in tiny benign cysts; change in CC/lateral views

semilunar or crescent shaped due to dependent layering

25
Q

sutural calcifications

A

BIRADS 2

calcium deposited on sutures, typically after radiation therapy

less common due to changes in modern surgical technique

26
Q

dystrophic calcifications

A

BIRADS 2

s/p surgery, biopsy, trauma, irradiation

27
Q

round calcifications

A

BIRADS 2

various etiologies

28
Q

punctate calcifications

A

BIRADS 2
round, <0.5 mm;

however, a cluster may warrant more observation

29
Q

lucent centered calcifications

A

BIRADS 2; 1 mm-1cm in diameter

30
Q

eggshell/rim calcifications

A

BIRADS 2

calcium in a sphere, oil cyst
fat necrosis or cyst with calcified walls

31
Q

amorphous/indistinct calcifications

A

BIRADS 4
too small/hazy to ascertain morphology

usually benign but mag views are needed if they seem clustered, regional, linear, or segmental distribution

32
Q

coarse heterogenous calcifications

A

BIRADS 4

irregular calcifications >0.5 mm, smalelr than dystrophic calcifications

may represent early hyalinizing fibroadenomas or fat necrosis vs malignancy when new, warranting biopsy

33
Q

fine pleomorphic calcifications

A

BIRADS 5

dot-dash appearance; suspicious for malignancy like DCIS or invasive ductal carcinoma

34
Q

fine linear/branching calcifications

A

BIRADS 5

highly suspicious for malignancy

suggests filling of lumen of duct system involved by DCIS

35
Q

Distribution terminology

A

BENIGN
-diffuse/scattered; regional

SUSPICIOUS
-linear, grouped/clustered, segmental

36
Q

diffuse/scattered calcifications

A

randomly between breast, often bilateral

fibrocystic change/sclerosing adenosis

37
Q

regional calciications

A

distributed in large volume (>2 cc) of breast tissue, not in ductal distribution

involves most of a quadrant

38
Q

linear calcifications

A

arranged in line

39
Q

segmental calcifications

A

secretory/rod like sgmental distribution benign

intermediate suspiciou (amorphous) or round/punctate calcifications in a segmental distribution

40
Q

grouped/clustered calcification

A

cluster: 5+ calcifications in <1cc of tissue

cluster is more worrisome than grouped

41
Q

when to use spot compression MAGNIFICATION

A

spot compression: evaluate focal suspicious mammographic abnormality

magnification used for calcifications

42
Q

if asymmetry disappears on compression views?

if asymmetry doesn’t disappear?

A

abnormality likely superimposed normal plaible fibroglandular tissue NOT parenchymal fibrosis from desmoplastic reaction

if it does not change when compressed then suspicious and better characterization of margins –> US

43
Q

what are the XCCL and XCCM views?

A

exagerrated craniocaudal views which pulls medial and lateral breast into detector

44
Q

rolled views

A

CC variant; localize lesion seen on CC view only

RCCM and RCCL as breast is rolled medially and laterally.

45
Q

if lesion moves medially with RCCM?

if lesion moves laterally with RCCM?

A

medially -> superior breast

laterally –> inferior breast

46
Q

reduced compression

A

reduced compression to image far posterior lesion that slip out of detector

47
Q

ML/LM views

A

true lateral views (ML most common); place lesion closest to detector

XR pass through medial breast and lateral breast is where detector is

48
Q

how is true lateral view used to triangulate lesion?

A

triangulate lesion seen only on MLO view

if lesion rises on lateral view, lesion located in medial breast

if lesion sinks, it is in lateral breast

medial: muffins rise; lateral: lead sinks

49
Q

if pt gets BIRADS 0, next step?

A

recalled for additional evaluation and spot compression views are obtained

if normal: BIRADS 1/2
if asymmetry persist: orthogonal views
>MLO only –> lateral views, or XCCL, rolled CC

> CC only –> upper inner quadrant lesion; get rolled views

once lesion localized to quadrant –> US

if lesion cannot be localized –> MRI

50
Q

when to biopsy

A

mass with any suspicious feature on US or mammography

51
Q

how long of stability to call a mass benign?

A

2 years

52
Q

workup for palpable mass?

A

all palpable findings are evaluated by ultrasound even in mammogram is negative

53
Q

when to give BIRADS 3

A

1) circumscribed benign appearing solid mass
2) cluster of punctate/round calcifications
3) focal asymmetry (non palpable lesion seen on 2 projections; usually interpersed with fat)

54
Q

developing asymmetry

A

focal asymmetry that has increased in size and is suspicious

CORE: Mammo (10 decks)

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