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From CtC Flashcards

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1
Q

Malignant a/w breast asymmetry

A

‘shrinking breast’ of invasive lobular breast cancer

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2
Q

Titty node levels

1

2

3

R

A

Relationship to pec minor

1 lateral

2 under

3 above and medial

R between major and minor

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3
Q

period phases

A

7-14 Follicular/proliferative - Estrogen

15-30 Secretory/luteal - Progesterone

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4
Q

Perimenopausal period hormone change

A

shorter follicular/proliferative phase

More progesterone

more pain, more fibrocystic change, cyst formation

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5
Q

Menopause changes

A

lobules go down

fibroadenomas degenerate — > popcorn

Secretory calcs develop —> Cigars

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6
Q

where do most cancers start

A

TDLU

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7
Q

when boobs most tender?

A

days 27-30

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8
Q

when to mammo or MRI

A

proliferative/follicular

7-14

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9
Q

Increased density non-preggo

A

Prolactinoma

anticrazy meds

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10
Q

When to LMO

A

kyphosis or pectus or medial wire/line

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11
Q

spot compression collimator change?

A

Leave collimator open on spot compression

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12
Q

Direction of mag views?

A

CC and ML

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13
Q

ML or LM on call back if only seen on CC?

A

ML if lateral

LM if medial

detector closer to lesion

ML if only seen on MLO (70% of cancers lateral)

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14
Q

Blur source

A

motion or inadequate compression

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15
Q

MLO misses?

CC misses?

A

MLO misses most medial

CC misses posterior-inferior

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16
Q

how to localize a CC only finding?

A

Rolled view

CC with boob twisted medial or lateral

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17
Q

BR 3 list

A

fibroadenoma

focal asymm that looks like breast tissue

Grouped or clustered round calcs

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18
Q

What does BR4 mean about biopsy results

A

that you would accept a negative

5 means if you call it benign I’m calling surgeon

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19
Q

BIRADS TERMINOLOGY

Shape

A

ROI

Round

Oval

Irregular

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20
Q

BIRADS TERMINOLOGY

Margin

A

COMIS

Circ

Obscured

Microlobulated

Indistinct

Spiculated

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21
Q

BIRADS TERMINOLOGY

Density

A

relative to parenchyma

Fat

Hypodense

Isodense

Hyperdense

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22
Q

Most reliable descriptor for malignancy

A

MARGIN

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23
Q

BIRADS TERMINOLOGY

US

Margin

A

US = CAMIS mammO = COMIS

US

Circumscribed

Indistinct

Angular

Microlobulated

Spiculated

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24
Q

MRI

Background Parenchymal Enhancement

which sequence

A

FIRST post contrast sequence

none, minimal, mild, moderate, marked

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25
MRI lexicon
Shape ROI Margin CIS Internal enhancement pattern **Homo, hetero, rim, dark internal septations** **NO ENHNANCING INTERNAL SEPT's or CENTRAL Enhancement**
26
NMLE buzzword for DCIS or IDC
**"clustered ring"**
27
Demo for secretory calcs
ONLY POSTMENOPAUSAL involuted ducts
28
milk of calcium (teacup) are 2/2?
**fibrocystic change** **trivia = needs to be viewed with polarized light after biopsy**
29
Round calcs thought process
**Round calcs are like masses** bilateral, scattered, symmetric ok (fibrocystic change) **clustered, singular or new = workup** **Grouped round calcs = BR3 (on first mammo)**
30
Suspicious calcs 3 types
**amorphous** - can't count MC = fibrocystic change DCIS= low grade **Coarse Hetero** **bigger than 0.5 mm, no ouch** Low-intermed DCIS or masses (FA or papilloma) **Fine Pleomorphic** **ouch, \<0.5mm, DCIS high grade**
31
Boob DVT
Mondor disease looks like you'd expect don't anticoagulate
32
lipoma look
radiolucent with **no calcs** enlarging = indication for bx
33
PASH look f/u
Pssshhh they b9 big, solid, oval, well defined
34
IDC subtype trivia tubular
Radial scar 10-15% contra involvement small, spiculated, favorable prog
35
IDC subtype trivia Medullary
round, circumscribed, no calcs a/w big nodes even when not mets young, good outcome
36
IDC subtype trivia Papillary
Old, black, complex (pappy) complex cystic and solid elderly, non whites **2nd MC besides IDC-NOS**
37
ILC look
arch distort US - shadowing with no mass
38
dark star ddx | (arch distortion with central lucency)
lobular radial scar (tubular) IDC - NOS surgical scar
39
ILC vs IDC
ILC more often multifocal fewer axilla mets more mets to weird places positive margins more often --\> mastectomy
40
Pagets of boob
Carcinoma in situ of nipple epidermis a/w high grade DCIS not T4
41
most suspicious nipple discharge combo
spontaneous bloody (serous also suspicious) single duct
42
galactography contraindx
mastitis, inability to express DC, allergy, prior surgery to nipple complex
43
AD with no US/MRI correlate?
gets a bx
44
male breast cancer and brca
1/4 have it ## Footnote **MC brca 2**
45
recurrence rate and period
6-8% usually around 4 years benign calcs occur early, within 2 years, bad calcs around 4 years
46
skin/trabecular thickening post RT
worst on 1st mammo
47
Skin thickening late with red plaques post RT
Secondary angiosarcoma
48
T staging
T1 = \<2cm **T2 = 2-5 cm** T3 = \>5cm **T4 = chest wall, skin, or inflammatory**
49
biggest predictor of overall survival?
axillary nodal involvment
50
contraindx's to breast conservation therapy
inflammatory large tumor multi-centric (multiple quadrants) prior RT to that titty
51
who gets MRI screener
lifetime risk \>20% (don't use Gail to calculate, Tyrer Cuzick is the best) 20 Gy to chest as a kid
52
tamoxifen and BPE
will decrease while on it, then cause **rebound**
53
BIRADS 3 focus on MRI
solitary with persistent kinetics
54
bad enhacement
heterogenous or rim
55
kinetics timing
upslope = **first 2 minutes** washout = **2-6 minutes**
56
MRI classic looks Fibroadenoma
T2 bright (usually means b9 anytime) **non-enhancing septa** type 1 kinetics
57
MRI classic looks DCIS
clumped, ductal, linear or segmental NMLE kinetics don't matter **DCIS = NMLE**
58
MRI classic looks IDC
**spiculated, irregular** **hetero enhancement** **type 3 curve**
59
MRI classic looks ILC
doesnt always enhance
60
T2 bright but bad
colloid cancer mucinous cancer
61
timing for MRI screening post RT to chest
20Gy = threshold age 25 or 8 years post tx (whichever later) risk peaks 15 years post RT
62
Cowden
breast follicular thyroid endometrial lhermitte duclos
63
BRCA 1 vs 2
1 more common in women 1 = chrom 17 2 = chrom 13 Men bad one = brca 2
64
male with indeterminate palpable
\< 25 US \>25 mammo then US if suspicious
65
woman \>40 with mammo that look like a lipoma, palpable?
no more imaging
66
woman \< 30 US looks b9 or negative?
NO mammo
67
woman \< 30 US BR3 (FA)
q6 month US f/u
68
US needle used for masses of passes
14 G spring loaded 5 passes
69
when is FNA ok
known breast cancer with a node you're pretty sure is a met
70
indx for cyst aspiration
anxiety, pain, uncertain dx NOT SIZE
71

Breast (3 decks)

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