Imaging of the Breast

Question 1

How many views are taken on a mammogram? What are they?

Answer 1

2 - oblique and horizontal

Question 2

When does mammographic breast screening take place?

Answer 2

Aged 50-71, every 3 years

Question 3

What type of tissue is seen in white on mammography?

Answer 3

Fibroglandular tissue

Question 4

What type of tissue is seen in black on mammography?

Answer 4

Fatty tissue

Question 5

Why is mammography less sensitive in younger women?

Answer 5

They have more dense, fibroglandular tissue which mammography is not as sensitive to

Question 6

Mammography has high sensitivity for detecting what?

Answer 6

DCIS and invasive cancers

Question 7

What is a major feature to look for on mammography which is often asymptomatic?

Answer 7

Calcification

Question 8

Calcification on mammography is often a sign of what? What else can it be due to?

Answer 8

Carcinoma in situ, duct ectasia

Question 9

What is the most important imaging modality in women with symptoms?

Answer 9

Ultrasound

Question 10

What are some indications for breast ultrasound?

Answer 10

Palpable masses, breast inflammation, breast problems during pregnancy, work up of a mammographically detected lesion

Question 11

What imaging modality is used for an image guided biopsy?

Answer 11

Ultrasound

Question 12

If you are under 40 and have a breast problem, what investigation will be done?

Answer 12

Ultrasound

Question 13

When would a mammogram be done in someone < 40?

Answer 13

If they had cancer

Question 14

It is an advantage that ultrasound can differentiate between what two types of masses?

Answer 14

Solid and cystic

Question 15

Is ultrasound a good test for invasive carcinoma?

Answer 15

Yes, good sensitivity and specificity

Question 16

What are two advanced ultrasound techniques that may be used to image the breast?

Answer 16

Strain elastography and shear wave elastography

Question 17

What colour will each of the following show up on strain elastography? A) Normal breast tissue B) Cancer

Answer 17

A) Blue B) Red

Question 18

Due to shear wave elastography, the management of what condition has changed?

Answer 18

Fibroadenoma - no need to biopsy if they are soft and benign on shear wave elastography

Question 19

Contrast enhanced ultrasound is used for what two reasons?

Answer 19

Assessing response to neoadjuvant chemotherapy and imaging of nodes

Question 20

What imaging modality is used for family history screening?

Answer 20

MRI

Question 21

What are some indications for the use of MRI?

Answer 21

Lobular cancer, assessing response to chemotherapy, positive axillary nodes with normal MGM and US, Paget’s disease

Question 22

What is the most common type of biopsy method?

Answer 22

Core needle biopsy

Question 23

What is the commonest cause of a breast lump in the under 30s?

Answer 23

Fibroadenoma

Question 24

What is the commonest cause of a breast lump in those aged 30-50?

Answer 24

Cyst

Question 25

What is the commonest cause of a breast lump in those aged > 50?

Answer 25

Cancer

Question 26

What imaging modality is the best for a breast lump?

Answer 26

Ultrasound

Question 27

Spiculate masses are 90% likely to be what?

Answer 27

Carcinoma

Question 28

For operable breast cancer, only what kind of staging is required?

Answer 28

Local

Question 29

For locally advanced disease (5cm or more) or recurrent breast cancer, what imaging modalities are used to look for metastases?

Answer 29

CT thorax, abdomen and pelvis

Question 30

What are the common sites of breast metastases?

Answer 30

Bones, lung, pleura, liver and brain

Question 31

When is nipple discharge a worrying symptom?

Answer 31

If unilateral and coming from a single duct

Question 32

What are some causes of nipple discharge?

Answer 32

Papilloma and DCIS

Question 33

Papillomas can be removed by what method?

Answer 33

Vacuum biopsy