Chapter 20 - Breast Imaging (BEANS NOTES) Flashcards Preview

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Flashcards in Chapter 20 - Breast Imaging (BEANS NOTES) Deck (93):
1

2 purposes of breast imaging?

1. Screen asymptomatic women for early brest CA
2. Evaluate beast abnormalities in symptomatic pxs or pxs with indeterminate screening mammo

2

National cancer institute (NCI) advises women at average risk for breast CA who are age ___ and over should undergo screening mammo every __ to __ years.

40, 1 to 2 years

3

American Cancer Society Guidelines for breast CA screening:

>Age 20-39, clinical examination every 3 years, mammo not recommended
>Age 40 and over, clinical examination annually, mammo annually

4

Factors known to increase a woman's risk of breast CA:

1. Personal history of breast Ca
2. Laboratory evidence that women is a carrier of the BRCA1 or BRCA2 genetic mutation
3. Having a mother, sister or daughter with breast CA
4. Atypical or precancerous lesions diagnosed on a previous beast biopsy
5. Nulliparity or having a first child at age 30 or older

5

Goal of screening asymptomatic women?

To find breast CA in its earliest stages

6

Minimum size of breast CA that can be felt on PE?

1.5 to 2 cm.

7

Other imaging technologies use in breast CA detection and diagnosis?

> UTZ
> MRI
> PET
> Tomosynthesis
> CT

8

The gold standard and single best test for early detection of breast CA?

Mammography

9

A __________ resulting from percutaneous FNAB can look similar to a small CA.

Hematoma (Best to perform a ff.up mammogram after 4-6 weeks later)

10

Women under age _____ should not undergo mammography.

20

11

Optimal mammography

High contrast and high spatial resolution.

12

Anode material utilized to generate the xrays in most dedicated mammography?

Molybdenum

13

Some units also have __________ that can be used to increase the contrast in denser breasts while keeping radiation dose and time of exposure low.

Rhodium anodes

14

Uses an electronic system for image capture and display. It has a higher contrast resolution and equal or better dynamicrange than film screen mammo. Spatial resolution is lower.

Full-field digital mammo (FFDM)

15

Advantages of FFDM:

> higher speed of image acquisition
> ability to perform image processing
> integration of computer aided detection and diagnosis software programs
> electronic storage
> possibility of teleradiography

16

The standard views for screening mammography are:

MLO and CC views.

17

What view depicts the greatest amount of breast tissue and it is the most useful view in mammography?

MLO view

18

Classic signs of malignancy?

Spiculated masses or pleomorphic clusters of microcalcifications

19

Localizing lesion seen in one view. Demonstrate milk of calcium due to gravity dependency.

90 degree lateral (ML or LM)

20

Determine whether lesion is real or is a summation shadow.

Spot compression

21

Better definition of margins of masses and morphology of calcifications.

Spot compression with magnification (M)

22

Show lesions in outer aspect of breast and axillary tail not seen on CC view.

Exaggerated craniocaudal (XCCL)

23

Show lesions deep in posteromedial breast not seen on CC view.

Cleavage view (CV)

24

Verify skin lesions. Show palpable lesions obscured by dense tissue.

Tangential (TAN)

25

Verify true lesions. Determine location of lesion seen in one view by seeing how location changes.

Rolled views (RM or RL)

26

Improved visualization of superomedial tissue. Improved tissue visualization and comfort for women with pectus excavatum, recent sternotomy, prominent pacemaker.

Lateromedial oblique (LMO)

27

Improve visualization of native breast tissue in women with implants.

Implant displacement (ID)

28

Mammographic features of mass

> convex borders
> denser towards the center
> distort the normal breast architecture
> seen in multiple projections
> can still be visualized when focal compression is applied.

29

Artifacts that resemble masses on mammography can be produced by overlapping breast tissue.

Summation artifacts

30

The following must be assessed once the radiologist concluded the presence of mass.

Margins, density, location and size

31

Most important characteristics to be assessed?

Margins

32

Classically appears as spiculated mass on mammo

Breast CA (majority are infiltrating ductal CA)

33

_________ from previous surgical biopsy can appear spiculated

Fat necrosis

34

Scars from previous breast surgery should be carefully marked with __________

Radiopaque wires

35

These are spontaneous lesion that are benign and consist histologically of central sclerosis and varying degrees of epithelial proliferation, represented by strands of fibrous connective tissue. Can also present as a spiculated lesion.

Radial scar or complex sclerosing lesion

36

Most commonly seen in subareolar location in lactating women. Clinical findings of pain, swelling and erythema.

Breast abscesses

37

Seen in women on anticoagulation therapy or in those with blood dyscrasias. Can also be secondary to trauma, needle aspiration or surgery.

Spontaneous hematomas

38

Most common well-circumscribed masses seen in women between the ages of 35 and 50 years. On utz, they are round or oval, smooth walled and anechoic.

Cysts

39

Another manifestation of fibrocystic change that can be seen mammographically. Appears as well-defined mass on the films. Sometimes may present with ill-defined borders.

Fibrosis

40

Most common well-defined solid masses. Hypoechoic masses on utz. Peak age is 20-30 years

Fibroadenomas

41

Primary breast malignancies when a well-defined density is visualized on mammography.

1. Infiltrating ductal CA
2. Papillary CA
3. Mucinous CA
4. Medullary CA

42

Most common primary CA to produce breast metastasis.

Melanoma

43

Benign breast lesions that are purely fat density includes the ff:

Oil cysts (from fat necrosis), lipomas and sometimes galactoceles

44

Cyst that generally result from trauma.
Round lucent lesions surrounded by a thin capsule, often multiple and can demonstrate rim calcifications

Oil cyst

45

Similar to oil cyst, also lucent with surrounding capsule.
Surrounding breast architecture may be distorted because of the mass effect

Lipomas

46

Occur in lactating or recently lactating women and are probably the result of an obstructed duct.

Galactocoeles

47

Benign masses that are mixed fat and water densities.
Rare benign tumors and intramammary lymph nodes.
Generally located in the UOQ in the posterior 3/4 of the breast parenchyma

Hamartomas

48

Intramammary nodes are almost always located in the _________

UOQ of the breast

49

Skin lesions are usually recognized by ________ around the edges or in the interstices. These can produce a dark halo around one edge.

Air trapping (will not be evident with flat, pigmented skin lesions or sebaceous cysts)

50

View to demonstrate that the lesion is located in the skin.

Tangential view

51

Size upper limit of _________ for masses that are to undergo follow-up.

1 to 1.5 cm (6month ff.up of the affected breast followed by bilateral mammogram 6 months later then annual mammo for at least 3 years to document stability)

52

Calcification pattern in primary breast cancer in mammography.

Clustered, pleomorphic microcalcifications.
Dystrophic

53

Large calcifications with lucent centers that are benign

Eggshell calcifications in oil cyts

54

Calcifications in the wall of tortuous vessel

Arterial calcifications

55

Magnification of a 90degrees lateral mammo showing diffuse linear calcifications and in CC view of the same area shows smudged, rounded calcifications. Appears as a line of meniscus when views from the side in lateral projection.

Milk of calcium in breast cysts

56

Long and thick calcifications in ectatic ducts that radiate toward the nipple

Secretory calcifications

57

Indeterminate calcifications aremost often associated with ________

Fibrocystic change (fibrosis adenosis, sclerosing adenosis, epithelial hyperplasia, cysts, apocrine metaplasia and atypical hyperplasia)

58

Biopsy of indeterminate calcification will yield a diagnosis of _______

LCIS (lobular carcinoma in situ)

59

Malignant calcifications are generally less than ______

<0.5mm

60

Causes of increased density of breast tissue

Hormone therapy, inflammatory CA, radiation therapy, diffuse mastitis, obstruction to the lymphatic or venous drainage

61

Bilateral increased density is usually the result of estrogen replacement therapy in postmenopausal women.

Hormone therapy

62

Unilateral increase in breast density with associated skin thickening

Inflammatory CA

63

Unilateral increase in parenchymal density with skin thickening can also be seen in patients who have undergone radiation therapy to the breast.

Radiation therapy

64

Generalized skin thickening and increase in breast density

Diffuse mastitis

65

From metastatic disease, surgical removal, or thrombosis can produce a unilateral increase in breast density with skin thickening due to edema.

Obstruction to the lymphatic or venous drainage

66

Axillary lymph nodes are frequently visualized on the ______ mammogram. Normally, they are ________ in size and have lucent centers or notches resulting from fat in the hilum.

MLO, <2cm

67

Benign or normal lymph nodes are ______ with a ________ on UTZ.

Hyperechoic, thin hypoechoic cortical rim

68

Screening mammography in the women with implants requires the use of at least 2 extra views of each breast.

Standard MLO and CC plus implant displacement views (2)

69

First examination performed in pxs noticing a change in implant contour or size and if women is older than 30 years

Mammography (not useful in the detection of intracapsular silicone implant ruptures)

70

Most accurate in identifying silicone implant rupture and in localizing free silicone.

MR (IR most effective sequence)

71

Indicates intracapsular rupture occurs when the collapsed implant shell floats within the silicone gel contained in the fibrous capsule.

Linguine sign

72

Indicates small amounts of silicone collected in a radial fold. Overtime, microscopic silicone can leak through the intact implant shell and collect at the implant shell surface giving a subcapsular line sign.

Noose, teardrop or keyhole signs

73

Most common indication for breast imaging in men.

Palpable asymmetric thickening or mass (gynecomastia is usually the cause)

74

Generally appears as a triangular or flame shaped area of subareolar glandular tissue that points toward the nipple

Gynecomastia

75

Male breast in mammo

Mound of subcutaneous fat without glandular tissue

76

Common clinical applications of breast MR

Screening of pxs at high risk for developing breast CA, preop staging of newly diagnosed breast CA, detection of mammographically occult malignancy in pxs with axillary nodal mets, evaluation of response to neoadjuvant chemotherapy.

77

Breast MR technique

1.5 Tesla or higher, px in prone position with breast hanging into a dedicated receiver breast coil, should be done between days 6 and 17 of the menstrual cycle.

78

Predictors of benignity in MR

Smooth margins, non-enhancing internal septations, minimal or no enhancement, and diffuse patchy enhancement

79

Features suggestive of malignancy in MR

Spiculated or irregular borders, peripheral or rim enhancement, segmental or regional enhancement, and ductal enhancement

80

Most invasive CA demonstrate rapid initial enhancement with a _____ or _____ on delayed imaging.

Plateau, washout

81

May demonstrate slow initial enhancement

DICS, invasive lobular CA, tubular CA, mucinous CA

82

BI-RADS

Breast Imaging Reporting And Data System (for mammo, breast UTZ and MR)

83

BI-RADS Category 0

Need additional imaging evaluation and/or prior mammogram for comparison

84

BI-RADS Category 1

Negative

85

BI-RADS Category 2

Benign finding (lipoma,oil cyst, galactocoele, intramammary LN, hamartoma, fibroadenoma, cyst etc.)

86

BI-RADS Category 3

Probably benign-initial short interval ff.up suggested

87

BI-RADS Category 4

Suspicious abnormality-biopsy should be considered

88

BI-RADS Category 5

Highly suggestive of malignancy-appropriate action should be taken

89

BI-RADS Category 6

Known biopsy proven malignancy-appropriate action should be taken

90

Interventional procedures for the breast

Percutaneous biopsy, image directed core biopsy and aspiration

91

The tip of the needle for a wire localization should be ______ beyond the lesion.

1 to 2 cm

92

Most useful in guiding a localization when the abnormality is seen well in one projection but is obscured by dense tissue in the second

Ultrasound

93

Can be used to investigate the cause of a spontaneous nipple diacharge. Most frequently lesions are papillomas.

Ductography