Radiology of the Breasts

Question 1

Breast imaging used periodically in asymptomatic patients

Answer 1

Screening mammography

Question 2

Breast imaging targeted to patients with signs or symptoms of breast cancer

Answer 2

Diagnostic breast imaging

Question 3

What is the primary purpose of breast imaging

Answer 3

Detect breast carcinoma early and increase survival

Question 4

Secondary purpose of breast imaging

Answer 4

Detect and evaluate benign disease

Question 5

Lobules and ducts show up _______ on imaging and fat shows up _________

Answer 5

White
Black

Question 6

Malignant cells from breast cancer can spread direct,t into the ___________ __________

Answer 6

Infraclavicular nodes

Question 7

The American cancer society recommends what for early detection of breast cancer

Answer 7

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

Question 8

_____ % of women will experience at least 1 false positive recall, ____% false positive short interval follow up, and _____% false positive

Answer 8

50
17
11

Question 9

False negative rates for mammography

Answer 9

15%

Question 10

Breast imaging reporting and data system (BI-RADS) categories

Answer 10

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

Question 11

3D vs 2D mammography

Answer 11

3D (digital breast tomosynthesis) decreases call backs, increases CA dx, better in dense breasts, increased costs

Question 12

What happens if a breast mass is located in a portion of the breast that is difficult to include in the image

Answer 12

The mammogram may fail to demonstrate the lesion

Question 13

What is the first step in picking a breast imaging technique for the patient

Answer 13

Determine if they are symptomatic or asymptomatic

Question 14

T or F: Asymptomatic patients only need routine mammography for screening

Answer 14

True

Question 15

What are symptoms that indicate further breast imaging?

Answer 15

New or enlarged lumps, skin changes, nipple retraction, eczema good changes, bloody or serous discharge, focal pain or tenderness

Question 16

If a diagnostic study is needed, what technique is obtained first?

Answer 16

Standard two view mammogram

Question 17

What should be made known to the radiologist when you order imaging for a suspected mass?

Answer 17

The location and description of a suspected breast mass

Question 18

What are the indications for ultrasonography?

Answer 18

Detected, indeterminate mass
Palpable mass not seen on mammography
Palpable Mass on patient under the age of 40
Significantly dense breast

Question 19

Ultrasound is highly reliable for

Answer 19

Differentiating cystic from solid masses

Question 20

If the criteria for a simple cyst are met, the diagnosis is over ___% accurate

Answer 20

99%

Question 21

What are limitations of ultrasound

Answer 21

It is operator dependent
Only images a small part of the breast at one moment

Question 22

What is the first Indication of image guided needle aspiration and biopsy

Answer 22

To confirm dx, relieve pain or both

Question 23

Cystic fluid is not routinely sent for cytology unless

Answer 23

It’s bloody

Question 24

What is the second indication for image guided biopsy? What is used for this?

Answer 24

Solid lesions- core needle biopsy is used in this case

Question 25

Why is core needle biopsy used for solid lesions?

Answer 25

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

Question 26

Guidance for needle biopsy can be accomplished with

Answer 26

Stereotactic mammography, ultrasound, and MRI

Question 27

What are the most common techniques for needle biopsy guidance

Answer 27

Ultrasound and mammography

Question 28

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?

Answer 28

Image guided needle localization

Question 29

Why is a hook wire inserted after the needle is in the appropriate position during image guided needle localization?

Answer 29

This prevents migration during patient transport and surgery

Question 30

Spherical calcifications with lucent centers are typically

Answer 30

Benign calcifications associated with fat necrosis and calcified cysts

Question 31

T or F: The majority of breast cysts are malignant

Answer 31

False, the majority are benign

Question 32

Breast cysts mostly occur in (older/younger) patients with FCC

Answer 32

Younger

Question 33

Breast cysts may indicate ___________, some of which are malignant and may be associated with nipple discharge

Answer 33

Intraductal papilloma

Question 34

T or F: breast cysts often recur

Answer 34

True

Question 35

On ultrasound breast cancers are ______ while on mammogram breast cancers are _______

Answer 35

Black
White

Question 36

What are the 9 possible causes of palpable masses

Answer 36

Fibroadenoma, lymph nodes, malignancies, cysts, abscess, galactocele, fibrocystic change, hematoma, fat necrosis

Question 37

What imaging captures multiple images of the breast and combines the images using a computer to create detailed picture

Answer 37

Breast MRI

Question 38

What are the indications for breast MRI

Answer 38

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

Question 39

When should you be concerned about nipple discharge?

Answer 39

If it is unilateral, bloody, or spontaneous