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17 Cards in this Set

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mass
space occupying lesion seen in two different projections

convex outward contour

dense in center than periphery
interpretation of masses
size

location-mass within skin cannot be primary breast ca

density

shape

margins

interval change
location
skin masses typically have a halo sign
density
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
lipoma, oil cysts, hamartoma
have thin pseudocapsule
shape
round-prob benign
oval-prob benign
lobular-prob benign
irregular-suspicious
margins
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
mass workup
spot-compression

magnification views

birads 3, 4, 5 only on dx mammogram
interval change-masses
newly apparent mass

interval enlargement of mass

borders more lobular or indistinct

appearance of calcifications
managemetn of masses
identify typically benign masses

ultrasonography to diagnose cysts

biopsy vs follow-up for solid masses-dep on shape, margin, interval change
evaluation of masses
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
asymmetry types
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
global asymmetry workup
almost always represent a normal variant, however additional workup should be performed if there is
associated mass, grouped microcalcifications, architectural distortion
palpable correlate
focal asymmetry vs mass
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
focal asymmetry workup
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
developing asymmetry workup
birads 4 unless proven to be simple cyst, birads 2
asymmetry generalization of birads with some exceptions
asymmetry birads 1
global asymmetry birads 2
focal asymmetry birads 3
developing asymmetry birads 4