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Radiology > mammographyflash > Flashcards

mammographyflash Flashcards

1
Q

Mammographic signs of malignancy

A

Spiculated mass. Pleomorphic microcalcifications. (40% of breast cancers)

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2
Q

Definition of breast mass

A

Space occupying lesion seen in two different projections. Convex borders. Distorts normal architecture. Increased central density.

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3
Q

Definition of breast focal asymmetry

A

Confined asymmetry with similar shape on two views. Lacks borders conspicuity of a true mass.

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4
Q

Definition of breast asymmetry

A

Space occupying lesion seen in only one view.

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5
Q

Descriptors of breast mass (5)

A

Size. Morphology. Associated calcifications. Associated findings. Location.

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6
Q

Descriptors of breast shapes (4)

A

Round. Oval. Lobular. Irregular.

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7
Q

Descriptors of breast margins (5)

A

Circumscribed (>75%). Microlobulated (undulated). Obscured. Indistinct (ill-defined). Spiculated.

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8
Q

Definition of circumscribed breast mass

A

> 75% of mass is circumscribed (well-defined).

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9
Q

Definition of obscured breast mass

A

Border is likely circumscribed but hidden by normal tissue.

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10
Q

Descriptors of breast density (4)

A

High. Equal. Fat-containing radiolucency. Non-fat-containing radiolucency.

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11
Q

Differential for breast mass with spiculated margins and or architectural distortion (4)

A

Breast cancer. Fat necrosis. Scar. Radial Scar.

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12
Q

Definition of Radial Scar/Complex Sclerosing Lesion

A

Central sclerosis with varying degrees of epithelial proliferation (precancerous).

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13
Q

Differential for well-defined mass (6)

A

Cyst. Fibrosis. Fibroadenomas. Breast cancer. Lymphoma. Metestases.

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14
Q

Differential for multiple bilateral masses (5)

A

Cysts. Fibroadenomas. Multiple Papillomas. Metastises. Multifocal breast cancer.

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15
Q

Differential for ill-defined breast mass (3)

A

Breast cancer. Abscess (usually subareolar in lactating women). Spontaneous Hematomas (coagulopathy).

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16
Q

Differential for fat-containing radiolucent breast mass (5)

A

Oil cyst (result of trauma). Lipoma. Galactocele. Hamartoma. Fibroadenolipoma.

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17
Q

Description of a breast fibroadenoma

A

Most common well-defined homogeneous solid mass. Large, coarse and irregular calcifications.

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18
Q

Descriptors of calcifications (4)

A

Morphology (shape). Distribution. Associated findings. Location.

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19
Q

Benign breast calcifications (10)

A

Skin/lucent center. Vascular. Coarse/Popcorn. Large/Rod-like. Round (small less than 1 mm, punctuate less than 0.5 mm). Eggshell/Rim. Milk of calcium. Suture. Dystrophic.

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20
Q

Milk of calcium

A

Sedimented calcifications in macro/microcysts. Amorphous on cranial caudal view. Semilunar, crescent, tea cup shaped on medial lateral oblique view.

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21
Q

Coarse popcorn calcifications

A

Involuting fibroadenoma.

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22
Q

Large rod-like calcifications

A

Ductal ectasia and/or secretory calcifications.

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23
Q

Lucent centered calcification

A

Fat necrosis or calcified debris in ducts.

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24
Q

Eggshell/rim calcifications

A

Fat necrosis. Calcifications within wall of cysts

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25
Q

Dystrophic calcifications

A

Post trauma. Radiation changes.

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26
Q

Dot-dash or casting calcifications

A

Comedocarcinoma type of intraductal carcinoma.

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27
Q

Intermediate concern breast calcifications (2)

A

Amorphous/Indistinct. Coarse heterogeneous (>0.5 mm but not the size of dystrophic calcifications).

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28
Q

High probability breast calcifications (2)

A

Fine pleomorphic (varying in size and shapes, less than 0.5 mm). Linear or branching (suggests filling of involved duct).

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29
Q

Calcification distribution modifiers (5)

A

Diffuse/Scattered. Regional. Grouped/Clustered. Linear. Segmental.

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30
Q

Definition of regional distribution

A

Scattered in large volume (>2cc) of Breast tissue. Does not conform to duct distribution. Less likely to be malignant.

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31
Q

Definition of grouped/clustered distribution

A

At least 5 calcifications occupy small volume (less than 1 cc).

32
Q

Definition of segmental distribution

A

Calcifications distributed in ductal distribution. Worrisome for malignancy.

33
Q

Definition of architectural distortion

A

Distorted architecture without definite mass. Suspicious for malignancy or radial scar, if no prior trauma or surgery.

34
Q

Significance of asymmetric tubular structure/solitary dilated duct

A

Little as long as no other findings.

35
Q

Intramammary lymph node

A

Typically reniform with radiolucent notch. Typically within upper outer breasts.

36
Q

Definition of global asymmetry

A

Greater volume of Breast tissue in one breast relative to the other. No mass, distorted architecture or associated suspicious calcifications.

37
Q

Associated breast findings (6)

A

Skin retraction, Skin lesion, Skin thickening (>2 mm), Nipple retraction, Trabecular thickening, Axillary adenopathy (> 2cm, non-fatty replaced are worrisome)

38
Q

Descriptors of mammography location (3) and depth (3)

A

Subareolar, Central, Axillary tail. Anterior, Middle, Posterior.

39
Q

Descriptors of Breast composition (4)

A

Almost entirely fat (less than 25% glandular). Scattered fibroglandular densities (25-50%). Heterogeneously dense (51-75%). Extremely dense (>75%).

40
Q

BIRADS Classification

A

0, Incomplete. 1, Negative. 2, Benign Findings. 3, Probably Benign (3-94%). 4, Suspicious abnormality (A,B,C). 5, Highly suggestive (>95%). 6, Proven malignancy.

41
Q

BIRADS 3

A

Probably Benign. Less than 2% chance of malignancy. Low grade cancer if present.

42
Q

Imaging decisionin patient less than 30 years with palpable abnormality

A

1st: US. 2nd: Single oblique view (only if necessary).

43
Q

Breast US, background echotexture descriptors (3)

A

Homogeneous: fibroglandular or fat. Heterogeneous: typically occurs in younger patients.

44
Q

Breast US, Mass Shapes (3)

A

Oval. Round. Irregular.

45
Q

Breast US, Orientation descriptors (2)

A

Parallel (wider than tall). Not Parallel.

46
Q

Breast US, Margin descriptors (5)

A

Circumscribed. Indistinct. Angular. Spiculated. Microlobulated.

47
Q

Breast US, Lesion boundary descriptors (2)

A

Abrupt. Echogenic: no sharp demarcation between mass and surrounding tissue.

48
Q

Echo Patterns (5)

A

Anechoic. Hyperechoic. Complex. Hypoechoic. Isoechoic.

49
Q

Posterior Acoustic Features (4)

A

None. Enhancement (echogenic deep to mass). Shadowing (echopenic deep to mass). Combined.

50
Q

Breast US, Clustered Microcysts (2)

A

Fibrocystic changes. Apocrine metaplasia: Tiny anechoic foci (less than 2 to 3 mm) with thin (less than 0.5 mm) septations.

51
Q

Differential for mass in or on skin (6)

A

Sebaceous or epidermal inclusion cysts. Keloids. Moles. Neurofibromas. Accessory nipples.

52
Q

Breast US, Normal lymph node appearance

A

Reniform (hypoechoic cortex and echogenic fatty hilus). Axillary LN typically less than 2 cm.

53
Q

Differential for abnormal lymph nodes (7)

A

Metastatic disease. Infectious. Connective tissue disorder (RA, Sarcoidosis). Lymphoma. Leukemia. Granulomatous disease (calcifications).

54
Q

Breast US, BIRADS 3

A

Solid mass with circumscribed margins, oval shape and parallel orientation. Likely fibroadenoma, nonpalpable complicated cysts, or cluster of microcysts.

55
Q

Breast MR, Focus versus Foci

A

Small (less than 5 mm) isolated spot(s) of enhancement. Not seen on precontrast images.

56
Q

Breast MR, Non-mass-like enhancement descriptors (7)

A

Focal area. Linear. Ductal. Segmental. Regional. Diffuse. Multiple areas of enhancement.

57
Q

Breast MR, Focal area definition

A

Internal enhancement. Non-mass like. Occupies less than 25% of breast quadrant.

58
Q

Breast MR, Difference between linear and ductal enhancement

A

Ductal: resembles a line on 2 views, points towards nipple. Linear: resembles a sheet rather than a line.

59
Q

Breast MR, Difference between segmental and regional enhancement

A

Segmental: triangular enhancement with apex towards nipple, suggests ductal morphology. Regional: geographic enhancement, not conforming to a duct.

60
Q

Breast MR, Internal MR enhancement patterns (5)

A

Homogeneous. Heterogeneous. Stippled/Punctate. Clumped. Reticular/Dendritic.

61
Q

Breast MR, Kinetic Curve

A

Initial phase: Slow, Medium, Rapid. Delayed phase: Washout (malignant), Plateau (either), Persistent (benign).

62
Q

Breast MR, Screening population selection criteria

A

> 25% risk, based on family history, PMH, etc.

63
Q

Risk factors for Breast cancer (6)

A

Personal History. Age. Mother, Sister, Daughter with breast cancer. Atypical or precancerous lesions on biopsy. Nulliparity or first child at or older than 30 years.

64
Q

Expected outcomes in group of 1000 asymptomatic women

A

80 require additional studies. 17 biopsied. 6 cancers.

65
Q

Percent of breast cancer not detected at mammography.

A

9-16%.

66
Q

Percent of malignancies found with biopsy of mammographically suspicious abnormalities

A

25-35%.

67
Q

Mammography radiation risk

A

Life time risk of breast cancer from 1 mammogram. 40-49 y/o: 2/mil, 50-59 y/o: 1/mil. Risk of dying from Breast cancer, 40-49: 700/mil, 50-59: 1000/mil.

68
Q

Convention labeling of Breast radiographs

A

Marker (l/r/cc/mlo) always placed by axillary tail/lateral breast.

69
Q

MLO view

A

Depicts most tissue. Must visualize posterior nipple line (perpendicular line from pec through nipple) and inframammary fold.

70
Q

CC view

A

Pec visualized central on the film (only occurs at 30%) with nipple in profile at 1 cm from image edge.

71
Q

Associated with indeterminate calcifications

A

Fibrocystic Change. Fibrosis adenosis. Sclerosing adenosis. Epithelial hyperplasia. Cysts. Apocrine metaplasia. Atypical hyperplasia.

72
Q

Differential for increased breast density

A

Hormone therapy (bilateral). Inflammatory cancer (skin thickening). Radiation therapy (at 6 months). Diffuse mastitis. Lymphatic/venous obstruction.

73
Q

Intracapsular versus Extracapsular implant Rupture

A

Intravascular: contained. Extravascular: free. Mammography can’t detect intracapsular silicone rupture (MR).

74
Q

Description of Gynecomastia

A

Triangular or flame shaped area of subglandular tissue with interspersed fat. Unilateral more common than bilateral.

75
Q

Causes of gynecomastia

A

Chronic liver disease. Meds (cimetidine, thiazides, digitalis). Marijuana. Testicular, adrenal, or pituitary tumor.

Radiology (11 decks)

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