Mammography

Front 1

Mammographic signs of malignancy

Back 1

Spiculated mass. Pleomorphic microcalcifications. (40% of breast cancers)

Front 2

Definition of breast mass

Back 2

Space occupying lesion seen in two different projections. Convex borders. Distorts normal architecture. Increased central density.

Front 3

Definition of breast focal asymmetry

Back 3

Confined asymmetry with similar shape on two views. Lacks borders conspicuity of a true mass.

Front 4

Definition of breast asymmetry

Back 4

Space occupying lesion seen in only one view.

Front 5

Descriptors of breast mass (5)

Back 5

Size. Morphology. Associated calcifications. Associated findings. Location.

Front 6

Descriptors of breast shapes (4)

Back 6

Round. Oval. Lobular. Irregular.

Front 7

Descriptors of breast margins (5)

Back 7

Circumscribed (>75%). Microlobulated (undulated). Obscured. Indistinct (ill-defined). Spiculated.

Front 8

Definition of circumscribed breast mass

Back 8

>75% of mass is circumscribed (well-defined).

Front 9

Definition of obscured breast mass

Back 9

Border is likely circumscribed but hidden by normal tissue.

Front 10

Descriptors of breast density (4)

Back 10

High. Equal. Fat-containing radiolucency. Non-fat-containing radiolucency.

Front 11

Differential for breast mass with spiculated margins and or architectural distortion (4)

Back 11

Breast cancer. Fat necrosis. Scar. Radial Scar.

Front 12

Definition of Radial Scar/Complex Sclerosing Lesion

Back 12

Central sclerosis with varying degrees of epithelial proliferation (precancerous).

Front 13

Differential for well-defined mass (6)

Back 13

Cyst. Fibrosis. Fibroadenomas. Breast cancer. Lymphoma. Metestases.

Front 14

Differential for multiple bilateral masses (5)

Back 14

Cysts. Fibroadenomas. Multiple Papillomas. Metastises. Multifocal breast cancer.

Front 15

Differential for ill-defined breast mass (3)

Back 15

Breast cancer. Abscess (usually subareolar in lactating women). Spontaneous Hematomas (coagulopathy).

Front 16

Differential for fat-containing radiolucent breast mass (5)

Back 16

Oil cyst (result of trauma). Lipoma. Galactocele. Hamartoma. Fibroadenolipoma.

Front 17

Description of a breast fibroadenoma

Back 17

Most common well-defined homogeneous solid mass. Large, coarse and irregular calcifications.

Front 18

Descriptors of calcifications (4)

Back 18

Morphology (shape). Distribution. Associated findings. Location.

Front 19

Benign breast calcifications (10)

Back 19

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.

Front 20

Milk of calcium

Back 20

Sedimented calcifications in macro/microcysts. Amorphous on cranial caudal view. Semilunar, crescent, tea cup shaped on medial lateral oblique view.

Front 21

Coarse popcorn calcifications

Back 21

Involuting fibroadenoma.

Front 22

Large rod-like calcifications

Back 22

Ductal ectasia and/or secretory calcifications.

Front 23

Lucent centered calcification

Back 23

Fat necrosis or calcified debris in ducts.

Front 24

Eggshell/rim calcifications

Back 24

Fat necrosis. Calcifications within wall of cysts

Front 25

Dystrophic calcifications

Back 25

Post trauma. Radiation changes.

Front 26

Dot-dash or casting calcifications

Back 26

Comedocarcinoma type of intraductal carcinoma.

Front 27

Intermediate concern breast calcifications (2)

Back 27

Amorphous/Indistinct. Coarse heterogeneous (>0.5 mm but not the size of dystrophic calcifications).

Front 28

High probability breast calcifications (2)

Back 28

Fine pleomorphic (varying in size and shapes, less than 0.5 mm). Linear or branching (suggests filling of involved duct).

Front 29

Calcification distribution modifiers (5)

Back 29

Diffuse/Scattered. Regional. Grouped/Clustered. Linear. Segmental.

Front 30

Definition of regional distribution

Back 30

Scattered in large volume (>2cc) of Breast tissue. Does not conform to duct distribution. Less likely to be malignant.

Front 31

Definition of grouped/clustered distribution

Back 31

At least 5 calcifications occupy small volume (less than 1 cc).

Front 32

Definition of segmental distribution

Back 32

Calcifications distributed in ductal distribution. Worrisome for malignancy.

Front 33

Definition of architectural distortion

Back 33

Distorted architecture without definite mass. Suspicious for malignancy or radial scar, if no prior trauma or surgery.

Front 34

Significance of asymmetric tubular structure/solitary dilated duct

Back 34

Little as long as no other findings.

Front 35

Intramammary lymph node

Back 35

Typically reniform with radiolucent notch. Typically within upper outer breasts.

Front 36

Definition of global asymmetry

Back 36

Greater volume of Breast tissue in one breast relative to the other. No mass, distorted architecture or associated suspicious calcifications.

Front 37

Associated breast findings (6)

Back 37

Skin retraction, Skin lesion, Skin thickening (>2 mm), Nipple retraction, Trabecular thickening, Axillary adenopathy (> 2cm, non-fatty replaced are worrisome)

Front 38

Descriptors of mammography location (3) and depth (3)

Back 38

Subareolar, Central, Axillary tail. Anterior, Middle, Posterior.

Front 39

Descriptors of Breast composition (4)

Back 39

Almost entirely fat (less than 25% glandular). Scattered fibroglandular densities (25-50%). Heterogeneously dense (51-75%). Extremely dense (>75%).

Front 40

BIRADS Classification

Back 40

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.

Front 41

BIRADS 3

Back 41

Probably Benign. Less than 2% chance of malignancy. Low grade cancer if present.

Front 42

Imaging decisionin patient less than 30 years with palpable abnormality

Back 42

1st: US. 2nd: Single oblique view (only if necessary).

Front 43

Breast US, background echotexture descriptors (3)

Back 43

Homogeneous: fibroglandular or fat. Heterogeneous: typically occurs in younger patients.

Front 44

Breast US, Mass Shapes (3)

Back 44

Oval. Round. Irregular.

Front 45

Breast US, Orientation descriptors (2)

Back 45

Parallel (wider than tall). Not Parallel.

Front 46

Breast US, Margin descriptors (5)

Back 46

Circumscribed. Indistinct. Angular. Spiculated. Microlobulated.

Front 47

Breast US, Lesion boundary descriptors (2)

Back 47

Abrupt. Echogenic: no sharp demarcation between mass and surrounding tissue.

Front 48

Echo Patterns (5)

Back 48

Anechoic. Hyperechoic. Complex. Hypoechoic. Isoechoic.

Front 49

Posterior Acoustic Features (4)

Back 49

None. Enhancement (echogenic deep to mass). Shadowing (echopenic deep to mass). Combined.

Front 50

Breast US, Clustered Microcysts (2)

Back 50

Fibrocystic changes. Apocrine metaplasia: Tiny anechoic foci (less than 2 to 3 mm) with thin (less than 0.5 mm) septations.

Front 51

Differential for mass in or on skin (6)

Back 51

Sebaceous or epidermal inclusion cysts. Keloids. Moles. Neurofibromas. Accessory nipples.

Front 52

Breast US, Normal lymph node appearance

Back 52

Reniform (hypoechoic cortex and echogenic fatty hilus). Axillary LN typically less than 2 cm.

Front 53

Differential for abnormal lymph nodes (7)

Back 53

Metastatic disease. Infectious. Connective tissue disorder (RA, Sarcoidosis). Lymphoma. Leukemia. Granulomatous disease (calcifications).

Front 54

Breast US, BIRADS 3

Back 54

Solid mass with circumscribed margins, oval shape and parallel orientation. Likely fibroadenoma, nonpalpable complicated cysts, or cluster of microcysts.

Front 55

Breast MR, Focus versus Foci

Back 55

Small (less than 5 mm) isolated spot(s) of enhancement. Not seen on precontrast images.

Front 56

Breast MR, Non-mass-like enhancement descriptors (7)

Back 56

Focal area. Linear. Ductal. Segmental. Regional. Diffuse. Multiple areas of enhancement.

Front 57

Breast MR, Focal area definition

Back 57

Internal enhancement. Non-mass like. Occupies less than 25% of breast quadrant.

Front 58

Breast MR, Difference between linear and ductal enhancement

Back 58

Ductal: resembles a line on 2 views, points towards nipple. Linear: resembles a sheet rather than a line.

Front 59

Breast MR, Difference between segmental and regional enhancement

Back 59

Segmental: triangular enhancement with apex towards nipple, suggests ductal morphology. Regional: geographic enhancement, not conforming to a duct.

Front 60

Breast MR, Internal MR enhancement patterns (5)

Back 60

Homogeneous. Heterogeneous. Stippled/Punctate. Clumped. Reticular/Dendritic.

Front 61

Breast MR, Kinetic Curve

Back 61

Initial phase: Slow, Medium, Rapid. Delayed phase: Washout (malignant), Plateau (either), Persistent (benign).

Front 62

Breast MR, Screening population selection criteria

Back 62

>25% risk, based on family history, PMH, etc.

Front 63

Risk factors for Breast cancer (6)

Back 63

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.

Front 64

Expected outcomes in group of 1000 asymptomatic women

Back 64

80 require additional studies. 17 biopsied. 6 cancers.

Front 65

Percent of breast cancer not detected at mammography.

Back 65

9-16%.

Front 66

Percent of malignancies found with biopsy of mammographically suspicious abnormalities

Back 66

25-35%.

Front 67

Mammography radiation risk

Back 67

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.

Front 68

Convention labeling of Breast radiographs

Back 68

Marker (l/r/cc/mlo) always placed by axillary tail/lateral breast.

Front 69

MLO view

Back 69

Depicts most tissue. Must visualize posterior nipple line (perpendicular line from pec through nipple) and inframammary fold.

Front 70

CC view

Back 70

Pec visualized central on the film (only occurs at 30%) with nipple in profile at 1 cm from image edge.

Front 71

Associated with indeterminate calcifications

Back 71

Fibrocystic Change. Fibrosis adenosis. Sclerosing adenosis. Epithelial hyperplasia. Cysts. Apocrine metaplasia. Atypical hyperplasia.

Front 72

Differential for increased breast density

Back 72

Hormone therapy (bilateral). Inflammatory cancer (skin thickening). Radiation therapy (at 6 months). Diffuse mastitis. Lymphatic/venous obstruction.

Front 73

Intracapsular versus Extracapsular implant Rupture

Back 73

Intravascular: contained. Extravascular: free. Mammography can't detect intracapsular silicone rupture (MR).

Front 74

Description of Gynecomastia

Back 74

Triangular or flame shaped area of subglandular tissue with interspersed fat. Unilateral more common than bilateral.

Front 75

Causes of gynecomastia

Back 75

Chronic liver disease. Meds (cimetidine, thiazides, digitalis). Marijuana. Testicular, adrenal, or pituitary tumor.