Breast Flashcards
(396 cards)
1
Q
US –> first line eval for breast abnormality –> who? (3)
A
- <30yo
- pregnant
- lactating
2
Q
MRI –> breast screen –> who?
A
high risk pt (>20% lifetime risk of breast CA)
3
Q
MRI breast –> indications? (6)
A
- screen in high risk pt
- breast CA –> new dx –> eval extent of dz
- eval neoadjuvant ctx response
- positive surgical margins –> assess residual dz
- eval tumor recurrence
- axillary mets –> eval occult breast CA
4
Q
invasive ductal breast CA –> stepwise progression?
A
1) flat epithelial atypia
2) atypical ductal hyperplasia
3) ductal carcinoma in situ (DCIS)
4) invasive ductal carcinoma
5
Q
flat epithelial atypia (FEA) & atypical ductal hyperplasia (ADH) –> obligatory or non-obligatory precursor lesion for breast CA?
A
non-obligatory –> inc risk
6
Q
breast CA –> RF? (7) which are most important RF?
A
- # 1 F
- # 1 age
- BRCA1/2
- 1st deg relative
- chest radiation
- long-term estrogen exposure (early menarche, late menopause, late first preg, nullipartiy, obesity)
- bx high risk lobular lesion (ie atypical lobular hyperplasia, lobular CA in situ)
7
Q
breast CA –> MC type?
A
invasive ductal CA (IDC) not otherwise specified
8
Q
breast CA –> invasive ductal CA (IDC) –> MC clinical presentation?
A
palpable mass
9
Q
breast CA –> invasive ductal CA (IDC) –> classic mammo appearance?
A
- spiculated mass
- architectural distortion
- pleomorphic calcs
10
Q
ductal breast CA –> subtypes? (5)
A
- invasive ductal, not otherwise specified
- tubular
- mucinous (colloid/mucoid/gelatinous)
- medullary
- papillary
11
Q
invasive ductal CA vs other ductal breast CA –> better prognosis –> T/F?
A
F –> other ductal breast CA have better prognosis than invasive ductal
12
Q
breast CA –> tubular CA –> mammo appearance?
A
small spiculated mass
13
Q
breast CA –> mucinous (colloid/mucoid/gelatinous) CA –> US appearance? T2 MRI?
A
- US: low density circumscribed mass –> mimic fibroadenoma
- T2 –> hyper
14
Q
breast CA –> medullary CA –> epidemiology?
A
young F –> BRCA1
15
Q
breast CA: invasive lobular CA –> mammo appearance?
A
architectural distortion –> “dark star”
16
Q
breast CA: what is inflamm CA?
A
tumor invasion of dermal lymphatics
17
Q
breast CA: inflamm CA –> clinical presentation?
A
breast:
- erythema
- edema
- firm
18
Q
breast CA: inflamm CA –> mammo appearance?
A
- breast –> lrg, dense
- trabecula thick
- skin thick
19
Q
what is Paget dz of nipple?
A
form of DCIS –> infiltrate nipple epidermis
20
Q
Paget dz of nipple –> clinical appearance?
A
nipple:
- erythema
- ulcer
- eczematoid changes
21
Q
breast CA –> prognosis –> most important factor?
A
axillary LN status
22
Q
breast CA –> axillary LN involvemt –> how to detect?
A
sentinel LN bx
23
Q
breast CA –> surgical axillary LN dissection –> indication? (2)
A
sentinel LN:
- positive
- not ID
24
Q
estrogen receptor (ER) & progesterone receptor (HR) –> positive –> longer disease free survival –> T/F?
A
T
25
ER, PR, HER2/neu negative --> triple neg CA --> poor prognosis --> MC epidemiology?
BRCA1
26
triple neg CA --> MC mammo appearance? MC location?
breast --> posterior --> round --> smooth margin --> no calcs
27
DCIS --> prognosis --> key factor?
presence of necrosis
28
DCIS --> which subtype gets sentinel LN bx?
DCIS w necrosis --> high grade
29
high grade DCIS --> MC mammo appearance?
calcs:
- pleomorphic
- fine linear branching
30
breast --> fibrocystic change --> epidemiology? clinical presentation?
pre-menopause:
- cyclic breast pain
- sometimes --> palpable lump
31
breast --> fibrocystic change --> imaging dx --> T/F?
F
32
sclerosing adenosis --> mammo appearance?
microcalcs --> can mimic DCIS
33
mastitis --> MC org?
Staph aureus
34
mastitis --> 2 MC epidemiology?
- nursing
| - diabetes
35
mastitis --> clinical presentation?
breast:
- pain
- induration
- erythema
36
mastitis --> imaging (mammo/US) appearance?
- skin thicken --> focal/diffuse
- edema
- adenopathy
37
breast abscess --> MC location?
subareolar
38
breast abscess --> mammo appearance?
irreg mass --> mimic carcinoma
39
breast abscess --> tx?
- US-guide aspiration
| - abx
40
what is granulomatous mastitis? epidemiology?
young F --> after childbirth --> rare idiopathic --> breast inflamm --> noninfx
41
granulomatous mastitis --> assoc RF? (2)
- breastfeed
| - OCP
42
granulomatous mastitis --> mammo/US finding? --> next step? why?
mimic breast CA --> bx
43
periductal mastitis (plasma cell mastitis) --> epidemiology?
post-menopause
44
periductal mastitis (plasma cell mastitis) --> MOA? classic mammo appearance?
intraductal lipids --> irritating --> large rod-like calcs
45
diabetic mastopathy --> MOA?
long term diabetes --> chronic hyperglycemia --> autoimmune rxn to matrix proteins --> firm mass --> can be painful
46
diabetic mastopathy --> mammo appearance? calcs?
- ill-defined asymm density
| - no microcalcs
47
diabetic mastopathy --> US appearance? next step?
- hypoechoic mass
- regional acoustic shadow
--> mimic scirrhous breast CA --> bx
48
what is Mondor thrombophlebitis?
breast --> superficial V --> thrombophlebitis
49
Mondor thrombophlebitis --> MC vein?
thoracoepigastric V
50
Mondor thrombophlebitis --> clinical presentation?
- superficial mass --> cordlike/elongated
| - pain/tender
51
Mondor thrombophlebitis --> US appearance?
dilated tubular struct --> "bead-like" --> no color flow
52
cleavage view --> purpose?
image medial breast tissue of both breasts
53
what is exaggerated CC (XCC) view?
pull lat/med tissue into image detector
54
what is online screening?
screen mammo --> pt wait for final read
55
online vs offline screen --> cons? (2)
online:
- more imaging
- more false pos
- same cancer detection rate
56
image quality --> how determine if CC and MLO view have imaged adequate tissue?
posterior nipple line --> w/in 1 cm
57
image quality --> nipple?
nipple should be in profile in at least 1 view
58
mammo signs of malig? (4)
- mass
- calc
- architectural distortion
- asymm
59
BI-RADS categories?
- 0: need additional imaging
- 1: neg
- 2: benign
- 3: prob benign
- 4: suspicious
- 5: highly sugg malig
- 6: known bx-proven malig
60
BI-RADS 3 --> next step?
short interval fu --> usu 6mo
61
screen mammo --> BI-RADS 3 --> T/F?
F
can only be categorized 3 after dx mammo
62
BI-RADS 3 --> %malig?
<2%
63
BI-RADS 4 --> %malig?
2-95%
64
BI-RADS 4 --> next step?
bx or aspiration
65
breast abscess --> BIRADS?
4
66
BI-RADS 5 --> % malig?
>95%
67
BI-RADS 5 --> next step?
- bx
| - surg
68
fibroglandular density --> categories? (4)
- almost entirely fatty
- scattered
- heterogeneous
- extremely dense
69
almost entirely fatty vs extremely dense fibroglandular tissue --> which has inc risk of breast CA?
extremely dense fibroglandular --> 5x more risk --> than almost entirely fatty
70
inc fibroglandular density --> bilat --> ddx? (2)
benign:
- hormone
- edema
71
inc fibroglandular density --> unilat --> ddx? (1)
malig --> lymph obstruct
72
skin thickening --> benign cause? (3)
- radiation
- acute mastitis
- fluid overload (CHF, renal fail, liver fail)
73
what is "mass"?
2 projections --> space occupying lesion --> convex borders
74
asymm --> seen on how many views?
1
75
mass --> margins? (5)
- circumscribed
- microlobulated
- obscured
- indistinct
- spiculated
76
margin --> circumscribed --> % margin that must be well-defined?
75%
77
mass --> densities? (4)
- radiolucent (fat)
- low density
- equal density
- high density
78
mammo: mass --> shape? (3)
- round
- oval
- irreg
79
mammo vs US --> preferred terminology for location?
- mammo: quadrants
| - US: clockface
80
mammo --> quadrants? (4)
- upper outer
- upper inner
- lower outer
- lower inner
81
assoc features? (7)
- architectural distortion
- microcalc
- skin retraction
- nipple retraction
- skin thick
- trabecular thick
- axillary LN
82
what is architectural distortion? concerning for CA?
radiating linear densities --> no definite mass
highly concerning for CA
83
skin retraction --> ddx? (2)
- postsurg
| - desmoplastic tumor rxn
84
calcs --> indeterminate or susp for malig --> require what view?
spot compression --> mag
85
skin calcs --> mammo appearance?
MC medial location:
- punctate
- lucent center
86
calcs --> how to determine if skin calcs?
tangential view
87
popcorn calc --> dx?
involuting fibroadenoma
88
large rod-like calc --> dx?
plasma cell mastitis (duct ectasia)
89
milk of calcium --> etiology
fibrocystic change
90
milk of calcium calc --> mammo appearance?
- CC view: fuzzy round amorphous
| - lat: semilunar/crescent shape
91
what is suture calc?
suture material --> calcium (usu after radiation)
92
dystrophic calc --> etiology? (4)
sequela:
- surg
- bx
- trauma
- rad
93
punctate calc --> shape? size (mm)?
round --> <0.5mm
94
lucent-center calc --> size?
<1mm - >1cm
95
eggshell (rim) calc --> ddx? (2)
- fat necrosis
| - cyst --> calc wall
96
benign calcs (BI-RADS 2)? (11)
- skin
- vascular
- suture
- popcorn
- lrg rod-like
- milk of Ca
- dystrophic
- round
- punctate
- lucent-center
- eggshell (rim)
97
interm concern calcs (BI-RADS 4)? (2)
- amorphous/indistinct
| - coarse heterogeneous
98
amorphous calc --> appearance?
too small or hazy to ascertain morphology
99
amorphous calc --> diffuse vs focal --> benign vs suspicious?
- diffuse --> benign
| - focal --> susp
100
coarse heterogeneous calc --> appearance?
- irreg
| - >0.5mm but smaller than dystrophic calc
101
higher prob of malig (BI-RADS 4-5) --> calcs? (2)
- fine pleomorphic
| - fine linear (branching)
102
fine pleomorphic calc --> appearance?
vary in shape & size --> "dot-dash" appearance
103
fine pleomorphic calc --> ddx? (2)
- DCIS
| - invasive ductal CA
104
calc --> distribution? (5) which are usu benign? more suspicious?
usu benign:
- diffuse/scattered
- regional
more suspicious:
- linear
- grped/cluster
- segmental
105
calc --> what is regional distribution?
lrg vol (>2cc) breast tissue --> not conform to ductal distribution
106
calc --> grped/cluster --> definition?
at least 5 calc in <1cc of breast tissue
107
what is rolled view? purpose?
CC view --> roll top breast med (RCCM) or lat (RCCL) --> localize lesion seen only on CC --> lesion mv med on RCCM --> in sup breast
108
what is reduced compression view? purpose?
reduced compression --> image far post lesions that slip out when full compression applied
109
true lat view --> when LM preferred over ML?
medial lesion --> LM --> lesion closer to detector
110
MLO --> lesion --> superior on lat view --> lesion is located med or lat?
med (Medial: Muffins rise)
111
MLO --> lesion --> inf on lat view --> lesion is located med or lat?
lat (Lat: Lead sinks)
112
punctate or round calc --> grp/cluster --> BI-RADS?
3
113
amorphous calc --> cluster --> next step?
indeterminate --> bx
114
what is focal asymm?
nonpalpable non-mass lesion --> seen on 2 projections
115
focal asymm --> US --> no correlate --> BI-RADS?
3
116
what is developing asymm? benign or suspicious?
focal asymm --> inc in size
suspicious
117
epidermal inclusion cyst --> US appearance?
circumscribed --> variable internal echotexture --> anechoic to heterogeneous
118
breast lesion --> dermis + hypodermis --> findings that dermal origin? (2)
- claw of dermal tissue --> wrap around lesion
| - lesion --> tract to epidermal surface
119
what is mammary zone? contains what tissue/structures?
zone bw subcutaneous & retromammary:
- ducts/TDLU
- fat
- fibrous tissue
- Cooper's lig
120
ultrasound: mass --> shape? (3)
- round
- oval
- irreg
121
ultrasound: mass --> orientation? (2)
- parallel
| - non-parallel
122
ultrasound: mass --> margin? (5)
- circumscribed
- indistinct
- angular
- microlobulated
- spiculated
123
ultrasound: mass --> what is lesion boundaries? 2 types?
transition bw mass & surrounding tissue:
- abrupt interface
- echogenic halo
124
ultrasound: mass --> echogenic halo --> ddx? (2)
- CA
| - abscess
125
ultrasound: mass --> posterior acoustic features? (4)
- no post acoustic feature
- enhancemt
- shadowing
- combined pattern
126
ultrasound: mass --> posterior acoustic shadowing --> ddx? (1)
fibrosis:
- neoplastic desmoplastic rxn
- surg scar
127
ultrasound: mass --> internal echo pattern? (5)
- anechoic
- hypoechoic
- isoechoic
- hyperechoic
- complex
128
benign mass --> ultrasound features? (5)
- internal echo pattern
- margin
- orientation
- shape
- marked hyperechoic
- circumscribed --> thin echogenic pseudocapsule
- parallel
- oval/few gentle macrolobulation
129
malig mass --> ultrasound features? (7) which 2 are most specific for malig?
- #1 spiculated
- #2 non-parallel
- angular, microlobulated
- post shadow
- marked hypoechoic
- assoc calcs
- wide zone of transition
130
lipoma vs oil cyst --> margin?
- lipoma --> no peripheral cacl
| - oil cyst --> peripheral calc
131
lipoma --> should be eval by US prior to dx --> T/F?
F
can be dx w mammo alone
132
oil cyst --> MOA?
trauma or surg --> fat necrosis
133
what is hamartoma (fibroadenolipoma)?
benign mass --> fat & glandular tissue
134
hamartoma (fibroadenolipoma) --> classic mammo appearance?
breast w/in breast --> displace normal breast tissue
135
hamartoma (fibroadenolipoma) --> should be eval by US prior to dx --> T/F?
F
mammo almost always diagnostic
136
what is galactocele?
lactating --> cystic collection of milk --> palpable mass
137
galactocele --> mammo appearance?
- circumscribed
- macrolobulated
- mixed high density + fat
- true lat view --> fat-fluid level
138
intramammary LN --> MC location?
lat --> upper outer quad --> adj to vessel
139
medial breast --> lesion that look like intramammary LN --> benign or suspicious?
suspicious
140
fibroadenoma --> mammo XR --> density?
equal density
141
fibroadenoma --> US --> density?
- hypoechoic
| - central hyperechoic band
142
fibroadenoma --> BI-RADS?
3
143
fibroadenoma --> variants? (3)
- complex
- juvenile
- giant
144
complex fibroadenoma --> characteristics? (2)
- prolif elements & internal cysts
| - inc risk of breast CA
145
juvenile fibroadenoma --> characteristics? (2)
- adol
| - very rapid growth
146
giant fibroadenoma --> characteristic? (1)
>8cm
147
fibroadenoma --> ddx? (1)
phyllodes tumor
148
what is intraductal papilloma? epidemiology?
30-50yo --> benign tumor of lactiferous ducts
149
intraductal papilloma --> clinical presentation?
nipple discharge:
- bloody
- serous
- serosanguinous
150
bloody nipple discharge --> ddx? (2)
- intraductal papilloma
| - DCIS
151
intraductal papilloma --> mammo XR --> shape? margin? MC location?
- round/oval
- circumscribed/irreg
- subareolar
152
intraductal papilloma --> galactography appearance?
intraductal filling defect
153
intraductal papilloma --> US --> appearance? solid/cyst? shape?
- solid
- round/oval
- mass in fluid-filled duct
154
intraductal papilloma --> dx by mammo/US alone --> T/F?
F --> dx by bx
155
bx --> intraductal papilloma --> next step? why?
surg excise
papillary CA may appear same
156
what is pseudoangiomatous stromal hyperplasia (PASH)?
hormone --> stromal & epithelial prolif
157
pseudoangiomatous stromal hyperplasia (PASH) --> mammo appearance?
mass:
- circumscribed
- oval/irreg
158
pseudoangiomatous stromal hyperplasia (PASH) --> US appearance?
mass:
- hypoechoic/mixed echogenicity
- oval/irreg
159
pseudoangiomatous stromal hyperplasia (PASH) --> demonstrate slow growth --> next step? why?
excisional bx
PASH can mimic low-grade angiosarcoma
160
mammo --> circumscribed round mass --> breast CA ddx? (2)
- medullary
| - mucinous
161
phyllodes tumor --> epidemiology?
40-50yo
162
phyllodes tumor --> benign or malig?
- most benign
| - 25% --> malig
163
lactational adenoma --> epidemiology?
- 2nd-3rd trimester
| - postpartum
164
lactational adenoma --> benign or malig?
benign
165
lactational adenoma --> tx?
none --> regress when stop lactating
166
mult intraductal papillomas --> epidemiology?
younger
167
mult intraductal papillomas --> location?
bilat breasts --> peripheral
168
mult intraductal papillomas --> inc risk of breast CA --> T/F?
T
169
what is steatocystoma multiplex?
AD --> mult intradermal oil cysts
170
simple cyst --> BI-RADS?
2
171
new --> complicated cyst --> next step?
- BIRADS 3
| - aspiration
172
complicated cyst --> aspiration --> fluid is white/clear/yellow --> next step?
discard fluid
173
complicated cyst --> aspiration --> fluid is bloody --> next step?
send fluid to cytology
174
what is complex mass?
cyst w complex feature:
- thick wall
- septation
- solid/nodular compont
175
complex mass --> BI-RADS?
4
176
complex mass --> cancer ddx? (4)
- intracystic CA
- intracystic papilloma
- cystic phyllodes tumor
- solid CA w central necrosis
177
what is intracystic CA?
cyst wall --> CA
178
complex mass --> benign ddx? (5)
- hematoma
- abscess
- fat necrosis
- galactocele
- benign cyst w adherent debris
179
what is clustered microcyst?
apocrine metaplasia or fibrocystic change --> several tiny 2-5mm cystic spaces separated by thin septae
180
clustered microcyst --> BI-RADS?
2
181
MC breast CA?
invasive ductal CA (IDC)
182
invasive ductal CA (IDC) --> typical mammo appearance?
- spiculated mass --> high density
| - often: pleomorphic or fine linear branching calcs
183
invasive lobular CA --> differences from invasive ductal CA (IDC)? (3)
invasive lobular:
- rare calc
- more often multifocal
- more often bilat
184
tubular CA --> typical mammo appearance?
small spiculated mass --> slow growing
185
possible precursor lesion to tubular CA?
radial scar
186
what is radial scar?
uncertain etiology --> dense fibrosis around ducts --> spiculated mass or architectural distortion
187
what is complex sclerosing lesion?
radial scar --> >1cm
188
radial scar/complex sclerosing lesion --> tx?
surg excision
189
postsurgical scar --> can get larger over time --> T/F?
F
190
what is sclerosing adenosis?
benign --> lobular hyperplasia --> fibrous tissue envelop & distort glandular elements --> sclerosis --> breast lesion --> maybe microcalcs
191
what is diabetic mastopathy?
long-term insulin-dep diabetes --> inflamm lymphocytes & fibrosis --> large painless firm mass
192
diabetic mastopathy --> mammo appearance? US?
- mammo: ill-defined mass or asymm density
| - US: hypoechoic shadowing mass
193
benign breast fibrosis conditions? (2)
- sclerosing adenosis
| - diabetic mastopathy
194
LN metastasis --> suspicious US features? (5)
- round
- thick cortex >3mm
- eccentric thick cortex
- focal outward cortical bulge
- thick cortex --> indent or obliterate hilum
195
1ary breast lymphoma --> MC etiology?
diffuse lrg B-cell lymphoma
196
breast lymphoma --> calcs or no calcs?
no calcs
197
known lymphoma --> new breast mass --> most likely mets or breast CA?
breast CA
198
2ary angiosarcoma of breast --> etiology?
prior breast conservation --> rtx
199
2ary angiosarcoma of breast --> T2 appearance? enhancemt?
- T2 hyper
| - intense enhance
200
new mult masses --> non-ductal distribution --> dx?
hematogenous mets to breast
201
mets to breast --> what 1ary cancers? (2)
- melanoma
| - RCC
202
what is asymm?
1 view --> prominent breast tissue
203
asymm --> MCC?
superimposed gland tissue
204
what is global asymm?
1 breast --> majority (>1 quad) --> asymm density
205
global asymm --> MCC?
greater vol of parenchyma in 1 breast
206
what is focal asymm?
abnormality --> 2 views --> <1quad --> concave contour
207
what is sternalis muscle?
<10% --> access parasternal chest wall muscle
208
sternalis muscle --> MC location?
unilat --> med --> far-post --> only see on CC view
209
access nipple (polythelia) --> mammo appearance?
mammo crest --> round mass
210
what is Poland synd? (3)
congenital:
- unilat --> pect major absent
- ispilat breast absent
- syndactyly
211
access (ectopic) breast tissue --> MC location?
axillary tail
212
breast MRI --> enhancemt kinetics --> enhancemt curve --> 2 parts (time)?
- early (2min) phase
| - delayed
213
breast MRI --> early enhancemt --> 3 categories?
- slow
- med
- rapid
214
breast MRI --> delayed enhancemt --> 3 categories?
- type 1 persistent
- II plateau
- III washout
215
breast MRI --> delayed enhancemt --> what is type 1 persistent? assoc w benign/suspicious/malig?
continuous inc enhance (>10%)
83% --> benign
216
breast MRI --> delayed enhancemt --> what is type II plateau? assoc w benign/suspicious/malig?
level off (w/in 10%)
susp --> PPV 64-77%
217
breast MRI --> delayed enhancemt --> what is type III washout? assoc w benign/suspicious/malig?
>10% dec in enhancemt
malig --> PPV 87-92%
218
breast MRI --> delayed enhancemt --> type III washout --> benign ddx? (3)
- LN
- adenosis
- papilloma
219
morphology vs enhancemt kinetics --> which is more important to determine if lesion is benign or suspicious?
morphology
220
breast MRI --> internal enhancemt? (4)
- homogeneous
- heterogeneous
- rim enhance
- dark internal septations
221
breast MRI --> dark internal septations --> highly specific for what condition?
fibroadenoma
222
breast MRI --> what is focus?
<5mm dot of enhancemt --> too small for accurate assess:
- no mass effect
- no correlate on precontrast seq
223
what is non-masslike enhancemt?
enhancing region --> not mass or focus
224
non-masslike enhancemt --> distribution? (6)
- linear/ductal
- segmental
- focal
- regional
- mult region
- diffuse
225
non-masslike enhancemt --> what is focal distribution? regional?
- focal: <25% quadrant
| - regional: >25% quadrant
226
non-masslike enhancemt --> internal enhancemt? (4)
- homogeneous
- heterogeneous
- clumped
- clustered ring
227
non-masslike enhancemt --> int enhancemt --> clustered ring --> ddx? (2)
- DCIS
| - invasive ductal
228
non-masslike enhancemt --> stippled/punctate enhancemt --> assoc w benign or malig?
benign
229
mass --> enhancing portion --> T2 hyper --> highly sugg benign or malig?
benign
230
breast MRI: type I kinetic curve + benign morphology --> BI-RADS? (3)
- 2
- 3
- 4
231
breast MRI: type II kinetic curve + benign morphology --> BI-RADS? (1)
4
232
breast MRI: type III kinetic curve + benign morphology --> BI-RADS? (1)
4
233
breast MRI: type I kinetic curve + malig morphology --> BI-RADS? (1)
4
234
breast MRI: type II/III kinetic curve + malig morphology --> BI-RADS? (2)
- 4
| - 5
235
high risk for breast CA --> definition?
>20% lifetime risk of develop breast CA
236
what is breast conservation therapy?
lumpectomy + rtx
237
status post lumpectomy --> enhancemt at lumpectomy site --> can be normal for how long?
6-18mo
238
MRI --> evaluate silicone or saline implants?
silicone
239
how differentiate silicone vs saline implant on screen mammo?
saline:
- valve
- wall is denser than center
silicone:
- uniformly dense
- no valve
240
breast implant --> screen mammo --> special view?
Eklund (implant-displaced) view
241
saline implant --> rupture --> clinical presentation?
sudden collapse --> instant dec breast size
242
silicone implant --> rupture --> clinical presentation?
- subtle change in implant contour
| - no change in size or shape
243
silicone implant --> rupture --> MRI sign?
linguine
244
silicone implant --> rupture --> US appearance?
snowstorm
245
reduction mammoplasty --> mammo findings? (2)
lower breast:
- skin thick
- curvilinear architectural distortion
246
gynecomastia --> clinical presentation?
subareolar palpable abnormality
247
gynecomastia --> mammo appearance?
subareola --> flame/triangle-shape density
248
male --> breast mass --> benign features --> benign or suspicious?
male --> any breast mass --> susp
249
breast bx --> path discordant --> next step?
repeat bx --> core or excision
250
benign-appearing cyst --> aspirate --> bloody --> next step?
send to cytology
251
benign-appearing cyst --> aspirate --> cloudy --> next step?
discard fluid
252
benign-appearing cyst --> aspirate --> clear --> next step?
send to cytology
253
benign-appearing cyst --> aspirate --> green --> next step?
discard fluid
254
calc --> MC bx technique?
stereotactic-guided core
255
stereotactic bx --> CI? (5)
- thin breast --> <3cm compressed
- far post location
- subareolar location
- pt can't be positioned on stereotactic table
- unctrl coag abnormal
256
breast --> asymmetric in size --> ddx? (1) buzzword?
"shrinking breast" --> invasive lobular breast CA
257
axillary lymph node drainage --> order?
level 1 (lateral) --> 2 --> 3 (medial) --> thorax
258
what are Rotter nodes?
nodes bw pec minor & major
259
Rotter nodes --> at same level as which axillary LN?
level 2
260
sternalis M --> seen only on what view?
CC
261
MC location for ectopic breast tissue?
axilla
262
CA --> MC quadrant?
upper outer
263
CA --> start in what unit?
terminal duct lobular unit (TLDU)
264
majority (60%) of blood flow to breast --> which vessel?
internal mammary
265
singular mets to internal mammary nodes --> common or uncommon?
uncommon
266
singular mets to internal mammary nodes --> indicate what about the CA?
medial location
267
sternalis M --> usu unilat or bilat?
unilat
268
breast tenderness --> greatest at day ___?
day 27-30 (near end of luteal phase - progesterone dominates -> lobules prolif --> breast density inc slightly)
269
mammography & MRI --> best performed in what phase of the breast/menstrual cycle?
follicular phase (day 7-14)
270
never bx a prepubescent breast --> T/F? why?
T --> can damage breast developmt
271
cyst formation --> greatest in pre/peri/post menopause?
perimenopause
272
breast pain --> greatest in pre/peri/post menopause?
perimenopause
273
fibroadenoma --> degenerate in pre/peri/post menopause?
(post)menopause
274
secretory calcs (rod-like) --> dev in pre/peri/post menopause?
10-20 yrs post menopause
275
lactating breast --> mammogram vs US --> which is more sensitive? why?
lactating breast --> more dense --> US more sensitive for mass
276
bilat breasts --> inc density --> ddx? (2)
- pituitary prolactinoma
| - meds --> ie antipsych
277
lactating breast --> bx --> comp?
milk fistula
278
lactating breast --> bx --> milk fistula --> tx?
stop breastfeeding
279
galactocele --> aunt minnie finding?
fat-fluid level
280
galactocele --> typical seen when? typical location?
- cessation of lactation
| - sub-areolar
281
lactating adenoma --> fu recommendation?
4-6mo postpartum/postdelivery/cessation of lactation --> US
282
lactating adenoma --> natural progression of dz?
stop lactation --> rapid regress
283
lactating adenoma --> usu single or multiple?
mult
284
when get LMO view? (3)
- kyphosis
- pectus excavatum
- avoid medial pacemaker/central line
285
which view contains most breast tissue?
MLO
286
spot compression view --> collimate or not?
leave collimator open --> larger FOV --> ensure get what you wanted
287
mag view --> which positional views are obtained?
- CC
| - ML (true lat)
288
screener --> lat breast --> microcalcs --> mag view --> ML or LM view?
ML
289
screener --> med breast --> microcalcs --> mag view --> ML or LM view?
LM
290
screener --> MLO only --> suspicious finding --> additional views --> ML or LM view? why?
ML view --> most (70%) breast cancers occur laterally
291
what is "camel nose"?
MLO --> breast not pulled up and out --> looks saggy
292
advantage of CC view over MLO?
maximize visualization of post medial tissue
293
advantage of MLO view over CC?
maximize visualization of axillary & post tissue
294
adequate technique: MLO --> pectoral muscle --> should be seen at level of what struct?
level of nipple or below
295
adequate technique: MLO --> pectoral muscle --> should be convex or concave?
convex
296
CC view --> lack adequate coverage of post lat tissue --> next step?
exagg lat CC view (XCCL)
297
ML view --> which is closer to the detector --> medial or lat breast?
lat
298
mass seen only on CC view --> next step?
rolled CC
299
mass in far post medial breast --> next step?
cleavage view (CV)
300
breast implants --> what views?
Eklund view (implant displaced) --> MLOID, CCID
301
Cooper's ligaments appear thick --> ddx? (2)
- blur
| - edema
302
mammo --> blur --> etiology? (3)
- motion (breathing, inadeq compression)
- exposure --> too long
- exposure --> too short
303
mag view --> use grid or no grid?
no grid
304
lesion seen only on MLO --> ML view --> how know if lesion is in med vs lat breast?
"Lead Sinks, Muffins Rise":
- inf on ML view --> lat breast
- sup on ML view --> med breast
305
screeners --> PPV? (anything other than BR1/2)
4% --> 3-8 cancers per 1000 mammos
306
mammo --> bilat --> mult circumscribed similar appearing masses --> BI-RADS?
2
307
grped round calcs --> BI-RADS?
3
308
screening mammo --> BI-RADS options?
- 0
- 1
- 2
309
diagnostic mammo --> BI-RADS options?
- 2
- 3
- 4
- 5
310
focal asymm --> compress --> less dense --> looks like breast tissue --> BI-RADS?
3
311
MRI --> background parenchymal enhancemt --> categories? (5)
- none
- minimal
- mild
- mod
- marked
312
MRI --> mass --> shape --> categories? (3)
ROI:
- round
- oval
- irreg
313
MRI --> mass --> margin --> categories? (3)
- circumscribed
- irreg
- spiculated
314
MRI --> mass --> T2 hyperintense signal --> categories? (3)
- grter than parenchyma
- grter than or equal to fat
- grter than or equal to water
315
MRI --> non mass enhancmt (NME) --> distribution --> categories? (6)
- focal
- linear
- segmental
- regional
- mult regions
- diffuse
316
complex cystic & solid mass --> BI-RADS?
4
317
complicated cyst (cyst w debris) --> BI-RADS?
2 or 3
318
calc --> "cigar shaped w lucent center" --> dx?
secretory (rod like) calcs
319
calc --> "dashes but no dots" --> dx?
secretory (rod like) calcs
320
milk of Ca --> bx --> no calcs visualized --> how to assess for milk of Ca?
view w polarized light --> birefringence
321
amorphous calc --> ddx? (4)
- #1 fibrocystic change
- sclerosing adenosis
- columnar cell change
- DCIS (low grade)
322
coarse heterogeneous calc --> ddx? (4)
- fibroadenoma
- papilloma
- fibrocystic change
- DCIS (low-interm grade)
323
fine pleomorphic calc --> ddx? (4)
- fibrocystic change
- fibroadenoma
- papilloma
- DCIS (high grade)
324
Mondor dz --> tx?
- NSAID
| - warm compress
325
lipoma --> enlrg --> next step?
bx
326
bx --> pseudoangiomatous stromal hyperplasia (PASH) --> fu?
12mo
327
young F --> MC palpable mass?
fibroadenoma
328
MRI --> fibroadenoma --> T2 signal? enhance?
- T2 bright
| - type 1 enhance (progressive enhance)
329
phyllodes tumor --> epidemiology?
middle age to older F
330
phyllodes tumor --> recommend sentinel node bx --> T/F?
F
if mets --> hematogenous --> lung & bone
331
phyllodes tumor --> rapid growth --> T/F?
T
332
ductal CA --> medullary subtype --> assoc finding?
lrg axillary LN (not necessarily mets)
333
ductal CA --> papillary subtype --> mass appearance?
complex cystic & solid
334
ductal CA --> #2 MC type?
papillary
335
breast CA --> multifocal vs multicentric?
- multifocal: same quad --> <4-5cm apart
| - multicentric: mult quad
336
DCIS --> comedo vs non-comedo --> which is more aggressive?
comedo
337
galactography --> mult intraductal masses --> ddx? (1)
DCIS
338
Pagets dz of breast --> topic therapy --> skin lesion still not resolve --> next step?
wedge bx
339
invasive lobular CA --> US appearance?
ill-defined area of shadowing --> "shadowing w/o mass"
340
prognosis: IDC vs ILC --> which is better?
similar prognosis
341
ILC --> often only seen on CC view --> T/F?
T
342
ILC --> common to get axillary mets --> T/F?
F
axillary mets is less common --> instead, like to go to strange places ie peritoneum
343
architectural distortion wo central mass ("dark star") --> ddx? (4)
- ILC
- IDC-NOS
- radial scar
- surgical scar
344
breast --> red, swollen, thick skin --> next step?
US
eval for focal lump to help target US
345
breast --> red, swollen, thick skin --> US --> no focal mass --> next step?
- punch bx
| - abx --> see if it gets better (if IBC, will improve but not resolve)
346
compare: inflamm breast CA vs locally advance breast CA
- rapid/prolonged onset
- age of presentation
- mets at presentation
inflamm breast CA:
- rapid onset
- younger (mid 50s)
- 30% mets at presentation
LABC:
- prolonged onset
- older (mid 60s)
- 10% mets at presentation
347
inflamm breast CA (IBC) --> tx? why?
1) ctx --> high chance of positive margins
| 2) mastectomy --> for local ctrl
348
bx --> 5 classic high risk lesions?
- radial scar
- atypical ductal hyperplasia
- atypical lobular hyperplasia
- LCIS
- papilloma
349
MCC bloody nipple discharge?
papilloma
350
1ary breast lymphoma --> what type of lymphoma?
non-Hodgkin (diffuse lrg B-cell)
351
1ary breast lymphoma --> require what type of stain to confirm dx?
IHC
352
1ary breast lymphoma --> mammo appearance?
hyperdense mass
353
2ary breast lymphoma --> typical mammo appearance?
inflamm thickening wo mass
354
inflamm breast CA --> painless or painful?
painless
355
nipple discharge --> suspicious features? (4)
- spontaneous
- bloody
- serous
- from a single duct
356
nipple discharge --> milky --> possible etiology? (3)
- thyroid dz
- pituitary adenoma --> prolactinoma
- meds (ie antidep, neuroleptic, reglan)
357
nipple discharge --> suspicious --> possible etiology? (2)
- intraductal papilloma
| - DCIS
358
nipple discharge --> benign --> possible etiology? (2)
- fibrocystic change
| - ductal ectasia
359
galactography --> contraindication? (4)
- active infx (mastitis)
- unable to express discharge at time of galactogram
- contrast allergy
- prior surg to nipple-areola complex
360
architectural distortion + calcs --> ddx? (1)
IDC + DCIS
361
architectural distortion, no calcs --> ddx? (1)
ILC
362
mammo --> architectural distortion --> no correlate on US --> next step?
bx
363
dx mammo --> suspicious spiculated mass --> US --> same thing --> next step?
US for axillary mets
364
axillary LN --> suspicious features? (3) which is most specific?
- #1 specific --> loss of central fatty hilum
- cortical thick >2.3mm
- irreg outer margins
365
male --> gender reassignmt --> hormone tx --> gynecomastia --> should get screening mammo --> T/F?
F
366
mammo --> dense LN --> US --> snowstorm appearance --> next step?
US --> eval for breast implant rupture
367
silicone breast implant --> intracapsular rupture --> US fiding?
"step ladder" appearance
368
breast implant --> contraindication for core needle bx --> T/F?
F
369
breast implant --> inc risk of breast CA --> T/F?
F
370
saline implant --> dx of rupture --> test of choice?
physical exam
371
breast implant --> MC comp?
capsular contracture
372
breast implant --> what is capsular contracture?
fibrous capsule --> contract --> cosmetic deformity
373
breast implant --> capsular contracture --> MC with...
- silicone/saline?
- subglandular/subpectoral?
subglandular silicone
374
silicone in axillary LN --> ddx? (2)
- breast implant rupture
| - gel bleed (not a rupture)
375
breast implant rupture --> #1 RF?
age of implant
376
saline breast implant --> what imaging modality to see implant rupture?
mammo
377
bx --> excisional vs incisional?
- excision: remv entire lesion
| - incision: bx portion of lesion
378
breast CA --> recurrence --> peak time? (yr)
4yr
379
breast CA --> breast conserving tx --> radiation vs no radiation --> %recurrence?
- radiation: 6-8%
| - no radiation: 35%
380
breast CA --> lumpectomy --> immediate postop mammo demonstrates residual calcs --> Ok or not ok?
not ok
residual calcs --> assoc w 60% local recurrence
381
DCIS --> lumpectomy --> new calcs --> benign vs recurrence --> timeline (yr)?
- benign calc --> 2 yr
| - recurrent calc (DCIS) --> 4yr
382
breast CA --> radiation tx --> comp? (1)
2ary angiosarcoma
383
breast CA --> radiation tx --> 2ary angiosarcoma --> classic clinical presentation?
red plaques/skin nodules
384
MC CA that mets to breast?
melanoma
385
breast conservation tx --> contraindications? (5)
- inflamm CA
- lrg cancer size relative to breast
- multicentric
- prior rtx to same breast
- CI to rtx (ie collagen vascular dz)
386
breast MRI --> focus --> size criteria?
<5mm
387
breast MRI --> tamoxifen --> what happen to background parenchymal enhancemt?
dec --> then rebound
388
child --> chest radiation --> how much rad (Gy) for inc risk of breast CA?
20gy
389
child --> chest radiation --> 20gy --> when start screening mammo?
whichever is later:
- 25yo
- 8yr post exposure
390
Cowden synd --> synd? (4)
- breast CA
- follicular thyroid CA
- bowel hamartoma
- Lhermitte-Duclos (brain hamartoma)
391
breast CA risk models --> all current risk models underestimate lifetime risk --> T/F?
T
392
breast CA risk models --> which is most comprehensive?
Tyrer-Cuzick
393
what meds that reduce incidence of ER/PR+ cancer? (2)
- tamoxifen
| - SERMs (raloxifene)
394
BRCA1 vs BRCA2 --> which is more common?
BRCA1
395
men w BRCA1 vs BRCA2 --> who gets more CA?
BRCA2
396
>20% lifetime risk of breast CA --> when start screening?
- 25-30yo
| - 10yr before 1st deg relative
