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From Q book Flashcards

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1
Q

Screening recs

American cancer society

A

Annual 45 to 54

option for annual 40-44

biennial at 55 with option to continue annual

(MOST COMPLICATED)

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2
Q

Screening recs

ACR and SBI

A

annual starting at 40

(most simple)

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3
Q

Screening recs

US Preventative Services Task Force

A

Biennial aged 50-74

(option to start earlier)

MOST lenient

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4
Q

Factors that make a woman high risk?

A

>20% lifetime risk

BRCA carrier

first degree BRCA, themselves untested

Radiated between 10 and 30

other mutations like Li-Fraumeni

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5
Q

When to start screening w/ h/o RT

A

8 years after RT

earliest age 25

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6
Q

Differential for a malignant fat containing breast lesion

A

Liposarc

phyllodes

IDC

ILC

(belieft is that tumors can engulf fat as they grow)

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7
Q

Additional study indicated in new Dx of inflammatory cancer?

A

PET/CT

bone mets mc

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8
Q

Breast MRI and preggos

breast feeding

A

Gad not safe to fetus so NO

OK during breast feeding

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9
Q

Preg associated breast cancer

how common?

MC type?

A

10% of all new dx in patients <40

MC HISTOLOGY IS high grade, E and P receptor NEGATIVE IDC

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10
Q

Prior RT and breast MRI

Cycle and BPE

A

DECREASES backgrough parenchymal enhancement

Ideal time with LEAST BPE is during FOLLICULAR phase (days 7-15)

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11
Q

First postcontrast phase acquired when?

A

First 2 minutes

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12
Q

American cancer society MRI screening rec?

A

For those with >20% lifetime risk

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13
Q

Required for birads 2 dx of bilateral benign appearing masses

A

3 masses, at least one in each breast

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14
Q

f/u for man boobs

A

none

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15
Q

looks like man boob on screener, next step?

A

diganostic bilat mammo

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16
Q

Patterns of gynecomast

A

nodular <1 year, reversible

Dendritic >1 year irrev chronic pattern

Diffuse 2/2 exogenous estrogen

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17
Q

Mass (or asymm, focal asymm, arch distort) on screener next step

Calcs?

A

Dx mammo with spot compression and US

Calcs get mag and US

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18
Q

Terminology shit

Mammo circumscribed margin % ?

other mammo margin descriptors ?

Density mammo terms?

A

Mammo circumscribed margin 75% sharply defined

(obscured more than 25% not defined)

Other mammo margins- circumscribed, obscured, microlobulated, indistinct, spiculated

Density mammo terms = fat-density, low-density, equal-density, high-density

Shape mammo terms = oval, round, irregular

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19
Q

Breast US terms

A

US margin terms = circumscribed or not circumsribed

circumscribed = 100% well defined (vs mammo only 75%)

US margin not circumsribed can be further described as

microlobulated, angular, indistinct and spiculated

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20
Q

US breast mass echogenicity described relative to?

A

Mass echogenicity described relative to FAT, not fibroglandular tissue

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21
Q

Ddx for malignant spiculated?

A

Invasive ductal

Invasive lobular

tubular

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22
Q

Ddx for benign spiculated ?

A

Postsurgical scar

fat necrosis

radial scar

sclerosing adenosis

fibromatosis

granular cell tumor

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23
Q

Ddx for malignant round mass

Study These Flashcards
A

high grade invasive ductal

mucinous carcinoma

medullary carcinoma

mets

Papillary

24
Q

Phantom pass

Study These Flashcards
A

four fibers

three masses

three speck groups

25
Dense breasts target/filter
Rh/Rh "thick" still mo/mo or mo/rh
26
birads 4 or 5 'attempts to communicate with healthcare provider' within
3 business days
27
ACR parameter for ambient light?
approximately equal to average luminance of image 25-40 lux range
28
radial scar vs complex sclerosing lesion
same histo differ by size. **radial scar \<1cm** both central stroma with glands radiating from central stellate lesion
29
MAMMO famous paper BULLSHIT ACRIN 6666 documentation of a negative screening breast US exam requirements
one image in each quadrant plus subareolar 5 images per tit
30
Mammo famous trial BULLSHIT Digital mammography imaging screening trial **D**MIST compared film screen mammo to?
full field **D**IGITAL mammo
31
Mammo famous trial BULLSHIT DMIST showed full field digital had greater dx accuracy in which subgroups
\<50 yo heterogenous or dense tits pre or perimenopausal
32
Mammo famous trial BULLSHIT First breast cancer screening trial in USA
Health Insurance Plan Randomized Control Trial 25% less mortality in intervention group
33
Mammo famous trial BULLSHIT Swedish 2 county trial ? prevented br ca deaths per 1000 women screened every 2 years
**8 - 11** prevented br ca deaths per 1000 women screened every 2 years
34
TIT TRIAL BULLSHIT Canadian National Breast Screening Study CNBSS 25 year survival was ? in women with br ca detected via mammo and PE vs PE alone
25 year survival was **HIGHER** in women with br ca detected via mammo and PE vs PE alone
35
TIT TRIAL BULLSHIT CNBSS cumulative mortality over 25 years ? in women dx with br ca over screening period via mammo and PE vs PE alone
cumulative mortality over 25 years **SIMILAR** in women dx with br ca over screening period via mammo and PE vs PE alone
36
TIT TRIAL BULLSHIT Simulation modeling for radiation induced br ca show that annual screening of 100k women projected to induce ? cancers leading to 16 deaths, relative to ? breast cancer deaths prevented by screening
Simulation modeling for radiation induced br ca show that annual screening of 100k women projected to induce **125** cancers leading to 16 deaths, relative to **970** breast cancer deaths prevented by screening
37
Triple neg br ca mutation
MC in BRCA 1
38
post lumpectomy mammo recs
q 6 months x 2-3 years
39
MC mets to breast
other breast (wah) melanoma, lymphoma
40
Breast US transducer
LINEAR **center** frequency of at least 10 MHz
41
Differential for T2 bright breast mass
Cyst fibroadenoma - non enhancing septations Lymph node - T2 dark fatty hilum central Necrotic bad or mucinous cancers
42
DDX for rim enhancement on MRI
Inflamed cyst Fat necrosis MUCINOUS cancer post op seroma
43
Non mass enhancement
Linear- suspicious - in a duct Focal - Less than one quadrant **single duct system** Segmental - conical - suspicious Regional - more than one quadrant - more than one ductal system
44
**Archtectural distortion** MC appearance? US look? Can be a/w adjacent finding?
distorted parenchyma with lines radiating from lucent center US - mass, distorted tissue or abnormal Coopers **can have adjacent skin or nipple retraction**
45
Architectural distortion Benign causes? a/w malignancy? what to do if no US correlate?
Benign causes - **post-surgical scarring, radial scar, complex sclerosing lesion**.... post bx change, fat necrosis, sclerosing adenosis, focal fibrosis Third MC presentation of Breast cancer IDC, ILC, Tubular (medullary and mets are round) NO US correlate --\> stereotactic bx
46
Workup of nipple DC \< or \> 30 yo galactogram contraindx filling defect =
\<30 US \>30 dx mammo and US contraindx = infection or allergy 0.3 ml filling defect = air bubble or intraductal lesion air bubble will move on orthogonal view
47
Suspicious nipple DC =
bloody, serous or **clear** ## Footnote **spontaneous = suspicious** **uniductal = suspicious** **Benign** **white, green, yellow** **non-spontaneous** **bilateral**
48
MC benign and malignant causes of nipple DC Pagets?
MC benign = INTRADUCTAL PAPILLOMA MC Malignant = DCIS Pagest can present with nipple DC, nipple eczema, subareolar mass
49
Demo, pres prognosis of Papillary carcinoma
complex cystic and solid mass OVER 60 YO good prognosis **PAPILLARY = OLD, COMPLEX, CYSTIC**
50
when is a focal assymetry considered benign (how long)
2 years A focal asymmetry screen detected with no suspicious features on diagnostic w/u = **birads 3**
51
When to use rolled view?
asymmetryseen only on CC opposite of roll = inferior
52
Solid, wide, circumscribed mass seen on US in 28 year old with palpable Probably is? birads? f/u?
Probably a fibroadenoma BIRADS 3 f.u 6, 12, 24 months
53
solitary complicated cyst birads? complex solid and cystic mass birads? simple microcysts?
solitary complicated = birads 3 complex solid and cystic mass = birads 4 simple microcysts are benign simple microcysts too small to characterize or real deep on US = birads 3
54
BIRADS 3 f/u q's mass resolves? markedly decreases in size? size increase that warrants bx? 2 years of stability?
Resolves = birads 1 Markedly decreases in size = birads 2 20% increase in 6 months = birads 4 bx rapidly growing think phyllodes 2 years of stability = birads 2
55

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