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77 Cards in this Set
- Front
- Back
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What is a mass
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a space occupying lesion seen in two different projections
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Describe the contour of a mass
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convex
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What is the density of a mass (center vs periphery)
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denser in the center than periphery
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3 characteristics of a mass according to birads
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seen in 2 projections
convex contour denser in center than periphery |
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What are 6 characteristics that must be examined when looking at a mass
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size
location density shape margins interval change |
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Does the size of a mass predict benign Vs malignant etiology
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no
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Does size affect the clinical managment of a mass
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no
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What does size affect
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the clinical managment (large palpable masses may be biopsied under palpation guidance)
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Where is the MC quadrant of breast cancer
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upper outer
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Does a mass being in the upper outer quadrant affect managment
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no bc the most common location of benign tumors is in the upper outer quadrant
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If a mass is seen within the skin can it be a primary breast cancer
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no
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What are the 2 common views of breast imaging in screening
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CC and MLO
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If a mass has indistinct margins should it be biopsied
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yes (make sure all supsicious lesions are not in the skin)
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What is the typical appearance of a skin lesion
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air halo surrounding it
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What view should be obtained if you suspect a skin lesion
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tangential
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What are the different birad density classifications
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fat
mixed fibroglandular |
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How is fibroglandular subdivided
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high, equal (isodense) and low
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What are fat density and mixed density considered; benign or malignant
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benign
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Name 3 fat containing masses
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oil cyst
lipoma galactocele |
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Name mixed density masses
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hamartoma
lymphnode |
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What is a hamartoma often referred to in the breast
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fibroadenolipoa
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What is a classic appearnace of a lipoma and oil cyst of the breast
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fat density mass with a pseudocapsule
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Are lipomas and oil cyst palpable
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yes (but still dont biopsy)
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What type of benign fat containing breast lesion may have a fat fluid level
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galactocele
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What is a classic give away that a lesion is a hamartoma
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this one is different it is mixed density but has a pseudocapsule and is classic for a hamartoma
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What is the classic appearance of a intramammary LN
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mixed density mass with a fatty hilum
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What are the 5 characteristics of interpreting a mass (we have be going throug)
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size
location density shape margin |
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What is the most helpful category for deteming how to manage a mass
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shape
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What is the BIRADS descriptors for shape
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round
oval lobular irregular |
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What shape is considered highly suspicious
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irregular
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What does BIRADS consider round, oval and lobular shapes
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probably benign
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What are the BIRADS descriptors for the margins of a mass
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circumscribed
microlobulated obscured indistinct spiculated |
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What margin does BIRADS consider likely benign
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well circumscribed
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What margins will always require additional work up
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microlobulated
obscured indistinct spiculated |
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What percent of the margin are you required to see inorder to call a lesion circumscribed
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>75%
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If a mass is microlobulated what percent of cancer is there
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50%
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Do masses with indistinct or spiculated margins need to be biopsied
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yes
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If a lesion appears well circumscribed but you are unable to see >75% of the border what should be done
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additional views or US
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What should be done with masses that have multiple margins (part well defined and part spiculated)
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act on the feature that is most suspicious
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Once you find a mass that is suspicious what is always the next step
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spot compression views and magnification
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What is the categorization of a suspicious mass on screening
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birads 0 (need additional workup)
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What are the 6 steps to interpretating a mass (fix prior slide)
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size
location density shape margins -->interval change |
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What are the 4 categories of interval change of a mass
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new mass
interval enlargement of mass borders mor lobular or indistinct appearance of new calcifications |
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Is new mass, interval enlargement of mass borders, more lobular or indistinct and appearance of new calcifications all worrisome
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yes
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Is US useful for diagnosing cyst
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yes
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What type of masses will be get a birads category 3
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shape; round, oval or lobular
margin; well circumscirbed |
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If a mass is stable for 2 years what is the birads classification
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birads 2
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If there is a mass and it is not a classic benign structure, is not round, oval, or lobular and have well circumscribed margin what should be done
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additional imaging and then biopsy if the same
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What are 3 benign features?
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fat
pseudocapsule in the skin |
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If a mass has benign features what is the birads category
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2
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What are 4 types of asymmetries
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asymmetry
global asymmetry focal asymmetry developing asymmetry |
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What was formerly called a density
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a asymmetry
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Define an asymmetry
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area of fibroglandular density tissue seen in one view only
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What do 80% of asymmetries represent
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superimposition of normal breast tissue
'summation artifact' |
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What is global asymmetry
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substantially greater volume of fibroglandular tissue in one breast than in the corresponding location of the contralateral breast
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Does global asymmetry occupy more than one quadrant
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yes
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Does global asymmetry have assoicated mass, calcification or architectual distortion
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no
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If the right breast is much denser than the left what is it called
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global asymmetry
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What do the vast majority of global asymmetry represent
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a normal variant
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When should additional workup be considered with global asymmetry
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associated mass
grouped microcalcifications architectual distortion palpable correlate |
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What are the first two categories of asymmetries that we have covered
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asymmetry
global asymmetry (next focal asymmetry) |
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What is a focal asymmetry
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fibroglandular tissue asymmetry occupying less than 1 quadrant
visible on two views lacks convex outward contours (not a mass) |
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What could a focal asymmetry represent
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an island of normal breast tissue
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What makes a focal asymmetry seem suspicious
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it may lack interspersed fat and therefore warrant additional workup
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What are the similarity between a mass and a focal asymmetry
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focal asymmetry and mass
space occupying lesion seen in two different views |
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What are the differences between a focal asymmetry and a mass
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focal asymmetry
concave borders (mass has convex) interspersed fat (mas is denser in the center than perphery) |
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When a focal asymmetry is not associated with suspicious features (no mass, calcification, architectual distortion or palpable correlate) has what % chance of malignancy
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less than 1%
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What is the work up for a focal asymmetry
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rule out summation artifact (repeat same view)
change beam obliquity slightly breast obliquity via the roll view spot compression and mag views targeted ultrasoud (like a real lesion) |
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What should be done if a pt has a focal asymmetry
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call patient back and repeat same view (slight different technique may 'resolve' asymmetry)
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What is the baseline Birads category for a focal asymmetry
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3
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What is the birads of a focal asymmetry after 3 years of stability
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2
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What are the 3 prior types of asymmetries we have discussed
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asymmetry
global asymmetry focal asymmetry (now developing asymmetry) |
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What is a developing asymmetry
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focal asymmetry that is new, larger or denser than prior study
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What is the category of a developing asymmetry
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4
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What is the likelihood of malignancy of a developing asymmetry
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13-27%
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If you see a focal asymmetry for the first time what is the birads category (if patient had priors)
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4
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What are the birads categories for all the breast asymmetries discussed (general)
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asymmetry 1
global asymmetry 2 focal asymmmetry 3 developing asymmetry 4 |
