Breast

Question 1

Second most common IDC breast cancer subtype?

Answer 1

Papillary IDC (after NOS)

Question 2

What is associated with Paget’s disease of nipple?

Answer 2

High grade DCIS

Question 3

What’s the second most common breast cancer subtype?

Answer 3

ILC

Question 4

Shrinking breast seen in?

Answer 4

ILC - the breast is not being compressed that much , but might look normal in size clinically.

Question 5

Which view ILC is seen better?

Answer 5

CC- since it compresses better. Appears as an architectural distortion

Question 6

ILC buzzwords:

Answer 6

Mammo: dark star - shrinking breast.

US: shadowing without a mass.

Question 7

Most common implants complication?

Answer 7

Capsular contracture: due to contraction in the fibrous capsule.

Question 8

Major risk factor for implant rupture?

Answer 8

Age on the implant

Question 9

Risk of breast cancer in NF-1?

Answer 9

Moderate risk.

Question 10

Salad oil sign

Answer 10

Mixing of silicone and saline in a double-lumen intracapsular rupture.

Question 11

Location of oil cysts in steatocystoma multiplex?

Answer 11

Intradermal While in post-traumatic are intra-parenchymal.

Question 12

What medication can cause focal fibrosis?

Answer 12

Hormone replacement therapy.

Question 13

What’s the rule of multiplicity?

Answer 13

• at least 3 masses (one in each breast).
• benign margins
• non palpable
• no suspicion calcs

Question 14

Which breast is involved in a seatbelt injury?

Answer 14

Driver: left breast

Passenger: right breast

Question 15

Most common sites for phylloids mets?

Answer 15

Lung and bone (it’s hematogenous route).

Question 16

Thickness of tomo slice?

Answer 16

1 mm

Question 17

Examples of cellular fibroepithelial lesions?

Answer 17

Fibroadenoma

Phylloides

Question 18

What’s picture framing in MRI?

Answer 18

Normal pattern of parenchymal enhancement from the periphery to the center.

Question 19

How does fat necrosis look on MRI?

Answer 19

T1 non-FS: hyper similar to normal fat.

T1 FS: hypo with rim enhancement.

Question 20

Thin, nonenhancing septa in MRI?

Answer 20

Fibroadenoma

Question 21

Types of needle loc systems?

Answer 21

Hook wire needle system: needle is removed and wire stays in lesion.

Rigid needle and J wire: both needle and wire remains in lesions while patient awaits surgery.

Question 22

In needle loc, how far the tip of the needle should be from the lesion?

Answer 22

The tip should be 1 to 1.5 cm beyond the lesion.

Question 23

What’s stroke margin in stereo?

Answer 23

The calculated distance between the needle tip and the detector once needle has been fired. Calculated by computer

Question 24

What’s positive stroke margin?

Answer 24

When there’s enough breast tissue beyond the post fired needle tip without traversing the entire breast or hitting the detector.

Question 25

What’s the maximum dose of 1% lidocaine without epinephrine?

Answer 25

4.5 mg/kg not exceeding 300mg

Question 26

What’s the maximum dose of 1% lidocaine with epinephrine?

Answer 26

7 mg/kg not exceeding 500 mg

Question 27

Pregnant diagnosed with breast cancer, how to treat?

Answer 27

Immediate surgery then radiation after delivery. No chemo or radio in first trimester.

Question 28

How to anesthetize nipple Areola complex?

Answer 28

Topical lidocaine!

Question 29

What’s the upgrade risk in sclerosing adenosis?

Answer 29

Less that 2%, therefore, it goes back to screening.

Question 30

How’s the z-axis generated in stereo?

Answer 30

By calculating the parallax shift of the target on the stereotactic images compared with the target location on the scout image.

Question 31

What local anesthetic is administered for skin wheel?

Answer 31

Lidocaine 1% buffered with sodium bicarbonate (1:9) m- to reduce burning.

Question 32

What local anesthetic is administered into breast parenchyma?

Answer 32

Lidocaine 1% with epinephrine (1:100,000) for hemostasis. Dose is 7mg/kg

Question 33

Cleft like cystic spaces in a well defined mass?

Answer 33

**Phylloids**. A feature that can differentiate it from fibroadenoma

Question 34

What's the soure to image distance in mammo?

Answer 34

50-80 cm

Question 35

how is motion in DBT compared to conventional mammo?

Answer 35

May be worse!

Question 36

Can you BIRADS MRI without giving Gad?

Answer 36

NO! Gad should be there to BIRADS!

Question 37

Male with clinical exam is consistent with gynecomastia

Answer 37

No imaging needed.

Question 38

Male under 25 with suspicion clinical exam?

Answer 38

Do US first

Question 39

Male above 25 with suspicion exam?

Answer 39

Do Mammo first then US.

Question 40

Can biopsy epidermal inclusion cyst?

Answer 40

NO - It's contraindicated.

Question 41

what's the typical compression thickness?

Answer 41

4-5 cm

Question 42

If a mass is seen on mammo then disappears on **C+ mammo**

Answer 42

**eclipse sign** - it's a cyst.

Question 43

What is used for molecular breast imaging?

Answer 43

Tc99m-sestamibi

Question 44

If radial scar if \>2 cm

Answer 44

is called --\> Complex sclerosing lesion.

Question 45

Mucocele-like lesions:

Answer 45

**fibrocystic change with columnar cell change.** They are high-risk lesions.

Question 46

What's the FDA recommendation regarding implant rupture screening?

Answer 46

MRI every 3 years.

Question 47

New fluid formed around in implant?

Answer 47

Aspirate and send it to r/o implant-associated lymphoma.

Question 48

When to biopsy a fibroadenoma?

Answer 48

if size\> 2.5 cm or interval growth of \> 20%.

Question 49

How long post-radiation changes last?

Answer 49

Peaks at 6 months and may last to 18 months.

Question 50

Chest radiation received after the age of 30?

Answer 50

Not a high risk for MRI screening

Question 51

When to perform Sentinel lymph node biopsy in DCIS?

Answer 51

Only if there's necrosis or microinvasive disease.

Question 52

Which part of breast can be excluded in MLO?

Answer 52

Superior medial breast.

Question 53

Invasive tumors with increased through transmission

Answer 53

are 10-24x more likely to be high grade than invasive tumors without this feature.

Question 54

What's the position of glandular tissue after reduction mammoplasty?

Answer 54

**INFERIOR** redistribution relative to pre op.

Question 55

How frequent localization accuracy is done for sterotactic machine?

Answer 55

Annually

Question 56

Pt didn't show up for mammogram after the initial screening exam, for how long her record should be kept?

Answer 56

10 years. If follow ups available, then records are kept for 5 years.

Question 57

Reduction mammoplasty findings

Answer 57

* Nipple: **Superiorly** shifted * Fibroglandular tissue: **Inferiorly** shifted

Question 58

Which type of breast cancer is associated with lymphoid infiltration?

Answer 58

Medullary carcinoma

Question 59

What's the name of the artifact?

Answer 59

Blurring-ripple artifacts. * Seen with breast tomosynthesis. * related to the **small number of projections acquired at DBT** * Analogous to **volume averaging.** * Oriented **perpendicular** to the x-ray tube sweep direction. * Corrected with an increasing number of projections, **disappearing when the number of projections matches the number of reconstruction sections**

Question 60

Examples of truncation artifact in breast tomo?

Answer 60

* Stair-step artifact. * Bright-edge artifact.

Question 61

Which mammography QC test is this?

Answer 61

Flat Field Test. Done **Weekly**.

Question 62

Developing asymmetry most likely is?

Answer 62

PASH PASH PASH

Question 63

Imaging difference between lactating adenoma and a galactocele?

Answer 63

LA: Has **Doppler vasularity**

Question 64

what additional views should be done in case of axillary oil cyst/fat necrosis?

Answer 64

Tangential