rad cases, in service, CTC mammo Flashcards
what is the enhancement pattern of phyllodes tumors
fast wash in and fast wash out
what is the stain that differentiates sclerosing adenosis from carcinoma?
SA has smooth muscle actin in myoepthilial cells
in what age does tubular adenoma present? what does it mimic?
women younger than 35. it mimics a FA but calcs are within dilated acini not within the ducts as in a FA.
what is the risk of low grade DCIS developing into ca?
30-60% over 10-30 years if not treated
what are the subtypes of DCIS?
solid, pappillary, micropappillary, cribiform
what is the risk of a single papilloma without atypia developing into cancer? what is the risk of multiple papillomas without atypia developing into cancer?
single papilloma: 2 fold increase risk, multiple: 3 fold increase risk
what is fibromatosis? where does it develop? what is the risk of recurrence?
it is an extra abdominal spindle cell desmoid tumor, develops in the pectoralis fascia, risk of recurrence is 25%
what medication is associated with fibroadenomas in post menopausal women?
cyclosporine A in patients with renal transplant
what is the measurement for a cluster of cysts?
1-7 mm in diameter
what cancer can PASH be mistaken for histologically?
angiosarcoma
what percent of papillomas are upgraded to cancer on surgical excision? are peripheral or central papillomas most commonly upgraded?
12-15% papillomas are upgraded - peripheral papillomas more than central.
what is the increased risk of developing cancer after a diagnosis of ADH?
4-5 times increased risk in BOTH breasts after a diagnosis of ADH
what is the increased risk of developing cancer in either breast after a diagnosis of radial sclerosing lesion?
2 fold increased risk in either breast
what percent of Phyllodes are benign?
40-80%
what percent of Phyllodes metastasize? what are the most common locations for mets? what percent of patients get axillary mets?
6-22%. mets are to lung, bone, and liver hematogeneously. 10% of patients get axillary mets.
what is the definition of low grade DCIS?
lacks central necrosis and is called non-comedo carcinoma
what percent of low grade DCIS is ER and PR positive?
70-100%
of the DCIS that is diagnosed, what percent is low grade?
20%
what is the E cadherin status of LCIS and DCIS?
LCIS: E cad negative, DCIS: E cad positive
what are factors that can DECREASE breast density?
vitamin D, calcium, danazol, weight gain
what is the upgrade rate of ADH on surgery?
20%
what percent of high grade DCIS has axillary nodes?
2%
what is the Van Nuys prognostic index?
assesses recurrence of DCIS treated with surgery in patients with XRT vs without XRT. It looks at the histology, tumor size, and margin status
angular margins on US has what percent PPV for malignancy?
60%
echogenic halo on US has what percent of PPV for malignancy?
70%
how many years is tamoxifen used for?
5 years - then side effects outweigh the benefits
how many lobes are there in the breast
15-20
what is the benefit of FFDM vs SF
more dynamic exposure
what is the spatial resolution in FFDM vs SF
spatial resolution is worse in FFDM
what are the cell layers in fibroglandular tissue
outer myoepithelial cell layer and epithelial secretory layer
what is the most important predictor of survival in breast ca
axillary node status
what is the most common malignancy to metastasize to the breast
melanoma
what is the treatment for inflammatory breast ca? what is the T stage of IBC?
neoadjuvant chemo. it is T4d.
what should be the orientation of the cathode-anode of an X-ray tube for mammo?
chest wall (cathode) to nipple (anode)
what is the time frame for residual disease vs recurrence?
residual disease is within 6 months of surgery for breast ca, recurrence is after 18 months
what are the recurrence rates of cancer at 5 years and 10 years?
5% -10 % at 5 years, 10-15% at 10 years
what is a “true recurrence” of cancer?
cancer at the original tumor site due to residual disease
what is the definition of multiple bilateral circumscribed masses?
at least 3 total with one in each breast
who gets diabetic mastopathy? is there increased risk of breast ca? is it more commonly unilateral or bilateral?
type 1 diabetic patients after 20 years of having the disease. no increased risk of cancer. often bilateral.
where does breast cancer metastasize?
bone, lung, then liver
what is the order from most common to least common of tumors that mets to the breast?
lymphoma, melanoma, lung, ovarian, soft tissue sarcoma, GI, GU, carcinoid
what is the most common presentation of breast lymphoma on mammo?
most commonly presents as axillary adenopathy
what percent of breast lymphoma is bilateral?
13%
what is the prevalence of gynecomastia in the US?
24 to 65%
what is the mean age of presentation for male breast cancer?
60-70
what percent of breast cancer is male breast cancer?
less than 1 %
what males get ILC?
males on estrogen
what percent of male breast cancer is IDC?
85% is IDC.
what ethnicity has higher prevalence of male breast cancer?
blacks, native american, jewish
what males develop lobules?
Klinefelter syndrome or on estrogen
what are the most common organisms that cause breast abcess?
staph epidermis and staph aureus
in what location is breast abcess most common and in what population?
subareolar, in smokers
do subareolar or peripheral breast abcesses have a greater proportion of recurrence?
subareolar
what is the definition of IDC with extensive intra ductal component?
tumor composed of at least 25% DCIS in the adjacent tissues either as direct extension or separate foci
what is outcome of IDC with extensive intra ductal component?
often have positive margins and recurrence rate is higher with breast conservation therapy
what is the definition of a synchronous cancer?
2 cancers at the same time or within 6 months of each other
what is the definition of multifocal vs multi centric cancer? in what age group is multifocal more common?
multifocal is the same quadrant, within 4 cm of each other. multi centric is in different quadrants or at least 4-5 cm apart. multifocal is more common in women younger than 45.
what percent of additional lesions in a patient with a palpable cancer will be multifocal vs multi centric?
if a patient has a clinically palpable breast ca, there is a 75% chance that an additional lesion will be multifocal vs 25% chance that an additional lesion will be multicentirc.
what is mastopexy?
mastopexy is moving the nipple higher up - don’t see changes in the breast parenchyma
what is the percent of occult cancer found in tissue sent to path from a reduction mammoplasty?
0.06 to 0.4 % of reduction specimens
is cancer smaller or bigger on elastography vs conventional ultrasound? cysts?
cancer is bigger on elastography, cysts are smaller
what is the elastography sign of a cyst?
bulls eye or target appearance. it is centrally bright surrounded by a dark rim.
what is the US finding of IC rupture?
“stair stepping” or “ladder appearance” of the collapsed implant envelope
what is the appearance of NF on mammogram?
multiple masses outlined by air, extend along inframammary fold
what is the max dose of lido and epi used for deep local anesthesia?
7 mg/kg body weight not to exceed 500 mg.
what are the relative contraindications to radiation therapy?
pregnancy, prior radiation, collagen vascular disease, multi centric disease
what are the absolute contraindications to radiation therapy (breast conservation)
1st or 2nd trimester of pregnancy, 2 or more primary tumors in different quadrants, diffuse malignant calcifications
when does radiation pneumonitis occur?
4-12 weeks after radiation therapy
what is the radiation dose of contrast enhanced mammo vs full field digital mammo?
CEDM is 1.2 times more radiation
what fraction of ILC is bilateral?
1/3
define stage 1, 2A, 2B and 3B breast ca
1: less than 2 cm without LAD
2A: between 2 and 5 cm without LAD
2B: between 2 and 5 cm with ipsilateral moveable axillary nodes or more than 5 cm without LAD
3B: any size extending to chest wall or skin (+/-LAD)
what is another name for the axillary tail view?
cleopatra view
what cancer arises in people with silicone or saline implants? how does it present and how long after getting an implant?
anaplastic large cell lymphoma, presents as a mass or periprosthetic fluid at a mean of 8 years after the implant placement
what is the PPV for linear and segmental NME?
30 and 60 % respectively
what vessel causes a cortical pattern of NME?
preferential diffusion through the lateral thoracic artery
what is tamoxifen rebound effect?
dramatic increase in BPE after stopping tamoxifen
what are the factors that increase the risk of recurrence after treatment for breast cancer?
premenopausal, extensive intraductal component, multi centric disease, positive margins, tumors with vascular invasion
with is the risk of local regional recurrence per year?
1%
after cessation of lactation, when can you return to doing mammo?
3 months after stopping lactation
what is the mean time to recurrence in breast cancer?
3.5 years
Breast MRI detects contralateral cancer in what percent of patients that get a pre op MRI?
3-4%
how many cancers should be found in 1000 screening mammo?
6 to 10
how should the shape of the pec major be anteriorly on an MLO view
should be convex anteriorly
how many times a year does MQSA review medical outcomes and audit data?
once a year
what direction is ghosting in?
phase encoding. ghosting is movement from patient, cardiac, or respiration
what is the definition of PPV1
the percent of exams with abnormal initial result leading to tissue diagnosis of cancer in one year
what chromosome is BRCA1 on? BRCA 2?
BRCA 1 is on chrome 17, BRCA2 is on chrome 13
what is the cancer detection rate? what is the formula?
2 - 10 per 1000. CDR = positive biopsies/total # screening mammo
how many hours of breast specific CME is needed per year?
15 hours
what is the screening recall rate formula?
BRCA 0/4/5 divided by total number of screeners
what is the diagnostic recall rate formula?
BRCA 4/5 divided by the total number of diagnostic
what is the cancer detection rate formula?
number of positive biopsies divided by total number of screeners
how do you fix incomplete fat sat?
shimming the magnet
how do you fix chemical shift artifact?
increase the bandwidth
how do you fix aliasing/wrap around artifact?
increase the FOV or increase sampling points in the phase encoding direction
what is gridline artifact caused by?
grid speed parameter set incorrectly
what is the inheritance of poland syndrome? what are they at increased risk for?
autosomal recessive. increased risk for breast cancer, leukemia, NHL and lung cancer
what is focal fibrosis in a post menopausal woman due to?
HRT
what is the ddx for bilateral breast edema?
SVC obstruction, CHF, renal failure
what is the ddx for unilateral breast edema?
mastitis, abscess, cancer, trauma, coumadin, XRT
at what time should enhancement after XRT decrease on MRI?
10-18 months
what percent does breast cancer account for in pregnancy associated cancer?
3%
up to what point is physiologic enhancement seen after surgery on MRI?
18-24 months
what are causes of Mondor disease?
trauma, surgery, physical activity
what do calcifications in nodes signify?
old granulomatous disease, mets from ovarian ca
in what percent of cases does MRI affect clinical management of ILC and in what percent of cases does MRI affect surgical management in ILC?
50% of clinical and 28% of surgical
what percent of breast cancer does inflammatory breast ca account for?
1-4% of breast cancer.
if you see calcs only in the medial breast on the CC view, what should you get an LM or ML view?
get LM view because calcifications will be closer to the image receptor
what is the prevalence of sternalis? more common to be unilateral or bilateral?
1-11%, more commonly unilateral
what is the definition of pleomorphic calcs? what percent chance of malignancy does it indicate?
varied size and shapes and less than 0.5 mm. it has 25-41% chance of malignancy.
what percent of male breast cancer have axillary mets at diagnosis? what percent of male breast ca is associated with DCIS?
50% have axillary nodes at diagnosis. DCIS is associated with male breast ca in 35-50% of cases.
what is the definition of a giant FA?
more than 8 cm
what is a rotter node?
btw pec major and minor
cancer where in the breast mets to internal mammary nodes?
medial breast
what percent of isolated mets go to internal mammary nodes?
3%
what is the follicular phase, what hormone dominates?
day 7-14, best time for mammo and MRI. estrogen dominates
what is the luteal phase, what hormone dominates?
day 15-30, progesterone dominates, breast density increases, get more cyst formation.
what level of radiation exposure to the chest wall qualifies you for a screening MRI?
20Gy to chest wall in a child - get screening MRI at age 25 or 8 years post exposure, whichever is later. the risk of cancer peaks 15 years post treatment.
BRCA 1 AND 2 increases your risk of breast ca and what other cancers?
breast, ovary, GI
what is cowden syndrome?
increased risk for breast ca, follicular thyroid ca, endometrial ca, bowel hamartoma, and lhermitte duclos
what are the different risk models for breast ca?
Gail model: personal risk factors, biopsy of ADH, family history, only validated in AA. BrCA pro model: genetics only. Tyler-Cuziek: most comprehensive, includes personal risk, biopsy of ADH or LCIS, family history, does not factor in breast density.
when do you get a LMO view instead of MLO?
patients with kyphosis, pectus excavatum, or to avoid a medial pacemaker line
when do you get a ML view vs LM?
if only seen on the CC and its lateral, get a ML. if only seen on the CC and its medial get LM. if only seen on the MLO, get ML because 70% of cancers occur laterally.
what area of the breast is worst visualized on a MLO view?
the medial breast
if finding is only seen on the CC view, how do you localize the lesion by rolled views?
if you roll the breast lateral, a superior tumor will move lateral. if you roll the breast medial, a superior tumor will move medial. superior tumors move in the direction you roll.
what are the descriptors for mass?
SHAPE: oval, round, irregular. MARGIN: circumscribed, obscured, microlobulated, indistinct, spiculated. DENSITY: high density, equal density, low density, fat containing
what is the likelihood of malignancy for a high density mass vs a low density mass?
70% vs 22%
at what age do you see secretory calcs? what is their diameter?
10-20 years after menopause. usually 0.5 mm or more in diameter
where in the breast do round/punctate calcs form?
in the acini of lobules
what is the most characteristic feature of milk of calcium on different views?
changes shape on different views
what are the suspicious types of morphology of calcifications?
amorphous -> PPV is 20%. coarse heterogeneous -> PPV is less than 15%. fine pleomorphic -> 29%. fine linear or fine linear branching -> PPV is 70%.
what is a regional distribution of calcifications?
occupies more than 2 cm of tissue in greatest dimension
a mass has what type of borders? a focal asymmetry has what borders?
masses are partially or completely convex outwards. focal asymmetries are concave outwards.
what percent of asymmetries seen only on one view on screening mammograms are due to summation artifact?
up to 80%
what is a global asymmetry?
asymmetric compared to the contralateral breast, represents a large amount of FGT over at least one quadrant
what percent of DCIS presents as a mass without calcifications?
8%
what is a developing asymmetry and what is the risk of malignancy?
developing asymmetry is a FOCAL asymmetry that appears larger or more prominent - 15% of cases of developing asymmetries are found to be malignant
what is the management of a developing asymmetry with no sonographic correlate?
biopsy
what is the BI RADS of a solitary dilated duct seen on mammogram, and what is the frequency of malignancy of a solitary dilated duct without other findings? what is it associated with?
BI RADS 4 - frequency of malignancy is reported to be 10% - it is associated with non calcified DCIS.
what is the definition in mm of skin thickening?
more than 2 mm
what is the Bi RADS manual recommendation for how to describe the location of a lesion?
laterality, quadrant, clock face, depth, distance from nipple
what is the likelihood of malignancy in 4A vs 4B vs 4C?
4A: 2-10%, 4B: 10-50%, 4C: 50-95%
what are three specific findings validated as probably benign?
non calcified solid circumscribed mass, solitary group of punctate calcifications, focal asymmetry
what solution should a specimen be kept in if you suspect lymphoma?
saline or RPMI 1640 to faciliate fluorecence activated cell sorting
what is the arterial supply to the breast?
subclavian and axillary arteries and the lateral thoracic, thoracoabdominal and internal mammary branches supply the breast
what structures are in the axilla?
lymph nodes, axillary artery/vein, brachial plexus
what frequency transducer must be used for breast US?
broad bandwidth linear array transducer with center frequency of at least 12 MHz
how should you adjust transducer frequency in patients with large breasts where you need to visualize deeper structures?
use a lower frequency
how can you reduce refraction shadowing in breast US?
put greater compression with the transducer
what is the field of view on breast US?
the depth setting of tissue that is displayed
what is trapezoidal acquisition?
widen the image at the base -> appears trapezoidal and allows you to see the base and lateral aspects of a larger lesion more clearly
what is the second most common invasive ductal cancer after IDC NOS?
papillary ca.
what percent of DCIS on IMAGING has an invasive component at the time of biopsy? what percent of DCIS on BX has invasive component on surgical excision?
if seen on imaging, 10% has invasive component at the time of bx. on core biopsy, 25% has invasive component on surgery.
what is the e cadherin status of lobular cancer?
cells lose e cadherin -> don’t stick to each other-> infiltrate the breast in a single file spread -> architectural distortion
what is pagets disease of the breast? what percent have a palpable finding?
Pagets = in situ of the nipple epidermis (usually DCIS). 50% have a palpable finding.
it is NOT T4 disease, it is still in situ ca but just involving the nipple epidermis.
what percent of radial scars are associated with DCIS and/or IDC?
10-30%
what is the histological difference between LCIS and ALH? what is the risk of subsequent breast cancer in LCIS vs ALH?
LCIS: lobule is distended, ALH: lobule is not distended. risk of ca with LCIS is 11 times, risk of ca with ALH is 4-6 times.
what systemic conditions is milky nipple discharge associated with?
thyroid issues or pituitary adenoma, also associated with meds: antidepressants
what is the ratio of males with breast cancer that have a BRCA mutation? what is the average age for a male with breast cancer?
1 in 4 males with breast ca have BRCA mutation, more commonly BRCA2. average age of male with breast ca is 70.
what percent of male breast cancers have calcifications?
25%
what is the signal intensity of extra capsular silicone on MRI?
T1 dark and T2 bright.
when do benign calcs at a surgical site usually appear?
2 years
what is the required resolution of line pairs for mammo?
13 lp/mm in the anode to cathode direction and 11 lp/mm left to right
how many fibers, microcalcs and masses do you need on a mammo?
4 fibers, 3 microcalc clusters, and 3 masses
what are the parameters of a breast phantom?
50% FGT, 4.2 cm thick, and dose less than 3 mGy per image with the grid
what is the average thickness of a compressed breast?
6 cm
what is the benefit of compound imaging?
it reduces noise/ speckle and improves resolution at the center of the image. can visualize architectural distortion.
what are the units of measurement of stiffness for shear wave elsastography?
m/s and k/Pa
what are the categories for elasticity assessment?
soft, indeterminate, hard
what are the tissue diagnoses associated with micro cysts?
FCC and apocrine metaplasia
when should bx be recommended for a BI RADS 3 solid mass?
if there is 20% or more growth in the longest dimension in 6 months
what are the US findings that based on strong evidence can be categorized as Bi RADS 3?
circumscribed, parallel hypoechoic mass and complicated cyst
how many images should be recorded on a normal screening breast US?
5 - one in each quadrant 4 cm FN and one retroareolar. based on ACRIN 6666 trial.
what are retroglandular implants?
anterior to the pectoralis
what are the MRS findings in breast ca?
elevated choline
what sequence is FGT determined on MRI?
T1
what is the ddx for a peri implant fluid collection in MRI?
recent implant, infection, or bleeding
what is a retropectoral implant?
behind the pectorals
what are the MRI descriptors for a mass?
shape (round, oval, irregular), margin (circumscribed/not circumscribed ->irregular or spiculated), internal enhancement (homogeneous or heterogeneous)
what are the MRI descriptors for NME?
distribution (focal, linear, regional, multiple regions, segmental, diffuse), internal enhancement patterns (homogeneous or heterogeneous-> clumped or clustered ring)
what are the parameters for initial and delayed enhancement?
initial (first two minutes): slow, medium, fast. delayed: persistent, plateau, washout.
what is the likelihood of malignancy of linear, clumped, and segmental enhancement?
more than 2% so these should be BI RADS 4
what are two T2 bright malignant masses?
mucinous ca and liposarcoma
what is false positive 1?
no cancer within one year of a positive screening exam (BI RADS 0)
what is false positive 2?
no tissue diagnosis of cancer within one year after recommending tissue diagnosis or surgical excision (BI RADS 4 or 5)
what is false positive 3?
concordant OR discordant benign tissue diagnosis and no known tissue diagnosis of cancer within one year after recommending tissue diagnosis (BI RADS 4 or 5)
what is PPV 1?
the percent of all positive screening exams (BI RADS 0) that result in a positive tissue diagnosis within one year. PPV1=TP/number of positive screening exams or PPV=TP/TP+FP1
what is PPV2?
involves bx recommended. the percent of all positive diagnostic exams that result in a tissue diagnosis of cancer within one year (BI RADS 4 and 5)
PPV2= TP/number of diagnostic exams recommending biopsy
what is PPV 3?
it is also known as biopsy yield of malignancy or the positive biopsy rate. it is the percent of biopsies that result from a BI RADS 4 or 5 and result in a tissue diagnosis of cancer within one year.
PPV3 = TP/number of biopsies
what is the abnormal interpretation rate
number of positive exams i.e. BI RADS 0,3,4,5 divided by the total number of exams - can have a screening or diagnostic abnormal interpretation rate
what is the definition of a minimal cancer?
DCIS of any size or invasive ca less than 1 cm
when should you use a lower frequency transducer in breast US?
dense breasts, deep lesions, large breasts
what is the best view to get to detect local recurrence after lumpectomy?
spot compression tangential
what is a bucky factor?
the increase in radiation dose to the patient due to the use of a grid.
for what patient should you get US before mammo for a palpable mass?
age less than 30, pregnant/lactating at ANY age
what are the major BI RADS classifications for calcs?
typically benign and suspicious morphology
what percent of all breast ca is triple negative?
7-10%
what percent of BRCA 1 patients have triple negative ca?
70%
triple negative cancers are more common in what populations?
BRCA 1, post menopausal, obese, AA
where do triple negative cancers metastasise to?
brain and lungs (as opposed to bones)
what is the sensitivity of MRI for detection of breast cancer vs mammo?
MRI sensitivity is 80-90%, mammo sensitivity is 30-50%
how do BRCA 2 cancers present as opposed to BRCA 1?
smaller, more likely to be ER and PR positive, and less aggressive than BRCA 1 cancers
what is the highest acceptable positive node status for cancers detected on screening?
25%. This means that 75% or more cancers picked up by screening should be node negative.
what is the goal PPV1? PPV2?
PPV1: 5-10%. PPV2: 25-40%
what is sensitivity vs specificity?
sensitivity: probability of picking up cancer when cancer is present. specificity: probability of a normal study when there is no cancer.
how many mammograms is 1 Sv?
200 mammograms
what is the radiation exposure from a single screening mammogram?
4-24 mSv
what is the cumulative average risk of developing a radiation induced breast cancer from screening mammography?
in women age 40-80 the cumulative average risk of a radiation induced breast cancer is 1/1000. individual risk is negligible
what is the underlying type of cancer in inflammatory breast cancer?
moderately diff IDC: 70%, poorly diff IDC: 20%, ILC: 10%
what is the definition of locally advanced breast cancer?
breast ca of any size that has skin or chest wall involvement, or breast cancer more than 5.5 cm
what is the definition of chest wall invasion in regard to structures affected?
chest wall invasion is involvement of rib, serratus anterior, or intercostal muscles. it does NOT include pec major or minor.
does medullary ca usually respond to hormonal therapy?
No - it is usually triple negative, does not respond to hormonal therapy but responds to chemo
screening mammo goal is to detect potentially curable cancer of less than or equal to what size?
less than or equal to 1 cm
what is the most important sequence in MRI for detecting implant problems?
T2W fat sat
what does compression do in mammography?
increases contrast, increases spatial resolution, decreases dose, decreases scatter
how often does the phantom with fibers/calcs/masses need to be imaged for QC? what are the components of the phantom? what is the minimum required visibility to pass QC?
weekly. components of the phantom: 6 fibers, 5 calcs, 5 masses. minimum required to pass QC is 2 less than this in each category (4 fibers, 3 calcs, 3 masses)
where do skin folds most often occur in the MLO vs CC view and what should be done to fix it?
on MLO view skin folds most commonly occur at the lateral breast at the point of contact with the receptor - tech should pay attention to the lateral breast to avoid skin folds. on the CC view, skin folds occur on the inferior aspect of the breast at the point of contact with the receptor - tech should pay attention to the inferior breast on the CC.
what kind of implants is desmoid tumor associated with? what is the treatment?
saline. Rx is surgical excision
what is increased in growth in gynecomastia? what are the types?
hyperplasia of ductal and stromal elements. types: nodular, dendritic, diffuse
what testicular tumors are associated with gynecomastia?
embryonal cell, seminoma, choriocarcinoma
what are the different types of myocutaneous flaps? what are contraindications to flaps?
transverse rectus abdominis, deep inferior epigastric perforator, latissmus dorsi myocutaneous. CI: poor health, extensive abdominal scarring, vascular disease, locally advanced primary breast ca
what is the percentage of primary breast lymphoma?
0.1-0.2%
what is a juvenile type fibroadenoma? what is adult type FA?
juvenile: a cellular FA with more epithelial components than stromal . adult type is less cellular and has more stromal components.
what is the definition of multiple bilateral masses? what percent of screening mammograms show multiple bilateral masses?
at least 3 total with one in each breast. 1.7% of screening mammograms.
what is the management after biopsy proven stromal fibrosis?
six month follow up
what are the imaging findings of reduction mammoplasty?
retroareolar fibrotic band, swirled FGT in lower inner quadrant, elevation of nipple with more skin inferior than superior
what does PET often show in ILC?
false negative
what percent of ILC is seen is an ill defined or spiculated mass on mammo?
45-65%
what is a silicone granuloma?
mass caused by FB reaction to free silicone
what symptoms can silicone in the axilla cause?
brachial plexus neuropathy
where does adenoid cystic carcinoma often present?
in the subareolar or central region
what are the cancers that cause SVC syndrome? what are the CXR findings?
bronchogenic ca most commonly. other etiologies are mets, lymphoma, thymoma. on CXR see wide mediastinum with enlarged azygous vein. right sided mass is more common.
what percent of all breast cancers are medullary ca? what is its growth pattern?
5-7%. fast growing and locally aggressive.
what is the increased risk of breast cancer in either breast with LCIS?
11 times increased risk
is poland syndrome more common in males or females, and on the right or left? what is the inheritance and associated features?
absence of pec major. more common in males, on the right side. autosomal recessive.
also have: ipsilateral syndactyly and brachydactyly, absence of pec minor, hypoplasia of ipsilateral breast, atrophy of ipsilateral 2nd-4th ribs.
associated with increased risk of: breast ca, leukemia, NHL, lung cancer.
what are pre disposing factors for ductal ectasia?
smoking, hyper prolactinemia, phenothiazine exposure
what is the difference between radial scar and CSL?
if greater than 1-2 cm it is a complex sclerosing lesion
what is a radial sclerosing lesion? what is it associated with?
includes radial scar and CSL. associated with tubular ca, IDC, DCIS, LCIS, ADH.
what is seen on mammo in turner syndrome? what is turners associated with?
mainly fatty breasts, widely spaced nipples. associated with aortic coarctation, aortic stenosis, horseshoe kidney, cystic hygroma
what is steatocystoma multiplex? what is seen on mammo?
autosomal dominant, multiple sebaceous cysts in the back, extremities, trunk, breasts. see multiple bilateral oil cysts.
what is a true recurrence of breast ca?
cancer at the original tumor site less than 5 years after BCT
what is the sensitivity and specificity of FDG PET for local recurrence?
89 and 84%
what is sclerosing adenosis? what is the increased risk of invasive ca?
caused by lobular hyperplasia. 1.7-2.5 increased risk of invasive cancer.
what is an angiolipoma?
scattered micro thrombi in small blood vessels. it is hyper echoic on ultrasound.
what is a granular cell tumor and how often is it malignant? what is the management?
it is composed of a nest or sheets of cells with eosinophilic cytoplasmic granules. it is malignant in 2%, management is excision.
what is the average age at diagnosis for angiosarcoma of the breast? what risk factor is it associated with?
35 years is mean age. associated with radiation exposure.
what do the keyhole sign, sub capsular line sign and linguini sign represent?
keyhole: silicone has leaked out of shell and becomes trapped in the folds of the implant. sub capsular line: silicone between the implant and fibrous capsule. linguini: folding and collapsing of the implant shell on itself
what is the most common presentation of ILC? second most common?
mass 44-65%, architectural distortion 10-30%
what is the dose difference in digital vs screen film mammo? what is the difference in spatial resolution?
digital is 15% less dose than screen film. spatial resolution is more in screen film.
how many false marks does CAD have for every 4 view mammo? by how much does CAD increase the detection rate of breast ca?
2.0 false marks. CAD increases detection rate by 7-20%.
to what organ is there the most dose from BSGI?
bowel
is BSGI more sensitive in dense or fatty breasts?
equally sensitive
what are the common histologies of interval cancer?
mucinous or lobular
when should you do BSGI?
day 2-12 of menstrual cycle
what is the van nuys prognostic index?
assesses recurrence of DCIS in patients with XRT vs without XRT
what is the peak incidence of breast cancer after XRT for lymphoma?
15 years after
what is the median time to rupture of a breast implant?
8-11 years
what marker is positive in angiosarcoma but not in PASH?
endothelial factor 8
what is the hormone status of most medullary cancers? what is the US appearance?
most are ER and PR negative. shows acoustic enhancement on US.
ACRIN 6667 trial found pre op MRI to detect contralateral breast cancer in what percent of patients?
3%
pre operative MRI is most useful in which cases of newly diagnosed breast cancer?
patients with dense breasts, ILC or IDC with extensive intra ductal component, locally adnvaced disease (tumor larger than 5 cm)
what are the types of detectors in FFDM?
direct: sleneium, indirect: CsI. computed: BaFl
what is the spatial resolution of screen film mammo? digital?
15 lp/mm vs 7 lp/mm
what is the mA for regular mammo and for mag mammo?
regular: focal spot 0.3 mm and mA is 100. magnification: focal spot 0.1 mm and mA is 50.
what are the smallest size of calcifications that can be seen on mammo?
150 micrometers
what is the benefit of single emulsion screen used in mammo?
less parallel, less crossover, better spatial resolution but increased dose
what is the bucky factor for mammo? for regular X-ray?
mammo BF = 2. all else BF = 5.
what is the percent for one SD? 2 SD? 3 SD?
1 SD = 67%, 2SD = 95%, 3 SD = 99%
what is the kVP used in mammo?
25-28
what is the gird made of in mammo and what is the grid ratio?
lead strips and carbon fiber. grid ratio is 4-5.
what is the HVL in mammo?
0.3 mm Al (thickness of Al that attenuates 50% of the incident energy)
how many pounds does compression paddle give?
25-45 lbs up to 1 minute
what are the image receptors in mammo?
18X24 or 24X30
how do u fix wrap around artifact?
enlarge FOV or switch F and P encoding
how to u fix incomplete fat sat?
shimming the magnet
what direction does zipper artifact occur in? what is it due to?
phase encoding, it is due to RF interference
what are the FDA requirements for HVL in mammo?
HVL cannot be less than kV/100 in mm (28 KVP HVL cannot be less than 0.28 mm)
for what types of breasts do you use lower/higher kV in mammo?
thinner or fatty breasts, higher kV for thicker or denser breasts
what is the least source to image receptor distance for regular mammo?
at least 55 cm
what is horizontal line artifact?
due to defective line of pixels on regular and mag views, Rx: image plexiglass to calibrate, or service machine
what is the FDA requirement for line pairs in screen film mammo?
11 lp/mm for mag and non mag
which has more spatial resolution screen film or digital? contrast resolution?
screen film has more spatial resolution. digital has wider dynamic range and more contrast resolution.
what is BI RADS 3 on US according to BI RADS?
solid oval parallel mass, complicated cyst with no posterior features
what are 2 benign rim enhancing lesions on MRI?
cyst and fat necrosis
what are the two locations of implants?
retroglandular (pre pectoral) is anterior to the pec, retropectoral
what are the high risk screening guidelines?
MRI and mammo for women with BRCA gene mutation,, first degree untested relatives, women who got chest XRT btw the age of 10-30, greater than 20% lifetime risk
when should high risk women start screening?
MRI and mammo at age 25-30 or 10 years before their first degree relative, or 8 years after XRT but not before the age of 25
what is the increased dose from BSGI or PEM compared to mammography?
15-30 times the dose of a digital mammo
what is the nerve supply to the breast?
intercostal nerves T3-T5
what are the three types of cancer that are more associated with breast pain than others?
adenoid cystic, anaplastic, and ILC
what is the screening cancer detection rate?
4.7/1000
