Imaging in Breast Disease

Question 1

types of breast imaging

Answer 1

mammography
USS
image guided techniques
MRI
nuclear medicine
screening

Question 2

traditional mammography views

Answer 2

oblique

craniocaudal

Question 3

additional mamography views

Answer 3

coned view
magnification view
true lateral
extended CC

Question 4

mammography may be performed in the under 40 if:

Answer 4

strong suspicion of cancer

FHx is > 40%

Question 5

radiation dose in mamorgraphy

Answer 5

1mSV

Question 6

signs of breast disease on mammography?

Answer 6

dominant mass
asymmetry
architectural distortion
calcifications

Question 7

soft tissue mass mammography findings: malignant

Answer 7

irregular, illdefined
spiculated
dense
distortion of architecture

Question 8

soft tissue mass mammography findings: benign

Answer 8

smooth or lobulated
normal density
halo

Question 9

breast USS can be used to differentiate

Answer 9

solid from cystic mass

solid benign from malignant

Question 10

breast USS is first line in what age?

Answer 10

<40

Question 11

breast USS findings: solid benign

Answer 11

smooth outline
oval shape
acoustic enhancement

Question 12

breast USS findings: malignant

Answer 12

irregular outline
interrupting breast architecture
acoustic shadowing and anterior halo

Question 13

triple assessment in breast Ca

Answer 13

clinical exam
imaging
FNA cytology

Question 14

MRI of the breast: indications

Answer 14

recurrent disease
implants
indeterminate lesion following triple assessment
screening high risk women

Question 15

sentinel node sampling in breast ca

Answer 15

• Peritumoral injection of 99m Tc sulphur colloid ± isosulphan blue dye
• Lymphoscintigraphy
• Intraoperative Gamma probe
• Single Lymph node removal
• 97% accurate in identifying sentinel node

Question 16

breast screening programme

Answer 16

►Women 50-70 invited every 3 years for mammography
►Mammograms detect 5 cancers/1000 screened
►Uptake is 80%
►Recall for further investigations is 5-10%
►Static centres in urban areas, mobile vans for rural areas
►Assessments in static centre with breast team-radiologist, radiographer, breast clinician, nurse, cytologist and surgeon
►Additional views, clinical exam, ultrasound, FNAC or core biopsy
►Aim to detect cancers at DCIS stage or less than 15mm in size ie impalpable

Question 17

what is cytology?

Answer 17

microscopic examination of a thin layer of cells on a slide

Question 18

name 3 ways of obtaining cells for cytology

Answer 18

Fine needle aspiration
direct smear from nipple discharge
scrape of nipple with scalpel

Question 19

role of cytology in symptomatic clinical breast ca

Answer 19

Patient presents with symptoms and undergoes “triple assessment” by surgeon, radiologist and cytopathologist

Question 20

breast benign cytology

Answer 20

• low/ moderate cellularity
• cohesive groups of cells
• flat sheets of cells
• bipolar nuclei in background
• cells of uniform size
• uniform chromatin pattern

Question 21

breast malignant cytology

Answer 21

• high cellularity
• loss of cohesion
• crowding/overlapping of cells
• nuclear pleomorphism
• hyperchromasia
• absence of bipolar nuclei

Question 22

malignant breast cytology usually gives a non-specific diagnosis i.e. adenocardinoma. occassionaly features may suggest:

Answer 22

lobular carcinoma
cytoplasmic vacuoles
tubular carcinoma
cells arranged in tubes

Question 23

fluid from breast cysts is discarded, unless:

Answer 23

blood stained

residual mass

Question 24

advantages of breast cytology

Answer 24

• Simple procedure - can be done at clinic
• Well tolerated by patients
• Inexpensive
• Immediate results

Question 25

limitations of breast cytology

Answer 25

``` • False Negatives • False Positives • Invasion cannot be assessed • Grading cannot be done • Sampling (lesion missed) – small lesions – small tumour in larger area of thickening • Technical (difficult to examine cells) – suboptimal smears (blood, thick, cells smeared) • Interpretation (features similar) ```

Question 26

complications of FNA

Answer 26

* Pain * Haematoma * Fainting * Infection, Pneumothorax –rare

Question 27

nipple discharge: duct ectasia

Answer 27

macrophages

Question 28

nipple discharge: intraduct papilloma

Answer 28

benign cells in papillary groups

Question 29

nipple discharge: intraduct carcinoma

Answer 29

malignant cells

Question 30

nipple scrape can differentiate between two conditions. name and how can you determine?

Answer 30

– Paget’s Disease (squamous cells and malignant cells ) v | – Eczema (squamous cells from epidermis only)

Question 31

when would you carry out a core biopsy on a breast?

Answer 31

* All cases with clinical OR radiological OR cytological suspicion * Breast screening – especially architectural distortion and microcalcification * Pre-operative classification * Rarely open biopsy