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17 Cards in this Set
- Front
- Back
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mass
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space occupying lesion seen in two different projections
convex outward contour dense in center than periphery |
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interpretation of masses
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size
location-mass within skin cannot be primary breast ca density shape margins interval change |
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location
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skin masses typically have a halo sign
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density
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fat density masses-benign
oil cyst lipoma galactocele mixed density masses-benign hamartoma or fibroadenolipoma lymph node fibroglandular density masses high density equal density (isodense) low density |
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lipoma, oil cysts, hamartoma
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have thin pseudocapsule
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shape
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round-prob benign
oval-prob benign lobular-prob benign irregular-suspicious |
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margins
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circumscribed (well defined)-likely benign, need to see 75% of margin, still workup with us
microlobulated-require additional wkup, 50% of cancer, ddx fibroadenoma obscured-require additional wkup indistinct (illdefined)-require additional wkup spiculated-require additional wkup |
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mass workup
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spot-compression
magnification views birads 3, 4, 5 only on dx mammogram |
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interval change-masses
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newly apparent mass
interval enlargement of mass borders more lobular or indistinct appearance of calcifications |
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managemetn of masses
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identify typically benign masses
ultrasonography to diagnose cysts biopsy vs follow-up for solid masses-dep on shape, margin, interval change |
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evaluation of masses
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1. identify mass
2. obtain additional views, benign features? ie fat or skin lesion if yes, stop, birads 2 if no. 3. ultrasound. if cyst or lymph nodes, yes, stop birads 2, if no 4. is mass round/oval/lobular, circumscribed margin. if yes, birads 3, if no birads 4/5 it mass has 2 yaer stability-benign (birads 2) other solid masses should be biopsied |
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asymmetry types
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1. asymmetry
formerly called density area of fibroglandular density tissue visible on a single view 80% represent superimposition of normal breast tissue 2 global asymmetry substantially greater volume of fibroglandular tissue in one breast than in corresponding location in contralateral breast, occupies more than one quadrant, no associated mass, ca++ or architectural distortion 3. focal asymmetry fibroglandular tissue asymmetry less than one quadrant visible on two views lacks the convex outward contours and conspicuity of a mass could represent an island of normal breast tissue, particularly when there is interspersed fat, but its lack of specific benign findings may warrant workup 4. developing asymmetry focal asymmetry that is new, larger, or denser than previous study uncommon <1% malignancy likelihood ranges from 13 to 27%, birads 4 |
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global asymmetry workup
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almost always represent a normal variant, however additional workup should be performed if there is
associated mass, grouped microcalcifications, architectural distortion palpable correlate |
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focal asymmetry vs mass
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mass
space occupying lesion seen in two projections convex outward contour dense in center than periphery focal asymmetry space occupying lesion seen in two different projections concave outward contour usually interspersed with fat |
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focal asymmetry workup
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when not associated with mass, calcifications, architectural distortion, or palpable correlate, likelihood of malignancy is <1%
diagnosis of summation artifact repeat view change beam obliquity slightly rolled view use spot-compression, magnification technique targeted ultrasound exam if no mammographic, sonographic, or palp abn->birads 3 stability for 2-3 years->birads 2 |
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developing asymmetry workup
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birads 4 unless proven to be simple cyst, birads 2
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asymmetry generalization of birads with some exceptions
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asymmetry birads 1
global asymmetry birads 2 focal asymmetry birads 3 developing asymmetry birads 4 |
