Flashcards in mammographyflash Deck (75):
Mammographic signs of malignancy
Spiculated mass. Pleomorphic microcalcifications. (40% of breast cancers)
Definition of breast mass
Space occupying lesion seen in two different projections. Convex borders. Distorts normal architecture. Increased central density.
Definition of breast focal asymmetry
Confined asymmetry with similar shape on two views. Lacks borders conspicuity of a true mass.
Definition of breast asymmetry
Space occupying lesion seen in only one view.
Descriptors of breast mass (5)
Size. Morphology. Associated calcifications. Associated findings. Location.
Descriptors of breast shapes (4)
Round. Oval. Lobular. Irregular.
Descriptors of breast margins (5)
Circumscribed (>75%). Microlobulated (undulated). Obscured. Indistinct (ill-defined). Spiculated.
Definition of circumscribed breast mass
>75% of mass is circumscribed (well-defined).
Definition of obscured breast mass
Border is likely circumscribed but hidden by normal tissue.
Descriptors of breast density (4)
High. Equal. Fat-containing radiolucency. Non-fat-containing radiolucency.
Differential for breast mass with spiculated margins and or architectural distortion (4)
Breast cancer. Fat necrosis. Scar. Radial Scar.
Definition of Radial Scar/Complex Sclerosing Lesion
Central sclerosis with varying degrees of epithelial proliferation (precancerous).
Differential for well-defined mass (6)
Cyst. Fibrosis. Fibroadenomas. Breast cancer. Lymphoma. Metestases.
Differential for multiple bilateral masses (5)
Cysts. Fibroadenomas. Multiple Papillomas. Metastises. Multifocal breast cancer.
Differential for ill-defined breast mass (3)
Breast cancer. Abscess (usually subareolar in lactating women). Spontaneous Hematomas (coagulopathy).
Differential for fat-containing radiolucent breast mass (5)
Oil cyst (result of trauma). Lipoma. Galactocele. Hamartoma. Fibroadenolipoma.
Description of a breast fibroadenoma
Most common well-defined homogeneous solid mass. Large, coarse and irregular calcifications.
Descriptors of calcifications (4)
Morphology (shape). Distribution. Associated findings. Location.
Benign breast calcifications (10)
Skin/lucent center. Vascular. Coarse/Popcorn. Large/Rod-like. Round (small less than 1 mm, punctuate less than 0.5 mm). Eggshell/Rim. Milk of calcium. Suture. Dystrophic.
Milk of calcium
Sedimented calcifications in macro/microcysts. Amorphous on cranial caudal view. Semilunar, crescent, tea cup shaped on medial lateral oblique view.
Coarse popcorn calcifications
Large rod-like calcifications
Ductal ectasia and/or secretory calcifications.
Lucent centered calcification
Fat necrosis or calcified debris in ducts.
Fat necrosis. Calcifications within wall of cysts
Post trauma. Radiation changes.
Dot-dash or casting calcifications
Comedocarcinoma type of intraductal carcinoma.
Intermediate concern breast calcifications (2)
Amorphous/Indistinct. Coarse heterogeneous (>0.5 mm but not the size of dystrophic calcifications).
High probability breast calcifications (2)
Fine pleomorphic (varying in size and shapes, less than 0.5 mm). Linear or branching (suggests filling of involved duct).
Calcification distribution modifiers (5)
Diffuse/Scattered. Regional. Grouped/Clustered. Linear. Segmental.
Definition of regional distribution
Scattered in large volume (>2cc) of Breast tissue. Does not conform to duct distribution. Less likely to be malignant.
Definition of grouped/clustered distribution
At least 5 calcifications occupy small volume (less than 1 cc).
Definition of segmental distribution
Calcifications distributed in ductal distribution. Worrisome for malignancy.
Definition of architectural distortion
Distorted architecture without definite mass. Suspicious for malignancy or radial scar, if no prior trauma or surgery.
Significance of asymmetric tubular structure/solitary dilated duct
Little as long as no other findings.
Intramammary lymph node
Typically reniform with radiolucent notch. Typically within upper outer breasts.
Definition of global asymmetry
Greater volume of Breast tissue in one breast relative to the other. No mass, distorted architecture or associated suspicious calcifications.
Associated breast findings (6)
Skin retraction, Skin lesion, Skin thickening (>2 mm), Nipple retraction, Trabecular thickening, Axillary adenopathy (> 2cm, non-fatty replaced are worrisome)
Descriptors of mammography location (3) and depth (3)
Subareolar, Central, Axillary tail. Anterior, Middle, Posterior.
Descriptors of Breast composition (4)
Almost entirely fat (less than 25% glandular). Scattered fibroglandular densities (25-50%). Heterogeneously dense (51-75%). Extremely dense (>75%).
0, Incomplete. 1, Negative. 2, Benign Findings. 3, Probably Benign (3-94%). 4, Suspicious abnormality (A,B,C). 5, Highly suggestive (>95%). 6, Proven malignancy.
Probably Benign. Less than 2% chance of malignancy. Low grade cancer if present.
Imaging decisionin patient less than 30 years with palpable abnormality
1st: US. 2nd: Single oblique view (only if necessary).
Breast US, background echotexture descriptors (3)
Homogeneous: fibroglandular or fat. Heterogeneous: typically occurs in younger patients.
Breast US, Mass Shapes (3)
Oval. Round. Irregular.
Breast US, Orientation descriptors (2)
Parallel (wider than tall). Not Parallel.
Breast US, Margin descriptors (5)
Circumscribed. Indistinct. Angular. Spiculated. Microlobulated.
Breast US, Lesion boundary descriptors (2)
Abrupt. Echogenic: no sharp demarcation between mass and surrounding tissue.
Echo Patterns (5)
Anechoic. Hyperechoic. Complex. Hypoechoic. Isoechoic.
Posterior Acoustic Features (4)
None. Enhancement (echogenic deep to mass). Shadowing (echopenic deep to mass). Combined.
Breast US, Clustered Microcysts (2)
Fibrocystic changes. Apocrine metaplasia: Tiny anechoic foci (less than 2 to 3 mm) with thin (less than 0.5 mm) septations.
Differential for mass in or on skin (6)
Sebaceous or epidermal inclusion cysts. Keloids. Moles. Neurofibromas. Accessory nipples.
Breast US, Normal lymph node appearance
Reniform (hypoechoic cortex and echogenic fatty hilus). Axillary LN typically less than 2 cm.
Differential for abnormal lymph nodes (7)
Metastatic disease. Infectious. Connective tissue disorder (RA, Sarcoidosis). Lymphoma. Leukemia. Granulomatous disease (calcifications).
Breast US, BIRADS 3
Solid mass with circumscribed margins, oval shape and parallel orientation. Likely fibroadenoma, nonpalpable complicated cysts, or cluster of microcysts.
Breast MR, Focus versus Foci
Small (less than 5 mm) isolated spot(s) of enhancement. Not seen on precontrast images.
Breast MR, Non-mass-like enhancement descriptors (7)
Focal area. Linear. Ductal. Segmental. Regional. Diffuse. Multiple areas of enhancement.
Breast MR, Focal area definition
Internal enhancement. Non-mass like. Occupies less than 25% of breast quadrant.
Breast MR, Difference between linear and ductal enhancement
Ductal: resembles a line on 2 views, points towards nipple. Linear: resembles a sheet rather than a line.
Breast MR, Difference between segmental and regional enhancement
Segmental: triangular enhancement with apex towards nipple, suggests ductal morphology. Regional: geographic enhancement, not conforming to a duct.
Breast MR, Internal MR enhancement patterns (5)
Homogeneous. Heterogeneous. Stippled/Punctate. Clumped. Reticular/Dendritic.
Breast MR, Kinetic Curve
Initial phase: Slow, Medium, Rapid. Delayed phase: Washout (malignant), Plateau (either), Persistent (benign).
Breast MR, Screening population selection criteria
>25% risk, based on family history, PMH, etc.
Risk factors for Breast cancer (6)
Personal History. Age. Mother, Sister, Daughter with breast cancer. Atypical or precancerous lesions on biopsy. Nulliparity or first child at or older than 30 years.
Expected outcomes in group of 1000 asymptomatic women
80 require additional studies. 17 biopsied. 6 cancers.
Percent of breast cancer not detected at mammography.
Percent of malignancies found with biopsy of mammographically suspicious abnormalities
Mammography radiation risk
Life time risk of breast cancer from 1 mammogram. 40-49 y/o: 2/mil, 50-59 y/o: 1/mil. Risk of dying from Breast cancer, 40-49: 700/mil, 50-59: 1000/mil.
Convention labeling of Breast radiographs
Marker (l/r/cc/mlo) always placed by axillary tail/lateral breast.
Depicts most tissue. Must visualize posterior nipple line (perpendicular line from pec through nipple) and inframammary fold.
Pec visualized central on the film (only occurs at 30%) with nipple in profile at 1 cm from image edge.
Associated with indeterminate calcifications
Fibrocystic Change. Fibrosis adenosis. Sclerosing adenosis. Epithelial hyperplasia. Cysts. Apocrine metaplasia. Atypical hyperplasia.
Differential for increased breast density
Hormone therapy (bilateral). Inflammatory cancer (skin thickening). Radiation therapy (at 6 months). Diffuse mastitis. Lymphatic/venous obstruction.
Intracapsular versus Extracapsular implant Rupture
Intravascular: contained. Extravascular: free. Mammography can't detect intracapsular silicone rupture (MR).
Description of Gynecomastia
Triangular or flame shaped area of subglandular tissue with interspersed fat. Unilateral more common than bilateral.