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49 Cards in this Set
- Front
- Back
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What are the considerations when deciding to peform a surgical breast bx
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cost
risk (anesthetic, infection) scar |
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What percent of pt that have biopsy of breast are not malignant
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90%
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According to birads when do we perform a biopsy
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if there is greater than a 2% chance of malignancy
(4 or 5) |
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If a pt has a papable lesion and it is not identified by imaging should a biopsy be done
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yes, guided by palpation
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What are risks of biopsy
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bleeding (pt on plavix, ASA, warfarin)
may want to postphone |
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Are there instances where one imaging modality suggest malignancy but the other does not
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yes (non concordant findings)
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Do we biopsy non-concordant findings (between modality of imaging)
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yes
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Do we have non-concordance between imaging findings and histologic findings sometimesq
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yes
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What is done if there is non concordance between imaging findings and histologic findings
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surgical excision
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What is the benefit of biopsying a lesion that is classic for malignancy
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the histologic dz may alter surgical managment (axillar dissection, neoadjunvant chemo, type of surgery)
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If a lesion is biopsied and found to be malignant what is the managment
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surgery will include staging of sentinel lymph node biopsy
(not done for DCIS) |
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What are the 3 means of guidance for biopsy
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(mammo) stereotactic
US MRI |
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What is the preferred modality for biopsy bc of speed and ease
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US
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What two instances is US especially preferred for biopsy
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breast implant
axilla |
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Do you do imaging pre and post firing in stereotactic biopsy
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yes
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If a pt has a palpable lesion only is it better to use US
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yes (better quality cores and increased accuracy)
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If you need to biopsy a deep LN what is the preferred technique
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FNA
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What is the preferred technique for biopsying a large and superificial, OR LN suspicious for lymphoma
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core
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Is the 14g core biospy use in MRI biopsy
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no, it is vacuum only
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What are 4 types of breast interventions
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FNA
Core biopsy Vacuum assisted Localization Biopsy |
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What is the size of the needle in a core biopsy
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14G
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What is the gauge of the needle in a vacuum assited biopsy
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11-7G
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Why is biopysing the axilla difficult
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because of major vessels
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Who does FNA
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surgeons in there office or breast clinic
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When is an FNA commonly done
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palpable lesion not seen on mammo or US
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Are LN commonly biopsied by FNA
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yes
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What is an important consideration when obtaining FNA biopsy
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need enough cells for diagnosis
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What is a major difference between FNA and core biopsy
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Tissue sample is obtained and now invasion could be differentiated from 'malignant' cells of FNA
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What is a potential problem of core biopsy
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underestimation
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What is underestimation
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calling a lesion less malignant than what it actually is
a DCIS on core biopsy being upgraded to a invasive cancer after surger |
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Why is underestimation problematic
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different management for different cancers
No SLNB for DCIS |
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What are some bordeline lesions diagnosed by pathologist
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papillary lesions
lobular lesion radial scar |
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What are lobular neoplasm
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LCIS, ALH
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What should be done if there is doubt about a bordeline pathology lesion (papillary lesion, lobular lesion, or radial scar)
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excisional biopsy
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What are lesions that always undergo excisional biopsy
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atypia
ADH radiologic-pathologic discordance pathologist recommends |
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When is the MC way to biopsy calcifications
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via sterotactics (but sometimes on US)
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If calcifications are biopsied via US what should be done at the end
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x-ray to ensure calcifications were biopsied
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If a lesion is deep what is the better position to biopsy
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prone on table
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If a lesion is anterior what is the better postion to biopsy
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upright
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What should the post biopsy x-ray be compared to
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the calcifications in the post x ray biopsy should look like the suspicious mammogram calcs
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How many cores should be obtained with stereotaxis (14g)
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at least 12
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What are the benefits and pitfalls of biopsing with a larger core
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more calcium and less underestimation
may remove the entire lesion and therefore have a difficult time finding it again |
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What should be done after biopsing a suspicious lesion
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insert a marking clip at the end of the procedure
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What are 2 reasons for marker clips
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marks biopsy site for future follow ups
If malignant able to find area of lesion |
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What is a reason for marker displacement in stereotactic biopsy
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breast compression
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What should be done after placing a marker
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post clip mammography to document if there is displacement
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Can a core biopsy be done by vacuum assisted device that is portable device
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yes but no evidence it is better than conventional core biopsy
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What modality is used for cyst aspiration
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ultrasound guidance
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Do you do a cyst aspiration on a complicated cyst
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no
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