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77 Cards in this Set

  • Front
  • Back
What is a mass
a space occupying lesion seen in two different projections
Describe the contour of a mass
convex
What is the density of a mass (center vs periphery)
denser in the center than periphery
3 characteristics of a mass according to birads
seen in 2 projections
convex contour
denser in center than periphery
What are 6 characteristics that must be examined when looking at a mass
size
location
density
shape
margins
interval change
Does the size of a mass predict benign Vs malignant etiology
no
Does size affect the clinical managment of a mass
no
What does size affect
the clinical managment (large palpable masses may be biopsied under palpation guidance)
Where is the MC quadrant of breast cancer
upper outer
Does a mass being in the upper outer quadrant affect managment
no bc the most common location of benign tumors is in the upper outer quadrant
If a mass is seen within the skin can it be a primary breast cancer
no
What are the 2 common views of breast imaging in screening
CC and MLO
If a mass has indistinct margins should it be biopsied
yes (make sure all supsicious lesions are not in the skin)
What is the typical appearance of a skin lesion
air halo surrounding it
What view should be obtained if you suspect a skin lesion
tangential
What are the different birad density classifications
fat
mixed
fibroglandular
How is fibroglandular subdivided
3
high, equal (isodense) and low
What are fat density and mixed density considered; benign or malignant
benign
Name 3 fat containing masses
oil cyst
lipoma
galactocele
Name mixed density masses
hamartoma
lymphnode
What is a hamartoma often referred to in the breast
fibroadenolipoa
What is a classic appearnace of a lipoma and oil cyst of the breast
fat density mass with a pseudocapsule
Are lipomas and oil cyst palpable
yes (but still dont biopsy)
What type of benign fat containing breast lesion may have a fat fluid level
galactocele
What is a classic give away that a lesion is a hamartoma
this one is different it is mixed density but has a pseudocapsule and is classic for a hamartoma
What is the classic appearance of a intramammary LN
mixed density mass with a fatty hilum
What are the 5 characteristics of interpreting a mass (we have be going throug)
size
location
density
shape
margin
What is the most helpful category for deteming how to manage a mass
shape
What is the BIRADS descriptors for shape
round
oval
lobular
irregular
What shape is considered highly suspicious
irregular
What does BIRADS consider round, oval and lobular shapes
probably benign
What are the BIRADS descriptors for the margins of a mass
5
circumscribed
microlobulated
obscured
indistinct
spiculated
What margin does BIRADS consider likely benign
well circumscribed
What margins will always require additional work up
microlobulated
obscured
indistinct
spiculated
What percent of the margin are you required to see inorder to call a lesion circumscribed
>75%
If a mass is microlobulated what percent of cancer is there
50%
Do masses with indistinct or spiculated margins need to be biopsied
yes
If a lesion appears well circumscribed but you are unable to see >75% of the border what should be done
additional views or US
What should be done with masses that have multiple margins (part well defined and part spiculated)
act on the feature that is most suspicious
Once you find a mass that is suspicious what is always the next step
spot compression views and magnification
What is the categorization of a suspicious mass on screening
birads 0 (need additional workup)
What are the 6 steps to interpretating a mass (fix prior slide)
size
location
density
shape
margins
-->interval change
What are the 4 categories of interval change of a mass
new mass
interval enlargement of mass
borders mor lobular or indistinct
appearance of new calcifications
Is new mass, interval enlargement of mass borders, more lobular or indistinct and appearance of new calcifications all worrisome
yes
Is US useful for diagnosing cyst
yes
What type of masses will be get a birads category 3
shape; round, oval or lobular
margin; well circumscirbed
If a mass is stable for 2 years what is the birads classification
birads 2
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
additional imaging and then biopsy if the same
What are 3 benign features?
fat
pseudocapsule
in the skin
If a mass has benign features what is the birads category
2
What are 4 types of asymmetries
asymmetry
global asymmetry
focal asymmetry
developing asymmetry
What was formerly called a density
a asymmetry
Define an asymmetry
area of fibroglandular density tissue seen in one view only
What do 80% of asymmetries represent
superimposition of normal breast tissue

'summation artifact'
What is global asymmetry
substantially greater volume of fibroglandular tissue in one breast than in the corresponding location of the contralateral breast
Does global asymmetry occupy more than one quadrant
yes
Does global asymmetry have assoicated mass, calcification or architectual distortion
no
If the right breast is much denser than the left what is it called
global asymmetry
What do the vast majority of global asymmetry represent
a normal variant
When should additional workup be considered with global asymmetry
associated mass
grouped microcalcifications
architectual distortion
palpable correlate
What are the first two categories of asymmetries that we have covered
asymmetry
global asymmetry

(next focal asymmetry)
What is a focal asymmetry
fibroglandular tissue asymmetry occupying less than 1 quadrant

visible on two views

lacks convex outward contours (not a mass)
What could a focal asymmetry represent
an island of normal breast tissue
What makes a focal asymmetry seem suspicious
it may lack interspersed fat and therefore warrant additional workup
What are the similarity between a mass and a focal asymmetry
focal asymmetry and mass
space occupying lesion seen in two different views
What are the differences between a focal asymmetry and a mass
focal asymmetry
concave borders (mass has convex)
interspersed fat (mas is denser in the center than perphery)
When a focal asymmetry is not associated with suspicious features (no mass, calcification, architectual distortion or palpable correlate) has what % chance of malignancy
less than 1%
What is the work up for a focal asymmetry
5
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)
What should be done if a pt has a focal asymmetry
call patient back and repeat same view (slight different technique may 'resolve' asymmetry)
What is the baseline Birads category for a focal asymmetry
3
What is the birads of a focal asymmetry after 3 years of stability
2
What are the 3 prior types of asymmetries we have discussed
asymmetry
global asymmetry
focal asymmetry
(now developing asymmetry)
What is a developing asymmetry
focal asymmetry that is new, larger or denser than prior study
What is the category of a developing asymmetry
4
What is the likelihood of malignancy of a developing asymmetry
13-27%
If you see a focal asymmetry for the first time what is the birads category (if patient had priors)
4
What are the birads categories for all the breast asymmetries discussed (general)
asymmetry 1
global asymmetry 2
focal asymmmetry 3
developing asymmetry 4