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Flashcards in Breast Review Deck (91)
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1

What structures comprise the TDLU?

Terminal Duct Lobule Unit - Lobule is the exocrine gland

2

What does MQSA of 1998 stand for and mean?

Mamo. Quality Standard Act. Applies to docs, physicists, rads technologists

3

ACS guidelines for breast screening?

Qyear at age 40

4

ACS guidelines for breast BSE and CBE

CBE should be done at 20-39 q3 years. BSE should be taught about BSE and limitations but can start at 20yo.

5

What is screening mamo for?

Healthy adult with no symptoms of BC

6

What is a diagnostic mamo for?

Done under supervision of radiologist for patient with signs or symptoms related to breast. Lump, focal, discharge, etc.

7

What is the sens/spec of mammography for detection?

Sens 80-90, spec 80-95%

8

What are the two standard views?

MLO, CC

9

What are 8 special views, additionally?

Spot compression, mag views, true lateral, axillary tail, cleaavage view, rolled, exaggerated CC, implant displaced.

10

How old should a comparison mammo study be?

2 years old! Because good to evaluate slow growing tumors.

11

Indications for BUS?

solid/cystic? biopsy planning. Evaluation of mass in woman under 30 years old. Staging.

12

What is ultrasound NOT good for detecting?

Calcifications

13

What two nuclear medicine studies detect breast cancer?

Tc-99m sestamibi, FDG PET

14

Four methods for getting samples of a breast lesion?

CNB, needle loc with surg bx, FNA, surgical excision of palpable mass.

15

What are the indications for a CNB?

Birads 5 and 4, and 3 if patient is anxious.

16

BIRADS

0 - needs additional imaging
1 - negative
2 - Benign - stable mass, cyst, calcs, 0% chance of malig
3 - Probably benign - round calcs, 90% chance
4 - Suspicious abnormality - 2%-90% chance of malig (35% biopsy positive)
5 - Highly suggestive of malig - >90% chance (99% biopsy positive)
6 - Known active malignancy

17

What are the three terms used to describe a mass in BIRADS lexicon?

Shape, Margin, density

18

What are the three most common palpable masses?

Fibroadenoma (young), cyst, carcinoma (older)

19

Lexicon words to describe benign lesions?

Round, oval, macrolobulated, circumscribed margin, radiolucent, or low dencity.

20

Lexicon words to describe malignant lesions?

Irregular mass shape, spiculated margin, high density, architectural distortion, enlargement over time

21

List a differential for a well defined mass

Cyst, fibroadenoma, phylloides, carcinoma, mets, papilloma, hematoma, hamartoma, lipoma, lymph node (intramammary), abcess, oil cyst, galactocele.

22

List a differential for a ill defined mass

Carcinoma, abcess, hematoma, radial scar, fibrocystic change, myoblastoma

23

List a differential for a lucent lesions

lymph node, lipoma, hamartoma, oil cyst, galactocele

24

What are DIRECT signs of malignancy?

Mass, spiculated, malignant calcs, assymetry, neodensity, architectural distortion

25

What are INDIRECT signs of malignancy?

Architectural distortion, skin thickening, nipple retration, lymphadenopathy, breast edema

26

What is "taller than wide" a sign of?

Bad sign

27

BUS sign of cystic lesion?

Anechoic, parallel orientation, increase through transmission

28

BUS sign of fibroadenoma?

Oval or macrolobulated, parallel, circumscried, iso/hypo echoic

29

BUS sign of carcinoma?

Irregular, spiculated, hypoechoic, NONPARALLEL

30

What are the stages of enhancement on MRI?

Type1a: persistent (likely benign), Type1b: bowing (typically benign), Type2: plateau (intermediate), Type 3: washout (bad sign)

31

What type of cancer only enhances 50% of the time?

DCIS

32

What calcifications are typically benign?

Diffuse/scattered, large, popcornlike, rodlike, smooth, round, stable

33

What calcifications are typically malignant?

Grouped/clustered, linear, micro (<0.5mm), pleomorphic/heterogeneous, increasing in number

34

What are ductal casts?

Can be a sign of malignany - these are necrotic debris or secretions that calcify in the ducts. They cand be sandlie or granular

35

What are two lesions that are almost always associated with calcifications?

DCIS and IDC

36

What causes PLEOMORPHIC or HETEROGENOUS calcs?

DCIS, fibrocystic change, fibroadenoma, papilloma

37

What causes AMORPHOUS calcs?

DCIS, fibrocystic change, sclerosing adenitis

38

What causes LINEAR BRANCHING calcs?

DCIS, VASCULAR, secretory

39

What causes LUCENT calcifications

fat necrosis, skin cals

40

What does a vascular calcification look like?

Tram-track

41

Appearance of fibroadenoma calc?

Popcornlike

42

Appearance of fibrocystic change calc?

scattered round or amorphous

43

Appearance of oil cyst calc?

lucent centereed

44

Appearance of plasma cell mastitis?

needle like calcs along orientation of ducts

45

Appearance of vascular calc?

tram tracks

46

Appearance of artifactual calcs of deodorant, talc?

distribution

47

Appearance of silicone, or foreign body calcs?

bizarre...

48

Milk of magnesium calcs?

Looks like tea cups on laterals and pearls on CC.

49

What can cause benign skin thickening?

Inadequate compression, irradiation or surgery, mastitis, cardiac failure, renal failure, liver or hypoalbuminemia, Mondor's disease, SVC thrombus

50

What can cause malignant thickening?

Locally advanced cancer, recurrent cancer, lymph obstruction, inflammatory breast cancer

51

What can cause a dialted duct?

Obstruction: DCIS, papilloma, adenoma, debris, duct ectasia

52

Risk factors for developing breast cancer?

Female, family history, previous BC, early menarche and late menopause, nulliparity, BRCA, prior radiation therapy

53

What are the histologic types of breast cancer?

Invasive ductal (65), DCIS (15), invasic lobular (10), medullary (3), mucinous (3), tubular (1), phyloides, pagets, inflammatory, papillary.

54

Keys for ductal carcinoma

could be palpable or discrete, usually spiculated in mammo

55

Keys for lobular carcinoma

Usually spiculated, usually mammographically occult, which is bad!

56

Keys for inflammatory carcinoma

Red swollen painful, peau d'orange.

57

Keys for phylloides tumor

Usually 70 or older, can be round, circumscribed, and look like fibroadenoma, BUT you have to be very suspicious in an old woman.

58

Keys for Paget's disease of the breast

Thickening of the nipple, can look normal

59

TNM staging

0: DCIS (nearly 100% survival)
I: Invasive tumor less than 2cm, no nodes. (96% survival)
II: Invasive tumor less than 5cm, not fixed to chest wall and w/wo local nodes (81% survival)
III: Invasive tumor of any size, fixed to chest wall, with nodes, but NO distant (52% survival)
IV: Distant mets (18% survival)

60

What is the most prognostic factor in patients with primary breast cancer?

Axillary nodes

61

Levels of lymph nodes related to what muscle

All in relation to pec minor

62

What are the levels?

I is lateral, II is over the muscle, III is medial to the muscle

63

Does ER positive status portend favorable or bad outcome?

Better outcome

64

What does a Halstead radical remove?

All breast tissue, pect major/minor, all lymph nodes

65

What does a modified radical remove?

Everything that the Halstead does minus the musclulature.

66

What does the total (simple) remove?

Modified minus the nodes

67

What does a subcutaneous mastectomy remove?

removal of most of the tissue but preservation of nipple, etc.

68

What is the difference between LCIS and DCIS?

LCIS is being debated to whether it is the precursor to ICS. Whereas 35% of DCIS progresses.

69

What is a cause of bloody discharge?

Papilloma

70

How could you try to diagnose this?

Ductogram

71

What does a radial scar look like radiographically?

Usually spiculated, may have black star (central lucency) appearance, whereas malignancy usually looks like a white star.

72

Are radial scars associated with cancers?

Yes. Tubular carcinoma. There is often atypia associated so excision is recommended.

73

How does a simple breast cyst develop?

Dilation of the TDLU!

74

What gives the appearace of a breast within a breast?

Hamartoma

75

What appears well circumscribed and entirely radiolucent?

Lipoma

76

What cystic lesion is caused by a sudden cessation of breast feeding?

galactocele

77

What is Mondor's disease?

Superficial thrombophlebitis of the veins of the breast.

78

What does fibrocystic change look like?

Mammo: increased glandular tissue, microcalcifications that are scattered or milk of calcium.

79

What does fibrcystic change look like on US?

macrocysts or microcyst <3 mm.

80

What would an abnormal lymph node look like?

dense, not fatty hilum.

81

When is nipple discharge worrysome?

Blood or serous.

82

When is nipple discharge not worrysome?

Bilateral, brown, green, milky

83

What is a study that's useful for evaluating discharge?

Galactogram (ductogram)

84

What are the two types of rupture?

Intracapsular, extracapsular

85

How does a breast react to an implant?

Fibrous capsule

86

What is the best method for evaluating breast implant rupture?

MRI

87

What is the linguine sign?

Lines in an implant may represent collapse of the capsule

88

What are radial folds?

NORMAL reduntant retaining capsule

89

What do crenelated margins indicate?

capsular contracture

90

What does a focal bulge in implant represent?

Possible herniation through a defect in the fibrous capsule

91

Breast density categories

Fatty, scattered, heterogenous, dense