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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
sutural calcifications
BIRADS 2 calcium deposited on sutures, typically after radiation therapy less common due to changes in modern surgical technique
26
dystrophic calcifications
BIRADS 2 s/p surgery, biopsy, trauma, irradiation
27
round calcifications
BIRADS 2 various etiologies
28
punctate calcifications
BIRADS 2 round, <0.5 mm; however, a cluster may warrant more observation
29
lucent centered calcifications
BIRADS 2; 1 mm-1cm in diameter
30
eggshell/rim calcifications
BIRADS 2 calcium in a sphere, oil cyst fat necrosis or cyst with calcified walls
31
amorphous/indistinct calcifications
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
coarse heterogenous calcifications
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
fine pleomorphic calcifications
BIRADS 5 dot-dash appearance; suspicious for malignancy like DCIS or invasive ductal carcinoma
34
fine linear/branching calcifications
BIRADS 5 highly suspicious for malignancy suggests filling of lumen of duct system involved by DCIS
35
Distribution terminology
BENIGN -diffuse/scattered; regional SUSPICIOUS -linear, grouped/clustered, segmental
36
diffuse/scattered calcifications
randomly between breast, often bilateral fibrocystic change/sclerosing adenosis
37
regional calciications
distributed in large volume (>2 cc) of breast tissue, not in ductal distribution involves most of a quadrant
38
linear calcifications
arranged in line
39
segmental calcifications
secretory/rod like sgmental distribution benign intermediate suspiciou (amorphous) or round/punctate calcifications in a segmental distribution
40
grouped/clustered calcification
cluster: 5+ calcifications in <1cc of tissue cluster is more worrisome than grouped
41
when to use spot compression MAGNIFICATION
spot compression: evaluate focal suspicious mammographic abnormality magnification used for calcifications
42
if asymmetry disappears on compression views? if asymmetry doesn't disappear?
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
what are the XCCL and XCCM views?
exagerrated craniocaudal views which pulls medial and lateral breast into detector
44
rolled views
CC variant; localize lesion seen on CC view only RCCM and RCCL as breast is rolled medially and laterally.
45
if lesion moves medially with RCCM? | if lesion moves laterally with RCCM?
medially -> superior breast | laterally --> inferior breast
46
reduced compression
reduced compression to image far posterior lesion that slip out of detector
47
ML/LM views
true lateral views (ML most common); place lesion closest to detector XR pass through medial breast and lateral breast is where detector is
48
how is true lateral view used to triangulate lesion?
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
if pt gets BIRADS 0, next step?
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
when to biopsy
mass with any suspicious feature on US or mammography
51
how long of stability to call a mass benign?
2 years
52
workup for palpable mass?
all palpable findings are evaluated by ultrasound even in mammogram is negative
53
when to give BIRADS 3
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
developing asymmetry
focal asymmetry that has increased in size and is suspicious

CORE: Mammo (10 decks)

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