Breast Imaging

Question 1

Patients with high % breast density have lower/higher risk than patients very low % breast density. Breast cancer is also easier/harder to detect in dense breasts.

Answer 1

higher risk, harder to detect

Question 2

What two views are used in mammography?

Answer 2

Mediolateral oblique and craniocaudal views

Question 3

4 micro-calcification signs in mammography that are benign

Answer 3

vascular calcification,
oil cyst eggshell calcification, (often after injury)
plasma cell mastitis: long, bilateral, pointing to nipple,
dystrophic calcification in scar

Question 4

3 micro-calcification signs in mammography that indicate DCIS

Answer 4

linear or branching micro calcifications,
clusters or segmental,
pleomorphic size and density

Question 5

Mammography pros (3)

Answer 5

images whole breast,
high sensitivity for DCIS & invasive,
accessible

Question 6

Mammography cons (4)

Answer 6

ionising radiation,
breast pain/discomfort,
challenging if limited mobility,
bad for dense breasts

Question 7

Indications for mammography (6)

Answer 7

screening (50-70yrs),
higher risk screening >40,
symptomatic assessment >40,
monitoring response to systemic treatment,
follow up,
image guided techniques e.g. biopsy/localisation

Question 8

Patients who had surgery for breast cancer will receive annual mammograms for approx. how long after?

Answer 8

3-5yrs

Question 9

Grey-scale USS uses?

Answer 9

breast or axilla

Question 10

USS benign signs

Answer 10

wide,
well-defined,
anechoic (black) - cysts,
hypo echoic

Question 11

USS malignant signs

Answer 11

tall,
ill-defined,
hypo echoic,
heterogeneous (dark/mixed)

Question 12

Treatment for cyst?

Answer 12

aspiration

Question 13

Grey-scale USS pros (3)

Answer 13

no radiation,
comfortable,
good sensitivity and specificity for invasive

Question 14

Grey-scale USS cons (2)

Answer 14

low specificity in screening,

low sensitivity for DCIS

Question 15

Grey-scale USS indications (5)

Answer 15

assess clinical/mammographic abnormality,
during pregnancy,
monitoring response to systemic treatment,
follow-up for cancers not visible in mammography,
image-guided procedures

Question 16

Both mammography and USS are useful for guiding biopsy/VAE and localisation. USS also has use for what other image-guided procedure?

Answer 16

aspiration of cyst or abscess

Question 17

What is tomosynthesis?

Answer 17

Pseudo 3D technique by taking images at diff. angles in arc then reconstructing int multiple slices

Question 18

Tomosynthesis pros? (2)

Answer 18

removes overlapping tissue,

lesion outline

Question 19

Tomosynthesis cons? (3)

Answer 19

more radiation,
accessibility,
low sensitivity in v. dense breasts

Question 20

Tomosynthesis indications? (3)

Answer 20

assessing mammography abnormalities,
screening sometimes in denser breasts,
not really used in follow up

Question 21

What is Contrast Enhanced Spectral Mammography (CESM)?

Answer 21

IV contrast given and two images made - one normal mammography and one that shows enhanced bits

Question 22

Why are mammographies usually only used in older women?

Answer 22

Because visibility not as good in younger breasts

Question 23

CESM pros (2)

Answer 23

good sensitivity and specificity for dense breasts,

shows tumour blood supply

Question 24

CESM cons (3)

Answer 24

radiation,
contrast use,
breast pain/discomfort

Question 25

USS technique strain elastography measures what and how?

Answer 25

measures tissue stiffness - cancer tissues stiffer - by palpation with ultrasound

Question 26

What is shear wave elastography?

Answer 26

ultra fast sequence to test tissue elasticity

Question 27

Shear wave indications? (2)

Answer 27

adjuvant to grey-sale USS, | diagnosis of fibroadenomas (25-40yrs)

Question 28

Contrast-enhanced USS (CE-US) indications? (3)

Answer 28

assessing response to chemo, axillary node characterisation, improving BIRADS classification of solid lesions

Question 29

What is the name of the classification system used for assessment of breast lesion in USS, mammography and MRI?

Answer 29

BI-RADS

Question 30

CE-US malignant features? (3)

Answer 30

hyper-enhanced, irreegular margin, rapid-iso-enhancement with penetrating vessels

Question 31

Automated breast USS (ABUS) is a new technique that is particularly useful for women with?

Answer 31

dense breasts

Question 32

Contrast-enhanced MRI contrast and patient position?

Answer 32

IV gadolinium, | lie prone

Question 33

MRI pros (1)

Answer 33

most sensitivity for all

Question 34

MRI cons (2)

Answer 34

``` moderate specificity (more mastectomies), may pick up parts that would've been treated by RT ```

Question 35

MRI is particularly useful for which type of breast carcinoma and why?

Answer 35

lobular because usually multi-focal and multi-central

Question 36

MRI indications (3)

Answer 36

for monitoring neoadjuvant chemotherapy, to figure out discrepancy between USS and mammogram or imaging and palpation, mammographically occult lesions