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51 Cards in this Set
- Front
- Back
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what percentage of malignancies are not seen on screening mammograms
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10-20%
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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 |
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what are US characteristics of a malignant lesion
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angular margins
hypoechogenicity shadowing microcalcs extension into a duct microlobulation taller than wide |
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name 4 US features of a benign lesion
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hyperechogenicity
wider than tall macrolobulation thin pseudocapsule |
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what percentage of carcinomas shadow on US
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50%
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what nucs test can be used to evaluate the breast and when is it used
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sestamibi can be used especially in the dense breast
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name 4 uses of MRI in breast imaging
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identify multifocal neoplasm
evaluate chest wall involvement scar vs recurrence implant evaluation *pearl* MRI is NOT used for microcalcs |
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compare benign and malignant lesion enhancement on MR
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cancer enhances early
benign disease enhances late (after 3 min) *pearl* DCIS enhances in only 50% of cases |
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what characteristics of a mass are always assessed at mammography
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shape, margin, density
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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 |
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ddx: well defined mass
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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 |
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ddx: ill defined mass
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carcinoma
abcess hematoma scar fibrocystic change myoblastoma |
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ddx: spiculated mass
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invasive carcinoma
radial scar surgical scar hematoma |
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what percentage of infiltrating ductal carcinoma presents as a well defined mass
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6%
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name 4 characteristics used to assess calcifications
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distribution
size shape stability |
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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 |
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what percentage of DCIS proceeds to invasive cancer
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30%
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what is inflammatory breast cancer
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spread of cancer in dermal lymphatics
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describe the features of phylloides tumor
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rare
rapid increase in size older women |
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what percentage of phylloides tumors are malignant
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15-20%
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where do phylloides tumors metastasize
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lung
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describe paget's disease of the breast
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erosion of the nipple tissue associated with ductal ca
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what are the two most important factors in prognosis of breast ca
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lymph nodes
tumor size |
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what are the criteria for inoperability of breast ca
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extensive skin edema
fixation to chest wall tumor greater than 5cm massive or fixed lymph nodes distant mets multifocal disease |
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what is the risk of developing invasive ca with LCIS
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30% in EITHER breast over 20 years
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what are the criteria for a simple cyst by US
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anechoic, well-defined, posterior wall acoustic enhancement with a thin wall
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what are the indications for aspirating a breast cyst
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enlarging
not simple at US painful |
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why should air be injected into a cyst following aspiration
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the risk of recurrence is halved
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what is the most common cause of bloody nipple discharge
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papilloma
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name 3 criteria for normal lymph nodes
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< 1.5 cm in size
well-circumscribed fatty hilum |
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why are calcs significant in implant patients
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leaking silicone may induce calcs
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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 |
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what is the US appearance of an implant
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anechoic
*pearl* any echogenic implant is abnormal |
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what is the US appearance of:
- extracapsular rupture - intracapsular rupture |
extracapsular rupture: snowstorm apparance - echogenic with shadowing
intracapsular rupture: stepladder appearance |
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US vs MRI for implant rupture
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US: 70% accurate
MR: 95% accurate |
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what are complicatoins of breast implants (6)
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fibrous capsule contraction
infection hematoma leakage or rupture collapse herniation |
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ddx: well-defined breast mass - the short list
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cyst
fibroadenoma phylloides tumor papilloma hematoma abscess carcinoma (medullary, mucinous and any rapidly growing infiltrating ductal ca) |
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what types of carcinoma are well defined
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medullary
mucinous rapidly growing invasive ductal *pearl* a well defined malignant mass is most likely an invasive ductal carcinoma because they are so common |
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ddx: fat containinglesion of the breast
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GO FLY
galactocele oil cyst fibroadenolipoma (hamartoma) lipoma lymph node |
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what are changes seen in the postop breast
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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 |
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what are indications for breast conserving therapy
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confined to breast and ipsilateral nodes
size < 4cm no multicentric lesions cosmetically acceptable result possible |
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ddx: solitary, focally dilated duct
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PATCH
papilloma adenoma trauma carcinoma hyperplasia |
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ddx: male gynecomastia
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drugs
cirrhosis renal failure (chronic) tumor |
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what drugs cause gynecomastia
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PETPAD
pot estrogen tagamet and thiazides phenothiazides amphetamines digitalis |
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ddx: skin thickening
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6 benign:
radiation mastitis trauma CHF/fluid overload lymphatic/venous obstuction inadequate compression 5 malignant: inflammatory breast cancer recurrent carcinoma lymphatic obstruction metastasis lymphoma |
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where do lesions seen on an MLO view move on an ML view
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lateral moves lower (L-L)
medial moves upper |
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ddx: intraluminal filling defect on galactogram (6)
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papilloma
papillomatosis ductal hyperplasia blood clot inspissated material intraductal carcinoma |
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what features favor carcinoma on a galactogram
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encasement
narrowing abrupt duct termination |
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what are indications for a galactogram
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unilateral discharge
single duct bloody or serous discharge |
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what are the steps in a galactogram
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identify the abnormal duct
sterile prep cannulate abnormal duct with 27g or smaller inject contrast until discomfort obtain 2 view mammogram |
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what is the appearance of silicone on MR
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T1WI: dark
T2WI: bright |
