Triple assessment Flashcards
What is BIRADS?
Breast Imaging Reporting and Data Systems.
Grading of likelihood of malignancy based on MMG
What does BIRADS 3 signify?
Likelihood of malignancy?
Probably benign
Malignancy < 2%
What does BIRADS 4 signify?
Likelihood of malignancy for 4a,b,c?
Suspicious of abnormality warranting biopsy
4a: 2-9%
4b: 10-49%
4c: 50-94%
What does BIRADS 5 signify? Likelihood of malignancy?
Suspicious of malignancy.
Likelihood of malignancy 95-100%
What is BIRADS 6?
Biopsy proven malignancy
What are the views for MMG?
Cranio-caudal
Mediolateral Oblique
What are suspicious features on MMG?
- Asymmetrical opacity with spiculation and irregular borders
- Micro-calcification (<0.5mm)
- Distortion of breast tissue
- Nipple retraction
- Skin thickening Lymph nodes (radio-opaque)
Suspicious USG features for breast lesion
- Taller than wide
- Irregular borders
- Solid lesion
- Posterior acoustic shadowing
- Increase vascularity
- Muscle/skin Invasion
- Metastatic axillary lymph nodes
Problems with FNAC
High false negative rate
Cannot differentiate between in-situ cancer from invasive
How to perform a trucut biopsy?
14 gauge needle automatic biopsy gun +/- USG guidance
LA injection
Stab incision
Insert needle at angle
Indication for vacuum assisted biopsy device
- Very small lesion
- Architectural distortion
- Failed conventional biopsy
- Small cluster micro-calcification
- Diffuse non-specific abnormality
Types of open biopsy
Palpable mass: excisional biopsy
Non-palpable: Hookwire, Radioisotope Occult Lesion Localization
MMG Sensitivity according to age group
>60: 95%
<40: <40%
What are methods of localization for non-palpable tumors
- Hookwire + Specimen MMG
- Radioguided occult lesion localization (ROLL)
- Sentinel node and occult lesion localization (SNOLL)
- Intra-operative USG
USG sensitivity
98%
