Radiology and Cytology of Breast Disease Flashcards
What are the different types of breast imaging techniques?
Mammography Ultrasound Image guided techniques MRI Nuclear Medicine
What is Mammography?
Mammography is specialised medical imaging that uses a low-dose x-ray system to see inside the breasts.
With what age groups of women is mammography used?
Mammography is mostly used in women over 40 years of age. (Less dense breast tissue). It can be used in women under 40 - if there is a strong suspicion of cancer. - family history greater than 40%
What is the radiation dose in mammography?
1mSv (millisivert) - This is very small, radiation only affects human at 100 mSv.
What are the signs of Disease in mammography?
- Dominant mass - Asymmetry - Architectural distortion - Calcifications
What are the differentiators between a malignant and benign soft tissue mass?
Malignant - irregular, illdefined - spiculated - mass has spikes or points on its surface. - Dense - Distortion of the architecture Benign - Smooth and lobulated - Normal density - Halo
Why are ultrasounds used to image breasts?
Differentiates - Solid mass from a cystic mass - Solid benign from malignant - First line of imaging in the under 40 age group - No ionising radiation - Improves specificity of imaging
How would a solid benign vs a malignant mass appear on Ultrasound?
Solid Benign - smooth outline - oval shape - acoustic enhancement Malignant - irregular outline - interrupting breast architecture - acoustic shadowing and anterior halo
What does “Triple Assessment” involve? Outline the sensitivity and specificity of this assessment.
- Clinical Examination - Imaging - FNA Cytology Sensitivity 97-100% Specificity 98-100% for detection of breast cancer. Imaging and cytology have been proven to be the two most reliable components.
What is a stereotactic biopsy?
A biopsy procedure that uses a computer and imaging performed in at least two planes to localise a target lesion in three-dimensional space and guide the removal of tissue for examination by a pathologist under a microscope.
What is an ultrasound biopsy?
Form of imaging guided biopsy where USS is used to guide the biospy needle to the correct area to perform a biopsy.
What is the difference in an FNA and a core needle biopsy?
FNA - takes a few cells, which are then look at on a microscope slide, like a biopsy but more limited, quicker and cheaper. Core Needle Biopsy - Large needle into the core of the area being assessed. Patient under local anaesthesia. More reliable than FNA.
What are the indications to use an MRI of the Breasts?
- Recurrent Disease - Implants - Indeterminate lesion following triple assessment - Screening high risk women
What are the Pros and Cons of MRI imaging the breast?
Pros - Sensitivity 94-98% for all breast density - Great Problem solving tool Cons - Specificity is poor - Claustrophobic, Noisy, Lengthy, IV contrast - Expensive
What is the Sentinel Node? Outline its identification and removal.
The sentinel node is the first few lymph nodes into which the tumour drains. This can be identified prior to mastectomy or lumpectomy using a radioactive trace. The majority of sentinel nodes are found in the axillary lymph nodes.
