Mammography

Question 1

goal of screening mammography

Answer 1

detect pre-clinical breast cancer in asymptomatic women

Question 2

ACR 2010 guidelines for screening mammography

Answer 2

annual screening > 40

screening 10 years younger than 1st degree relative with breast cancer

Question 3

USPSTF recommendation for screening (2009)

Answer 3

class C: based on individual recommendations for women 40-49

recommend biannual screening for women 50-74

Question 4

2 standard mammographic views

Answer 4

CC and MLO (45-60 degres from axial plane; parallel to pectoralis muscle heading into axilla

Question 5

additional mammogram views technologists can obtain at their discretion

Answer 5

cleavage view (CV): medial breast tissue of both breasts

exaggerated CC (XCC): pulls lateral/medial tissue into image detector

Question 6

online vs offline screening

Answer 6

offline: batch of exams reviewed in bulk, some time after films taken
online: mammography read while patients wait; typically leads to more imaging and false positives (same cancer detection rate)

Question 7

is diagnostic radiology online or offline?

Answer 7

online

Question 8

reasons for diagnostic mammography

Answer 8

breast problem (pain, lump, skin thickening, nipple discharge)

annual mammography in a asymptomatic pt with hx of breast cancer

short interval follow-up (BiRADS3)

evaluation of abnormality found on screening

Question 9

diagnostic mammography steps

Answer 9

1. localize mammographic abnormality in 3D
2. US?
3. pt waits until getting final interpreations/recommendations

Question 10

technically adequate mammogram

Answer 10

• nipple in profile on at least one view
• MLO posterior nipple line to pectoralis muscle or edge of film on CC muscle
• posterior nipple lines on CC/MLO should be within 1 cm of each other
• no blur/artifacts

Question 11

approach to mammography

Answer 11

1. evaluate adequacy
2. compare each side/symmetry
3. evaluate for malignancy (mass, calcification, architectural distortion, asymmetry) and magnifcy
4. compare to priors

Question 12

BIRADS structure

Answer 12

1. history/indication with risk factors stated
2. list of comparisons
3. description of breast composition
4. description of significant findings/location
5. BIRADS assessment and course of action

Question 13

Types of breast composition

Answer 13

The breast is almost entirely fat (<25% glandular).
There are scattered fibroglandular densities (approximately 25%–50% glandular).
The breast tissue is heterogeneously dense, which could obscure detection of small masses (approximately 51%–75% glandular).
The breast tissue is extremely dense. This may lower the sensitivity of mammography (>75% glandular).

Question 14

BiRADS 0

Answer 14

needs additional imaging; only for screening

such as spot compression, magnification, special mammographic views, or ultrasound) and/or prior mammograms are necessary before a final assessment can be assigned

Question 15

BiRADS 1

Answer 15

negative

normal breasts. NO findings

Question 16

BiRADS 2

Answer 16

benign findings. no work-up

Question 17

BiRADS 3

Answer 17

probably benign, short interval follow-up recommended

<2% risk of malignancy

t is necessary to conduct a complete diagnostic imaging evaluation using diagnostic views (e.g., spot compression magnification, etc.) and/or ultrasound before assigning a probably benign (Category 3) assessment. Category 3 is never appropriate for screening mammography.
• According to the 4th Edition of BI-RADS (2003), Category 3 is not for palpable lesions. However, more recent data suggest that it is acceptable to assign appropriate palpable lesions as BI-RADS 3 after a full imaging workup.
• Action required: Short interval follow-up, typically 6 months. In general, if a benign- appearing lesion demonstrates 2 years of stability it can be considered benign (BI- RADS 2). Any interval change is suspicious and may warrant biopsy

Question 18

follow-up recommendation for BiRADS 3

Answer 18

short interval follow up 6 monts ; if benign and demonstrates 2 years of stability, consider benign (BIRADS 2); interval change –> biopsy

Question 19

BIRADS 4

Answer 19

suspicious of malignancy: 2-95% chance

can be subdivided into 4A-C

Question 20

follow-up recommendation for BiRADS 4

Answer 20

biopsy/aspiration

Question 21

BIRADS 5

Answer 21

highly suggestive of malignancy – biopsy or direct surgical treatment recommended

Question 22

follow-up recommendation for BiRADS 5

Answer 22

biopsy/surgery

Question 23

BIRADS 6

Answer 23

proven malignancy; identified lesion on prior biopsy

Question 24

causes for unilateral increase in fibroglandular density

Answer 24

lymphatic obstruction

Question 25

cause for bilateral increase in fibroglandular density

Answer 25

hormones/breast edema; pregnancy/lactation/weight loss

Question 26

causes for bilateral trabecular blurring/skin thickening

Answer 26

CHF

Question 27

benign causes of skin thickening

Answer 27

radiation, acute mastitis, CHF, renal failure, liver failure

Question 28

malignant causes of skin thickening

Answer 28

inflammatory carcinoma, locally advanced carcinoma, lymphatic obstruction