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51 Cards in this Set

  • Front
  • Back
what percentage of malignancies are not seen on screening mammograms
10-20%
what view is used to evaluate:
- calcs
- mass
- axillary lesion
- medial lesion
- overlapping lesions
calcs: magnification
mass: spot compression
axillary lesion: exaggerated CC lateral view
medial lesion: rolled view
overlapping lesions
what are US characteristics of a malignant lesion
angular margins
hypoechogenicity
shadowing
microcalcs
extension into a duct
microlobulation
taller than wide
name 4 US features of a benign lesion
hyperechogenicity
wider than tall
macrolobulation
thin pseudocapsule
what percentage of carcinomas shadow on US
50%
what nucs test can be used to evaluate the breast and when is it used
sestamibi can be used especially in the dense breast
name 4 uses of MRI in breast imaging
identify multifocal neoplasm
evaluate chest wall involvement
scar vs recurrence
implant evaluation

*pearl* MRI is NOT used for microcalcs
compare benign and malignant lesion enhancement on MR
cancer enhances early
benign disease enhances late (after 3 min)

*pearl* DCIS enhances in only 50% of cases
what characteristics of a mass are always assessed at mammography
shape, margin, density
what is the most common palpable mass in:
- a woman < 35 y
- a woman 35-50 y
- a woman > 50 y
< 35 y : fibroadenoma
35-50 y : cyst
> 50 y : carcinoma
ddx: well defined mass
cyst
fibroadenoma
carcinoma (esp mucinous, medullary and high grade ductal)
phylloides tumor
mets
papilloma
hematoma
hamartoma
lipoma
lymph node
abcess
oil cyst
galactocele
skin lesion
ddx: ill defined mass
carcinoma
abcess
hematoma
scar
fibrocystic change
myoblastoma
ddx: spiculated mass
invasive carcinoma
radial scar
surgical scar
hematoma
what percentage of infiltrating ductal carcinoma presents as a well defined mass
6%
name 4 characteristics used to assess calcifications
distribution
size
shape
stability
what are the calcification patterns for:
- fibroadenoma
- fibrocystic change
- oil cyst
- plasma cell mastitis
- arteries
- dermal lesion
fibroadenoma: popcorn
fibrocystic change: scattered, punctate
oil cyst: ring-like
plasma cell mastitis: needle-like
arteries: tram-track
dermal lesion: riny, round with lucent centres
what percentage of DCIS proceeds to invasive cancer
30%
what is inflammatory breast cancer
spread of cancer in dermal lymphatics
describe the features of phylloides tumor
rare
rapid increase in size
older women
what percentage of phylloides tumors are malignant
15-20%
where do phylloides tumors metastasize
lung
describe paget's disease of the breast
erosion of the nipple tissue associated with ductal ca
what are the two most important factors in prognosis of breast ca
lymph nodes
tumor size
what are the criteria for inoperability of breast ca
extensive skin edema
fixation to chest wall
tumor greater than 5cm
massive or fixed lymph nodes
distant mets
multifocal disease
what is the risk of developing invasive ca with LCIS
30% in EITHER breast over 20 years
what are the criteria for a simple cyst by US
anechoic, well-defined, posterior wall acoustic enhancement with a thin wall
what are the indications for aspirating a breast cyst
enlarging
not simple at US
painful
why should air be injected into a cyst following aspiration
the risk of recurrence is halved
what is the most common cause of bloody nipple discharge
papilloma
name 3 criteria for normal lymph nodes
< 1.5 cm in size
well-circumscribed
fatty hilum
why are calcs significant in implant patients
leaking silicone may induce calcs
what is:
- the linguine sign
- a radial fold
- an inverted tear drop sign
linguine sign: intra-implant linear signal abnormality due to intracapsular rupture
radial fold: normal redundancy in the implant wall
inverted tear drop sign: silicone leak into a radial fold due to focal implant rupture
what is the US appearance of an implant
anechoic

*pearl* any echogenic implant is abnormal
what is the US appearance of:
- extracapsular rupture
- intracapsular rupture
extracapsular rupture: snowstorm apparance - echogenic with shadowing
intracapsular rupture: stepladder appearance
US vs MRI for implant rupture
US: 70% accurate
MR: 95% accurate
what are complicatoins of breast implants (6)
fibrous capsule contraction
infection
hematoma
leakage or rupture
collapse
herniation
ddx: well-defined breast mass - the short list
cyst
fibroadenoma
phylloides tumor
papilloma
hematoma
abscess
carcinoma (medullary, mucinous and any rapidly growing infiltrating ductal ca)
what types of carcinoma are well defined
medullary
mucinous
rapidly growing invasive ductal

*pearl* a well defined malignant mass is most likely an invasive ductal carcinoma because they are so common
ddx: fat containinglesion of the breast
GO FLY

galactocele
oil cyst
fibroadenolipoma (hamartoma)
lipoma
lymph node
what are changes seen in the postop breast
skin thickening
retraction
asymmetric glandular tissue
architectural distortion
hematoma
fat necrosis
scarring
calcification
sutures

*pearl* skin thickening and changes in architecture should not persist beyond 6 months
what are indications for breast conserving therapy
confined to breast and ipsilateral nodes
size < 4cm
no multicentric lesions
cosmetically acceptable result possible
ddx: solitary, focally dilated duct
PATCH

papilloma
adenoma
trauma
carcinoma
hyperplasia
ddx: male gynecomastia
drugs
cirrhosis
renal failure (chronic)
tumor
what drugs cause gynecomastia
PETPAD

pot
estrogen
tagamet and thiazides
phenothiazides
amphetamines
digitalis
ddx: skin thickening
6 benign:
radiation
mastitis
trauma
CHF/fluid overload
lymphatic/venous obstuction
inadequate compression

5 malignant:
inflammatory breast cancer
recurrent carcinoma
lymphatic obstruction
metastasis
lymphoma
where do lesions seen on an MLO view move on an ML view
lateral moves lower (L-L)
medial moves upper
ddx: intraluminal filling defect on galactogram (6)
papilloma
papillomatosis
ductal hyperplasia
blood clot
inspissated material
intraductal carcinoma
what features favor carcinoma on a galactogram
encasement
narrowing
abrupt duct termination
what are indications for a galactogram
unilateral discharge
single duct
bloody or serous discharge
what are the steps in a galactogram
identify the abnormal duct
sterile prep
cannulate abnormal duct with 27g or smaller
inject contrast until discomfort
obtain 2 view mammogram
what is the appearance of silicone on MR
T1WI: dark
T2WI: bright