Ch 14 Breast Procedures + Imaging Advancements

Question 1

Brachytherapy is a type of ___?

Answer 1

APBI (accelerated partial breast irradiation)

Question 2

Explain how brachytherapy works?

Answer 2

-Insertion of a radiation source at the lumpectomy site
-Delivers a localized high dose of radiation (spares the adjacent healthy tissues)

Question 3

When is brachytherapy typically performed?

Answer 3

After a lumpectomy in early, node-negative breast cancer

Question 4

With brachytherapy, planning + insertion of devices is typically done under ___ guidance?

Answer 4

CT, but sometimes u/s is used

Question 5

List 3 types of breast biopsies?

Answer 5

-FNA
-Large CNB
-Directional VAB

Question 6

List 4 advantages to breast FNAs?

Answer 6

-Fast
-Lowest cost
-Minimally invasive
-Small gauge needle used (22-25g)

Question 7

List a disadvantage to breast FNAs?

Answer 7

Increased risk of under sampling + false negatives

Question 8

How are samples obtained with a breast FNA?

Answer 8

Multiple passes/samples are obtained from different sections of the mass

Question 9

What is a CNB?

Answer 9

-Minimally invasive percutaneous core needle biopsy
-Spring loaded devices/biopsy guns are used

Question 10

Is FNA or CNB more accurate?

Answer 10

CNB b/c it obtains multiple core tissues for histology

Question 11

Does an FNA or CNB use a larger needle?

Answer 11

CNB - it uses a 14-18g needle

Question 12

List 3 advantages to having a breast CNB done?

Answer 12

-Increased accuracy compared to FNA
-Parallel approach limits complications + allows for a better visualization of the needle
-Coaxial reduces the number of needle passes

Question 13

What is a VAB?

Answer 13

-Vacuum assisted biopsy
-Rapid acquisition of multiple tissue cores through a single needle insertion site

Question 14

Does a VAB or CNB use a larger needle?

Answer 14

VAB - uses 8-1g needle (it has a larger core size)

Question 15

When would u/s guided VAB be preferred?

Answer 15

When:
-Sampling small suspicious solid lesions (<1.5cm)
-Visible suspicious calcifications
-Intraductal papillary lesions
-Complex cystic + solid lesions

Question 16

Explain how a VAB works?

Answer 16

-VAB prove is inserted directly under the mass
-Vacuum suction is applied to pull the mass into a hollow needle through the aperture
-A rotating cutter then slides across the aperture to obtain the core
-The vacuum pulls the specimen into a collection chamber w/o removal of the probe

(position = vacuum = cut = remove)

Question 17

List 4 technologic advancements in breast?

Answer 17

-3D/4D imaging
-Contrast enhanced doppler
-Elastography
-ABUS

Question 18

What is breast elastography?

Answer 18

-It assesses the relative “stiffness” of breast tissues + masses
-Stiffness is displayed by variations of shades of grey or range of colors

(note: cancer + malignant masses are harder + stiffer)

Question 19

Cancer tends to be ___ than normal breast tissue + benign masses?

Answer 19

Harder + stiffer

Question 20

What is strain elastography?

Answer 20

-Compression force gets applied to tissue (due to probe pressure)
-Provides qualitative info about stiffness of a mass compared to the surrounding tissues

Question 21

What is shear-wave elastography (SWE)?

Answer 21

-Probe emits a focused pulse of sound to the mass inducing the formation of shear waves
-Provides quantitative info about tissue stiffness

Question 22

Is strain or shear-wave elastography more reproducible + less operator dependent?

Answer 22

Shear-wave

Question 23

High breast density is associated with?

Answer 23

An increased risk of cancer

Question 24

Does high breast density make cancer detection easier or harder on standard screening mammograms?

Answer 24

Harder

Question 25

Supplementary whole breast u/s screening exams may be indicated in women with?

Answer 25

-Dense breasts -Women with high lifetime breast cancer risk -Cancer staging (where breast MRI is not available or appropriate)

Question 26

What is the purpose of dedicated whole breast automated systems (ABUS)?

Answer 26

-It reduces operator reliance!! -Rapidly acquires image sets of the entire breast in a preset manner -It displays the images in a reconstructed 3D view

Question 27

Is ABUS approved for use in Canada?

Answer 27

Yes! Used in adjunct/addition to mammography

Question 28

What is quantitative transmission (QT) u/s?

Answer 28

-An advancement in ABUS -It creates a 3D scan from speed of sound transmission, attenuation + reflection characteristics

Question 29

Explain the QT u/s procedure?

Answer 29

-Pt lies prone on the QT table -Breast is placed in a warm water bath through an opening in the table -The water bath houses the probe arrays around the breast

Question 30

Is QT u/s approved for use in Canada?

Answer 30

Clinical trials are ongoing

Question 31

Which imaging modality has the greatest sensitivity at detecting breast cancer?

Answer 31

MRI (although false positives occur due to overlap in benign vs malignant features)

Question 32

The American Cancer Society recommends using what 2 imaging modalities to screen for cancer in high risk pt's?

Answer 32

Contrast enhanced MRI + mammography

Question 33

What is the pt set up for a breast MRI?

Answer 33

Pt's lie prone with their breast suspended in dedicated breast coils

Question 34

What is contrast enhanced MRI very effective at evaluating?

Answer 34

The morphologic features of a mass + dynamic blood flow patterns

Question 35

Non-contrast MRI is the best imaging tool for assessing ___?

Answer 35

Implant integrity

Question 36

List 5 disadvantages to breast MRIs?

Answer 36

-Costly -Limited availability -Exam time -Lower specificity -Need for contrast for most exams