Radiology and Cytology of the Breast Flashcards
Using which modalities can breast imaging be done?
- Mammography (gold standard)
- Ultrasound (not normally used in isolation- in conjunction with mammography can be helpful)
- MRI
- Nuclear medicine
- CT
Which are the two standard views for mammography?
Mediolateral oblique
Craniocaudal
What additional views can be used in mammography?
- Coned view
- Magnification view
- True lateral
- Extended cc
- Eclund views
How are the breasts compressed for mediolateral oblique and craniocaudal mammography?
Mediolateral oblique- left/right compression
Craniocaudal- top/bottom compression
What are the characteristics of cancer on mammography?
- Mass
- Asymmetry
- Architectural distortion
- Calcifications
- Skin changes
What are the characteristics of malignant soft tissue masses on mammography?
- Irregular, ill-defined
- Spiculated
- Dense
- Distortion of architecture
What are the characteristics of benign soft tissue masses on mammography?
- Smooth or lobulated
- Normal density
- Halo
- No distortion of architecture
When is ultrasound used for breast imaging?
Can differentiate between solid and cystic masses as well as benign and malignant
First line investigation <40 as breast tissue will be too dense for mammography
What are the characteristics of benign solid lesions on ultrasound?
- Smooth outline
- Oval shape
- Acoustic enhancement
- Orientation
What are the characteristics of malignant masses on ultrasound?
- Irregular outline
- Interrupting breast architecture
- Acoustic shadowing
- Anterior halo
What are the uses of image guided needle biopsy in breast clinic?
Obtain FNA or core biopsy from mass
Therapeutic excision of lesion
What are the indications for an MRI of the breast?
- Recurrent disease
- Implants
- Indeterminate lesion following triple assessment
- Screening high risk women
What are the downsides of a breast MRI
Sensitive but not specific Claustrophobic Noisy Uncomfortable Involves IV contrast Expensive
How is sentinel node sampling done?
Sentinel node sampling involves a peritumoral injection of dye followed by a lymphoscintigraphy and removal of one (sometimes two) nodes
Between what ages are women invited for mammography and how often are they invited?
50-70 every 3 years
What are the possible outcomes of breast screening?
Detects 5 cancers for every 1000 women screened
5-10% recalled for further investigation
What are the characteristics of benign and malignant breast masses on cytology?
Benign: -Flat layers of cells -Cells of uniform size -Cohesive groups of cells Malignant: -High cellularity -Loss of cohesion -Crowding/overlapping of cells -Nuclear pleomorphism -Hyperchromasia -Absence of bipolar nuclei
How is breast cytology scored?
C1- unsatisfactory C2- benign C3- Atypia (probably benign) C4- suspicious (probably malignant) C5- malignant
What steps are taken based on cytology score?
Anything C3 or worse will get an ultrasound guided core biopsy. Aspiration of cysts is curative and if only straw-coloured fluid is withdrawn then it is almost definitely not malignant.
What are the downsides of FNA?
Can give false positives Can give false negatives Cannot give a grading Has complications: -Pain -Haematoma -Fainting -Infection (Rare) -Pneumothorax (Rare)
When is a core biopsy done?
In everyone with clinical, radiological or cytological suspicion
What are the pros of a core biopsy?
Gives full picture of disease pre-operatively
Useful in confirming invasion and giving grade/stage
