Radiology of the Breasts Flashcards
Breast imaging used periodically in asymptomatic patients
Screening mammography
Breast imaging targeted to patients with signs or symptoms of breast cancer
Diagnostic breast imaging
What is the primary purpose of breast imaging
Detect breast carcinoma early and increase survival
Secondary purpose of breast imaging
Detect and evaluate benign disease
Lobules and ducts show up _______ on imaging and fat shows up _________
White
Black
Malignant cells from breast cancer can spread direct,t into the ___________ __________
Infraclavicular nodes
The American cancer society recommends what for early detection of breast cancer
Women should be familiar with how their breasts normally look and feel and should report any changes to health care provider
Women between 40-44 have the option to start screening with a mammogram every year
Women 45-54 should get yearly mammograms
At 55 women can switch to every other year
_____ % of women will experience at least 1 false positive recall, ____% false positive short interval follow up, and _____% false positive
50
17
11
False negative rates for mammography
15%
Breast imaging reporting and data system (BI-RADS) categories
0- incomplete
1- normal; annual
2- benign; annual
3- probably benign, short-term follow up
4- suspicious abnormality, consider biopsy
5- highly suspicious of malignancy, biopsy indicated
6- biopsy proven malignancy, intervention
3D vs 2D mammography
3D (digital breast tomosynthesis) decreases call backs, increases CA dx, better in dense breasts, increased costs
What happens if a breast mass is located in a portion of the breast that is difficult to include in the image
The mammogram may fail to demonstrate the lesion
What is the first step in picking a breast imaging technique for the patient
Determine if they are symptomatic or asymptomatic
T or F: Asymptomatic patients only need routine mammography for screening
True
What are symptoms that indicate further breast imaging?
New or enlarged lumps, skin changes, nipple retraction, eczema good changes, bloody or serous discharge, focal pain or tenderness
If a diagnostic study is needed, what technique is obtained first?
Standard two view mammogram
What should be made known to the radiologist when you order imaging for a suspected mass?
The location and description of a suspected breast mass
What are the indications for ultrasonography?
Detected, indeterminate mass
Palpable mass not seen on mammography
Palpable Mass on patient under the age of 40
Significantly dense breast
Ultrasound is highly reliable for
Differentiating cystic from solid masses
If the criteria for a simple cyst are met, the diagnosis is over ___% accurate
99%
What are limitations of ultrasound
It is operator dependent
Only images a small part of the breast at one moment
What is the first Indication of image guided needle aspiration and biopsy
To confirm dx, relieve pain or both
Cystic fluid is not routinely sent for cytology unless
It’s bloody
What is the second indication for image guided biopsy? What is used for this?
Solid lesions- core needle biopsy is used in this case
Why is core needle biopsy used for solid lesions?
To confirm benignity of a lesion with low suspicion of malignancy
To confirm malignancy in a highly suspicious lesion prior to initiating further surgical planning and treatment
To eval any other lesion for which further imaging or excision is a less desirable option
Guidance for needle biopsy can be accomplished with
Stereotactic mammography, ultrasound, and MRI
What are the most common techniques for needle biopsy guidance
Ultrasound and mammography
When a non palpable breast lesion must be excised, imaging is used to guide placement of a needle into the breast, with the needle tip traversing or flanking the lesion. What is this called?
Image guided needle localization
Why is a hook wire inserted after the needle is in the appropriate position during image guided needle localization?
This prevents migration during patient transport and surgery
Spherical calcifications with lucent centers are typically
Benign calcifications associated with fat necrosis and calcified cysts
T or F: The majority of breast cysts are malignant
False, the majority are benign
Breast cysts mostly occur in (older/younger) patients with FCC
Younger
Breast cysts may indicate ___________, some of which are malignant and may be associated with nipple discharge
Intraductal papilloma
T or F: breast cysts often recur
True
On ultrasound breast cancers are ______ while on mammogram breast cancers are _______
Black
White
What are the 9 possible causes of palpable masses
Fibroadenoma, lymph nodes, malignancies, cysts, abscess, galactocele, fibrocystic change, hematoma, fat necrosis
What imaging captures multiple images of the breast and combines the images using a computer to create detailed picture
Breast MRI
What are the indications for breast MRI
Preop eval in patients with newly dx breast CA
Eval of breast CA treated with chemo
Eval of breast CA patients with positive surgical margins after breast conservation therapy
Eval of patients with metastatic axillary lymphadenopathy and unknown primary malignancy
Determine silicone implant integrity
CA screening in high risk women
Problem solving tool for equivocal mam findings
When should you be concerned about nipple discharge?
If it is unilateral, bloody, or spontaneous
