RD breast formatted Flashcards
- Breast cancer on MRI – features:
a. Peripheral enhancement
b. Central enhancement
c. Non-enhancing septa
d. Gradual enhancement
e. Rapid enhancement
e. Rapid enhancement T rapid enhancement + washout = 87% malignant( best answer)only false is D1. Breast cancer on MRI – features (SK):
a. Peripheral enhancement T rim enhancement can be a feature of benign (e.g. fat necrosis, seroma, cyst, abscess) & malignant (e.g. IDC or DCIS) lesions – rim usually smooth & uniform if benign & irregular in malignant. Periphery tends to enhance first with malignant lesions. Rim enhancement is frequently a feature of high-grade IDC, fat necrosis & inflammatory cysts. If not a cyst, a lesion with rim enhancement has a 40% chance of being malignant.
b. Central enhancement T Central enhancement is pronounced enhancement of a nidus within an enhancing mass. Central enhancement has been associated with high-grade ductal cancer & vascular breast tumours.
c. Non-enhancing septa T dark internal (non-enhancing) septations can occur in both benign (e.g. FA, phyllodes) & malignant (e.g. mucinous, IDC) – septa have no intrinsic clinical significance, prognosis is that of underlying lesion
d. Gradual enhancement F more suggestive of benign lesion
e. Rapid enhancement T rapid enhancement + washout = 87% malignant
- GP finds ‘?mastopathy’ on examination. Mammo and US very suspicious (cat 4 lesion). Biopsy shows fibroglandular tissue (no malignancy). Best course of action?
a. Call referrer to discuss
b. Note path and file report
c. Make sure referrer CC’d on path report
d. Note path and send copy to referrer
e. Call pathologist and ask him to review tissue
a. Call referrer to discuss will need repeat percutaneous biopsy or excision biopsy
2. GP finds ‘?mastopathy’ on examination. Mammo and US very suspicious (cat 4 lesion). Biopsy shows fibroglandular tissue (no malignancy). Best course of action?
a. Call referrer to discuss will need repeat percutaneous biopsy or excision biopsy
b. Note path and file report
c. Make sure referrer CC’d on path report
d. Note path and send copy to referrer
e. Call pathologist and ask him to review tissueCat 4 = suspicious findings of malignancy = requires further investigation, even if non-excision biopsy is benign (RANZCR BIG guidelines)
- Mammographic appearance of radial scar, which is false:
a. Long radiating spicules with intervening lucency
b. Architectural distortion
c. May have overlying skin retraction
d. Variable appearance on different projections
e. May have associated calcifications
c. May have overlying skin retraction F radial scar must have no overlying skin thickening or retraction. Excision biopsy indicated
Patient with palpable breast lesion upper outer quadrant left breast. GP thinks related to hormone treatment. No family or personal history. U/S and mammogram normal. What is your advise.
a. return to normal biannual screening.
b. re imaging in 3 months
c. mammogram in 12 months
ANS = A return to normal screeningTriple test comprises:
• Clinical history & breast physical exam
• Imaging – mammo &/or US
• Biopsy – FNA &/or core biopsy
Triple test positive if any of the 3 components is positive. When a discrepancy between thetriple test components occurs, further investigation is mandatory.This may include excision biopsy.
However, if clinical mass, but normal tissue and no discrete lesion at Imaging:
• If consistent with clinical findings reassure & return to normal screening (in this case GP thinks its related to HRT, so likely concordant)
• If inconsistent needs biopsy (&/or referral to breast surgeon)
Regarding breast imaging, which is most correct:
a. fat necrosis can present as speculated mass and architectural distortion.
b. lobular carcinoma most commonly presents as mass
c. lobular carcinoma most commony presents with mass and calc
• A = T fat necrosis commonly spiculated & distorted
• B = T lobular carcinoma = spiculated mass (most common) on mammography (StatDx); Cardenosa says 40% present as spiculated mass (most common); no calcifications
Radiopedia agrees, most common mammographic feature of ILC is spiculated mass.
Lobular carcinoma (StatDx)
• Size underestimated on mammography and US
• Imaging appearance:
o Spiculated mass (most common) on mammography
o Isolated architectural distortion
o New focal asymmetry, often seen only on CC view o Calcifications rare (1-11%)
• 52% sensitivity on mammography (range 34-72%) o Difficult to detect mammographically due to insidious growth pattern
• Commonly multifocal or multicentric
• Increased rate of contralateral cancer
• Often coexists with LCIS and ALH
Patient dx with phyllodes. Next best management.
a. simple excision
b. wide local excision
c. mastectomy
d. follow up
ANS = B WLE required with margin ≥ 1cm; if very large mastectomy; do not need axillary node dissection (stromal tumour, nodes uncommon)
Phylloides - Fine needle aspiration is inaccurate, and even core biopsy has moderate sensitivity due to tumour heterogeneity causing inadequate sampling
Ultrasound General sonographic features are non-specific and can mimic that of a fibroadenoma 7.
Regarding ruptured internal breast implant:
a. on u/s snow storm
b. reliably dx on u/s
c. reliable dx on mammo
d. reliatbly dx on MRI
e. on MRI appears as gentle folds
• D = T MRI most accurate for implant integrity
Regarding screen. Which is true:
a. annual screen picks up more cancer than bi annual screen
b. screening with mammogram and u/s decreases Ca mortality.
c. screening with mammogram decreased mortality.
c. screening with mammogram decreased mortality.
Re DCIS:
a. can present as branching 1mm micro calcs
b. can present as coarse calc
c. can present as mass
C = T 10% of DCIS present as a mass
*LW:
Wording is difficult in this one:
A: branching 1mm micro calcs, is not specific BIRADS lexicon, but this would imply course heterogenous on size, and branching which is suspicious, thus could represent DCIS.
B: coarse calcification: non specific by itself, if stated “course heterogenous” this is deemed intermediate risk and can represent low grade DCIS.
C: agree this is true in that upto 10% can present as a mass.
regarding medullary/colloic ca
a. a/w dcis in 75%
b. rarely palpable
c. speculated mass
d. rarely seen on U/s
Not sure? Bad recall – medullary vs mucinous/colloid cancer (2 different types)
• A - a/w dcis in 75%= F for medullary and mucinous (Cardenosa p302 – low-grade DCIS may be found adjacent to mucinous Ca, but is not a prominent component of these lesions)
• B - rarely palpable = F often palpable masses
• C speculated mass = F usually not spiculated – usually rounded masses with circumscribed to ill-defined margins
• D rarely seen on U/s = F rounded hypoechoic mass +/- posterior enhancement
- A 53 year old woman presents with a clinically suspected breast implant rupture. Which of the following is the NEXT MOST APPROPRIATE:
a. Clinical examination
b. Mammogram including push back views
c. US examination
d. MR examination
e. Imaging guided biopsy
d. MR examination T MRI is the most accurate imaging examination for the evaluation of silicone implant rupture (although may only need mammo if saline implantAJR 1993 – MR more sensitive & specific than mammo, CT & USBJR 2008 (RE single lumen implants) – mammography of “little value”; US “can be useful”; MRI is “gold standard” with a sensitivity of 89% & specificity of 97% for assessing possible rupture
- If proven BRCA1 mutation, what is most likely to develop in the way of breast cancers?
a. Mucinous
b. Medullary
c. Invasive ductal
d. Invasive lobular
b. Medullary
Among cancers arising in BRCA1 carriers, 13% are of medullary type, and up to 60% have a subset of medullary features. Although, the majority of medullary carcinomas are not associated with germline BRCA1 mutations, hypermethylation of the BRCA1 promoter is observed in 67% of medullary carcinomas, suggesting an association of this morphology with underlying gene expression (Robbins p1087)BRCA1-associated breast cancers are commonly poorly differentiated, have “medullary features” (a syncytial growth pattern with pushing margins and a lymphocytic response), and do not express hormone receptors or overexpress HER2/neu (the so-called “triple negative” phenotype). Their gene profiling signature is very similar to basal-like breast cancers, a distinct molecular subtype that is discussed later. BRCA1 cancers are also frequently associated with loss of the inactive X chromosome and reduplication of the active X, resulting in the absence of the Barr body.[25] BRCA2-associated breast carcinomas also tend to be relatively poorly differentiated, but are more often ER positive than BRCA1 cancers.
- 55 year old female with a left breast mass. Mammography demonstrates a fat density mass. Appropriate further management:
a. Reassure
b. MRI with contrast
c. US with core biopsy
d. Surgical excision
e. Follow up mammography at 3, 6 and 12 months
a. Reassure T Radiolucent (fatty) • Lipoma • Oil cyst • Galactocele
Fat containing lesions
- lipoma
- oil cyst
- galatocele
- lymph node
- harmatoma
Radiolucent mixed • Hamartoma (fibroadenolipoma) • Galactocele • Lymph node • Haematoma
- 52 year-old female has a breast mass containing calcifications. 12 x 14 gauge core biopsies containing calcifications on specimen mammography. Pathologist report states consistent with fibrocystic change without comment on calcifications.
a. Repeat biopsy
b. Surgical excision
c. Mammography at 3/12
d. Mammography at 6/12
e. Repeat pathology assessment of initial biopsy specimens
e. Repeat pathology assessment of initial biopsy specimens
Breast fine needle aspiration cytology and core biopsy: a guide for practice (NBCC, Australia)Core biopsy pathology must be correlated with the clinical and imaging findings, and the results later reviewed in conjunction with associated surgical pathology or clinical and imaging findings.
Pathologic report must include:
o a brief microscopic description of the tissue received
o description of any abnormal findings, both benign and malignant
o indication of the presence or absence of microcalcifications of sufficient size to be radiologically detected and their correlation with the specimen radiograph.
Calcifications of > 100-µ assessed histologically are not visible on core biopsy specimen radiographs and may not represent the mammographically detected calcificationo findings should be correlated with the clinical and imaging findings. Note that lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are incidental findings and are not usually detected on imaging.
- Radial scar on biopsy
a. Hookwire & open biopsy
b. Hookwire & breast conservation
c. Mastectomy
a. Hookwire & open biopsy T
Radial scar, or complex sclerosing lesion, is a rosette-like proliferative breast lesion. It is not related to surgical scarring. Some authors, however, reserve the latter term to lesions over 1 cm 5. It is an idiopathic process with sclerosing ductal hyperplasia. Its significance is that it is a mimicker of scirrhous breast carcinoma. Although some classical differential descriptions exist (see below), these cannot be relied on, and the diagnosis must not be made on radiological features alone. Furthermore, there is an association with atypical ductal hyperplasia and carcinoma.
Epidemiology
The reported prevalence of radial scars is 0.1-2.0 per 1,000 screening mammograms. Radial scar is very rare in women younger than 40 years and older than 60 years. Most often in women between 41-60 years 12-13 . Clinical presentation
They are usually not palpable. Clinical examination of the breast containing regions of radial scar is often normal, although in about 25% of cases radial scars can be palpable. They do not cause skin thickening or retraction. Lesions are usually small and detected by mammography when they are at least 5 mm in size. Lesions <1 cm are called radial scars, while larger ones are often referred to as complex or radial sclerosing lesions. PathologyA radial scar is a benign hyperplastic proliferative disease of the breast. Proposed possible causes include localized inflammatory reaction and chronic ischaemia with subsequent slow infarction.Histopathologically radial scars contain hyperplastic tissue cells and a central fibrous core, with radial extension of tubular structures (the spiculated peripheral borders), mimicking infiltrating carcinoma. This tubular formation has two rows of cells, epithelial and myoepithelial 9-10. The malignant potential is two times greater than in the normal population without radial scar 11-12.
Associations
In approximately 30% of cases, a radial scar is associated with ductal carcinoma in situ and tubular carcinoma of the breast. The occurrence of these is higher when there is associated atypia on histology.
Other associations include 4:
atypical ductal hyperplasiaatypical lobular hyperplasia
Radiographic features
Mammography A radial scar has a spiculated appearance similar to carcinoma, but the centre tends to be a translucent, low-density area rather than a mass. The breast tissue behind the lesion is almost visible through the lesion. The relatively low density of the centre is a relevant and visible difference between carcinoma and a radial scar.A carcinoma tends to have a dense centre. With radial scars there is no dense centre; in fact, the lesion is usually as dense centrally as peripherally. There is no “attempt” at forming a mass in a radial scar.The spicules running from the centre are in general longer and gracile than those of a carcinoma (look at the image in Case 1 and 2 thoughtfully. These are representative images).The spicules are described as long and thin with radiating radiolucent linear structures, which against a radiolucent fat background gives a black star or dark star appearance 6. Microcalcifications are possible but rare in a radial scar. However, unlike a carcinoma, features such as skin thickening and retraction are characteristically absent 2. There is no visible scirrhous reaction in the radial scar.Its mammographic appearance is also similar to a post-surgical breast scar and can vary markedly with differing projections (i.e. CC vs MLO).UltrasoundOn ultrasound, a radial scar is often ill-defined and disturbs the architecture of surrounding breast parenchyma. The lesion is usually round, oval or lobulated. Variable internal echoes can be found. Some radial scars show retro-acoustic attenuation. MRIFeatures are replicated as described in the aforementioned modalities. There will be spiculation and archiectural distortion. Non-enhancement of the lesion favours a benign process. Enhancement suggests an underlying malignancy.Treatment and prognosisA radial scar is considered a high-risk breast lesion and histological differentiation from associated carcinoma is required. FNA and core biopsies can underestimate the underlying associated malignancy and are controversial. The lesions are biopsied and removed.Differential diagnosisDifferential considerations for mammographic appearances include:breast cancer: a central mass tends to form. The spicules are shorter and thicker and there is retraction of the parenchyma; however sometimes the invasive lobular carcinoma, due to lack of the E-cadherin and diffuse infiltration of the tumour cells, it can be impossible to distinguish it from radial scar post-surgical breast scar: in practice this is rarely if ever a source of confusion; it is really rare to find post-surgical scarring with such long spicules as a radial scar and you also have the history on the technologist notes and if all else fails, the scar on the patient’s skin
- Tubular breast carcinoma
a. 70% 5 year survival
b. Palpable
b. Palpable T/F Most lesions detected on screening mammography. 30-40% of patients present with a palpable mass. (StatDx)
6. Tubular breast carcinoma (Cardenosa p298)
a. 70% 5 year survival F 95-98% five-year survival (StatDx)
b. Palpable T/F Most lesions detected on screening mammography. 30-40% of patients present with a palpable mass.
(StatDx)
- Tubular/cribriform (6%) –
o Younger women (late 40s)
o Best differentiated – best prognosis
o Small irregular densities (stellates)
o Consist exclusively of well-formed tubules without myoepithelial layer
o Associated amorphous or pleomorphic microcalcifications (Ca++) in up to 50%
- Which isn’t a mass at mammography?
a. Lobular carcinoma
b. Medullary carcinoma
c. Mucinous carcinoma
d. Other answer not recalled
d. Other answer not recalled
- Which isn’t a mass at mammography?
a. Lobular carcinoma T spiculated mass (most common) on mammography (StatDx); Cardenosa says 40% present as spiculated mass (most common); no calcifications (StatDx says calcifications rare)
b. Medullary carcinoma T round-oval, circumscribed or ill-defined mass
c. Mucinous carcinoma T round-oval, circumscribed or ill-defined mass
d. Other answer not recalled
1) 40yo female with hx node positive breast Ca. Constant right shoulder pain for 2 weeks. Normal Xray. Best next examination:
i) Repeat xray 10 days
ii) US
iii) Bone scan
iv) CT
v) MRI
iii) Bone scan
WA imaging guideline- suspect bone met-> bone scan-> x-ray +/- targeted CT of hot spot
Invasive ductal carcinoma. True.
a. account for 50% of detected cancer
b. may appear hyper echoic on U/S
c. may appear as coarse calcification on u/s
d. is negative on FDG PET
e. typically slow moderate enhancement on MRI
*LW: would favour incomplete recall with words used in question stems, as all are technically wrong:
Options A and B and become correct with changes in answer wording….
a. Account for 50% of detected cancer = F = invasive cancer is 70-85% of detected cancer (remainder is in-situ disease), of which 80% is IDC = 56-68% of all breast cancers are IDC (StatDx says 65-80% of all breast cancers) (the least false answer!)
12. Invasive ductal carcinoma. True.
a. Account for 50% of detected cancer = F = invasive cancer is 70-85% of detected cancer (remainder is in-situ disease), of which 80% is IDC = 56-68% of all breast cancers are IDC (StatDx says 65-80% of all breast cancers) (the least false answer!)
b. May appear hyperechoic on US = F usually hypoechoic, may have thick hyperechoic rim SG thinks this is probably most correct.
c. May appear as coarse calcification on US= F
d. Is negative on FDG PET = F – usually high uptake, but well-differentiated IDC & lobular cancers can have lower FDG uptake (StatDx). FDG-PET also insensitive to tumours < 2cm.
e. Typically slow moderate enhancement on MRI breast = F – rapid uptake, washes out
Breast papillary carcinoma.
a. well circumscribed on mamma. hyperechoic
b. well ccircumscribed on mamma with anechoic area
c. speculated on mamma
d. mammo seen as duct ectasia??
e. enhance moderately and slowly on MRI
b. Well circumscribed on mammo with anechoic areas T best answer
23. Breast papillary carcinoma
a. Well circumscribed on mammo. Hyperechoic F well-circumscribed subareolar mass, but complex cystic mass with variable solid component at US
b. Well circumscribed on mammo with anechoic areas T best answer
c. Spiculated on mammo F
d. Mammo seen as duct ectasia (?) F
e. Enhances moderately & slowly on MRI. F variable appearance & enhancement – heterogeneous if solid, mural/nodular enhancement if intracysticDefinition of
Intracystic papillary carcinoma:Encapsulated carcinoma with papillary architecture consisting of papillae with fibrovascular cores within single circumscribed cystic space; lacks myoepithelial layer, but clinical behavior parallels in situ carcinomai.e papillary DCISSpectrum:Benign papillomaLarge duct papillomaSmaller, intraductal mass on USSingle or multiple circumscribed massesIndistinct margin suggests invasive componentAtypical papillomaAtypical cytology, or focal areas within papilloma fulfill criteria for atypical ductal hyperplasiaLobulated mass ± Ca++Sclerosing papillomaPseudoinvasive growth pattern; can be mistaken for carcinoma on histopathologyPapillary DCIS (intracystic papillary carcinoma)Involves multiple ductal spacesDCIS that partially involves papillomaMyoepithelial cells presentSolid papillary carcinomaMultiple nodules rather than single dilated space~ 2/3 are positive for neuroendocrine markers (chromogranin or synaptophysin)
Screening mammo. t/f
a. single reader pick up rate same as dual reader
b. single reader + CAD pick up same rate as dual reader
c. single reader + CAD same accuracy in architectural distortion
d. single reader + CAD same accuracy in micro calcification.
e. single reader + CAD same accuracy in mass
true : b, d, e
- Screening mammo
a. Single reader pick up rate same as dual reader F
b. Single reader + Computer aided detection pick up same cancer as dual reader T if referring to numbers, but do have different strengths/weaknesses & thus may not pick the same “cancer”
c. Single reader + CAD same accuracy in architectural distortion F CAD struggles with architectural distortion
d. Single reader + CAD same accuracy in microcalcification T as good for mass and microcalcification as double reading
e. Single reader + CAD same accuracy in mass TCAD primarily for screening: Does not process spot compression or magnification viewsFactors affecting CAD performanceSensitivity for malignant Ca++ averages 97%; masses (without Ca++): 52-98%; lower for architectural distortion: 33-75%; radiologist ignores marksCAD false-positives: Vascular Ca++, pectoral muscle, postsurgical scars, benign masses1 helpful (true positive) CAD mark per 2,000-20,000 false-positive marks; less benefit to specialistsLack of CAD mark should not deter work-up of suspicious finding(s), esp. developing asymmetries and distortions
DCIS
a. on mammography can look branching lucent centred calcification
b. can look like a mass on mammography
c. on ultrasound can look like a mixed echogenic mass
d. may be heavily calcified
b. Can look like a mass on mammography T Mass with Ca++ 10%; mass alone 10%94.
DCIS
a. On mammography can look branching lucent centred calcifications F form inside the ducts – may be fine linear or branching (high-grade), pleomorphic or amorphous (low-grade) – sounds more like the ‘cigar’ calcifications of duct ectasia (plasma cell mastitis)
b. Can look like a mass on mammography T Mass with Ca++ 10%; mass alone 10%
c. On ultrasound can look like a mixed echogenicity mass F May be visible as hypoechoic mass ± Ca++
d. May be heavily calcified F
- Women present to GP with self detected lump. Mammo and US normal. GP says can feel the lump. (repeat)
a. Follow up mammogram in 3 mo
b. Percutaneous biopsy
c. MRI breast
d. Back to screening
e. Surgery
*LW: following discussion with BreastCare…
Real world answer is breast surgeon referral and MRI.
So MCQ option is MRI.
Below reasoning:
- Reassure GP and patient - nope. Mammography has a sensitivity of 90%, meaning that it misses up to 10% of breast cancers. US sensitivity is lower than this
- Refer for core biopsy - possible, but not the best answer - there is no target for core biopsy, it would need to be a blind palpation biopsy, which means it can ‘rule in’ breast cancer, but not rule it out (because you can’t see what you biopsied, the cancer may be right beside where the needle went)
- Refer for breast MRI - I think this is the best answer - while mammogram has sensitivity of 90%, MRI is 97-99% sensitive. It can not fully exclude breast cancer, but it can get very close to ruling it out. It would make you feel better about follow up.
- 3 month mammogram - nope. Things don’t change enough on mammograms for 3 months to be useful. You might repeat US in 3 months, but we wait 6 to 9 months to repeat a mammo. And you are still stuck with the problem of the lump.
- Return to 2 year mammogram. - this is ‘return to routine screening’. A cancer could grow and metastasize in 2 years. This is another way of trying to get you to say mammogram was sensitive enough to rule out cancer.
**LJS - triple test not satisfied, , needs further investigation. Problem solving tools include MRI and referral to surgeon on clinical grounds, they may biopsy by palpation.
Previous answers:
I think it is MR -25. Women present to GP with self detected lump. Mammo and US normal. GP says can feel the lump. (repeat)
a. Follow up mammogram in 3 mo - F
b. Percutaneous biopsy - F - nothing to biopsy
c. MRI breast ?T may find lesions occult on mammo & US
d. Back to screening - F
e. Surgery - F
- Regarding breast calcifications, which is FALSE?
a. Microcalcifications are a feature of sclerosing adenosis
b. Coarse calcifications is a feature of fibroadenoma
c. Irregular branching rods are a typical manifestation of ductal carcinoma in situ
d. Calcification is commonly seen in a hamartoma
e. A coarse rod with a lucent centre is seen in secretory disease
- LW: think both options C and D are incorrect based on wording provided.
d. Calcification is commonly seen in a hamartoma F? breast within a breast – fat and soft tissue density; StatDx - Benign appearing calcifications may be present; not ‘common’ though. RG 1999 – “coarse dystrophic or punctate calcifications are rarely seen”.1.
Regarding breast calcifications, which is FALSE? (SK/NT)
a. Microcalcifications are a feature of sclerosing adenosis T Microcalcifications found in 47%; Clustered or scattered, amorphous ± punctate. Cardenosa p351,
b. Coarse calcifications is a feature of fibroadenoma T
c. Irregular branching rods are a typical manifestation of ductal carcinoma in situ F? rod-shaped ≥ 1mm calcifications = duct ectasia (plasma cell mastitis) “secretory calcifications”, but should have a ‘smooth border’. High-grade DCIS has pleomorphic, linear, branching, casting-type microcalcifications; should be < 0.5mm.
* LW: the use of the term rods is kinda synonomous with plasma cell mastatis, while suspicous calc patterns include: amorphous, course heterogenous, fine pleomorphic and fine linear / fine linear branching, so I think this option is also incorrect.
d. Calcification is commonly seen in a hamartoma F? breast within a breast – fat and soft tissue density; StatDx - Benign appearing calcifications may be present; not ‘common’ though. RG 1999 – “coarse dystrophic or punctate calcifications are rarely seen”.
e. A coarse rod with a lucent centre is seen in secretory disease T
- Mammography, which of the following statements are TRUE?
a. Optimally exposed image demonstrates a visible skin line under normal viewing conditions
b. Pectoral edge shadow on the oblique should not extend as low as the nipple
c. The subareolar region is the most common region in which to miss cancer
d. Current accepted practice in Australia is a one-view screening study and a two-view diagnostic study.
e. Medial lesion is projected more inferiorly on the oblique than on the lateral
e. Medial lesion is projected more inferiorly on the oblique than on the lateral T “Muffins rise, Lead sinks” – if the mass moves up from the MLO to the lateral view, the lesion is in the medial half of the breast2.
Mammography, which of the following statements are TRUE?
a. Optimally exposed image demonstrates a visible skin line under normal viewing conditions F the ideal exposure (film-screen) will require a bright light to visualize the skin line – although with new CR/DR can usually see skin also
b. Pectoral edge shadow on the oblique should not extend as low as the nipple F on the MLO view pectoral muscle should be seen to the level of the nipple
c. The subareolar region is the most common region in which to miss cancer ?F
d. Current accepted practice in Australia is a one-view screening study and a two-view diagnostic study. F
e. Medial lesion is projected more inferiorly on the oblique than on the lateral T “Muffins rise, Lead sinks” – if the mass moves up from the MLO to the lateral view, the lesion is in the medial half of the breast
- With regard to management papillary tumours of the breast, which of the following is most correct?
a. An intracystic papillary mass with benign cytology should be managed conservatively
b. An intracystic papillary mass with benign cytology is often malignant
c. An intracystic papillary mass with benign cytology has a poor prognosis
d. An intracystic papillary mass with benign cytology should be core biopsied
e. An intracystic papillary mass with benign cytology should be surgically removed
e. An intracystic papillary mass with benign cytology should be surgically removed T
Fine-needle aspiration and core needle biopsy may be unable to distinguish between in situ and invasive papillary lesions because the center of the lesion is often targeted, and invasion is often identified at the periphery of the tumor. Therefore, in general, excision is suggested when papillary lesions are suspected or diagnosed at fine-needle aspiration or core needle biopsy. AJR 2003; 181:186.The results strongly suggest that papillary lesions diagnosed as benign at core-needle biopsy should be surgically excised because a substantial number of lesions were upgraded to ADH and DCIS at excision.March 2006 Radiology, 238, 801-808.The accuracy of FNAC in diagnosing papillary lesions and differentiating benign and malignant papillary lesions is low [20]. Among the aspirates diagnosed as atypical, intraductal papilloma represents about 6% [21]. To date, there have been no well-defined cytological criteria to differentiate between benign and malignant papillary lesions. Their significant overlap in terms of architecture and cytological atypia is the primary reasons for not differentiating them cytologically.Pathology Research International. Volume 2011 (2011)
