Mammography and GYN imaging Flashcards
Dense breat tissue categories
![](https://s3.amazonaws.com/brainscape-prod/system/cm/353/301/763/a_image_thumb.png?1628857815)
Mammogram anatomy
![](https://s3.amazonaws.com/brainscape-prod/system/cm/353/301/784/a_image_thumb.jpeg?1628857882)
Mammogram views
![](https://s3.amazonaws.com/brainscape-prod/system/cm/353/301/833/a_image_thumb.jpg?1628858010)
Breast cancer screening recommendations
- They vary for general population:
- Most conservative: Start at age 40, image anually
- USPSTF: Start at age 50, image every two years
-
For patients at high risk:
- Start imaging at age 30 with mammogram and breast MRI
BIRADS
![](https://s3.amazonaws.com/brainscape-prod/system/cm/353/571/151/a_image_thumb.jpg?1629232161)
When is BIRADS 0 appropriate?
When a screening mammogram (not diagnostic) finds something of uncertain signfiicance
Diagnostic vs screening mammograms
Screening mammograms show only two views of each breast (CC and MLO)
Diagnostic mammograms have multiple views from different angles and better magnification, enabling much better characterization of a lesion. An ultrasound is often additionally indicated following a diagnostic mammogram, and is performed at the same appointment.
Indications for a diagnostic mammogram
- Callback from a screening mammogram (BIRADS 0)
- Palpable mass on exam
- Patients with short interval followup for abnormal mammograms (BIRADS 3)
- Patients with known breast cancer who require further pretreatment or preoperative workup (BIRADS 6)
Utility of dopplar ultrasound in workup of a breast mass
Can tell you if it is cystic (no flow) or solid (bloodflow)
For biopsy-confirmed breast cancer with clinically suspected stage 1 disease . . .
. . . no further imaging is required before surgery (at least for staging purposes)
Indicatons for breast MRI
- High risk screening
- Intermediate risk screening
- New diagnosis of breast cancer – to evaluate for contralateral malignancy not detected on mammography (note, requires contrast)
- Evaluating for breast implant rupture (does not require contrast)
Does MRI ever replace mammography for screening?
NO
It only ever is used in conjunction with mammography
Some low-grade conditions, like DCIS, are more easily identifiable on mammography than MRI
Handling of axillary lymph nodes
The sentinel lymph node will typically be biopsied for breast cancer surgery.
If positive, the patient will return for an axillary lymph node dissection.
When should a patient with a history of thoracic radiation begin mammography screening?
10 years following radiation
Often contrast MRIs are also indicated for these cases
The classic example is radiotherapy for childhood or young adulthood Hodgkin’s lymphoma
When should a patient with family history of breast cancer begin mammography screening?
If their family member was diagnosed before age 50, 10 years prior to their age of diagnosis
Otherwise, standard screening schedule
What is the only situation in which you don’t use contrast on a breast MRI?
If you are evaluating for ruptured breast implants
BRCA1 and BRCA2
![](https://s3.amazonaws.com/brainscape-prod/system/cm/353/701/006/a_image_thumb.jpg?1629390092)