Ucsf: Video C 29 Mammography (Problem Solving)

Front 1

What are 4 things we are looking for on screening mammography

Back 1

mass
calcifications
architectual distortion
developing asymmetry

Front 2

What should be done if a lesion appears suspicious

Back 2

spot magnification or spot compression views

Front 3

What are 3 characteristics of a mass

Back 3

densest in center
convex margins
2 views

Front 4

If the margin of a mass is spiculated what must the shape be

Back 4

irregular

Front 5

If you see a spiculated appearing lesion on mammography do you order an US

Back 5

yes, to make sure it is not a cyst

Front 6

What are 3 essential characteristics of a cyst on breast US

Back 6

anechoic
smooth walls
posterior acoustic enhancement

Front 7

What is the biopsy technique used when doing US guided biopsy

Back 7

core biopsy

Front 8

Do you leave a clip flollowing ultrasound guided biopsy

Back 8

yes (then do a post mammo for displacement)

Front 9

What are to reasons clip placement is helpful
2

Back 9

future localization
corellate US and mammographic findings

Front 10

What is the most common histology of invasive breast cancer

Back 10

invasive ductal carcinoma

Front 11

Does breast cancer increase as a women gets older

Back 11

yes

Front 12

What is a complex mass

Back 12

mixed cyst and solid components

Front 13

What are benign causes of a complex mass

Back 13

abscess
evolving hematoma

Front 14

Is the term complex cystic mass used

Back 14

no

Front 15

Are punctate calcificatons seen on US suspicious

Back 15

yes (punctate on mammo is not)

Front 16

Does overpenetration allow you to see calcifications better

Back 16

yes

Front 17

What are two important factors to consider when analyzing calcificaitons

Back 17

shape
distribution

Front 18

Is linear a morphology and distribution when describing calcifications

Back 18

yes

Front 19

If there is a solid and cystic lesion what is a technique to find solid component

Back 19

use doppler and look for flow

Front 20

What is the cause of a cystic component of a invasive ductal carcinoma

Back 20

necrosis

Front 21

What modality are neoadjuvant chemotherapy patients followed with

Back 21

MRI

Front 22

If a pt has a lesion that may warrant the use of neoadjuvant chemotherapy what should be done

Back 22

MRI baseline

Front 23

Is rim enhanement a relatively specific sign of breast malignancy

Back 23

yes

Front 24

Do the majority of cancers show wash out kinetics

Back 24

no, but if they do it is a sign of malignancy

Front 25

What is a complex cyst

Back 25

cyst and internal echoes (if any solid components it is a complex mass)

Front 26

After neoadjuvant chemotherapy what happens to a malignant lesion that is responsive

Back 26

mass decreases in size

the calcifications stay

Front 27

What are the breast density categories
4

Back 27

fatty
scattered fibroglandular tissue
heterogenously dense
extremely dense

Front 28

When you see calcifications what should you automaticaly think

Back 28

morphology
distribution

Front 29

If calcifications correlate with a paplpable lump does that increase clinical suspicion

Back 29

yes

Front 30

Why is it hard to see cancer in dense breast

Back 30

the cancer is white
the dense breast are white

Front 31

Is a solid mass that is hypoechoic a sign of malignancy

Back 31

yes

Front 32

What are examples of neoadjuvant chemotherapy
2

Back 32

adriamycin
cytoxan

Front 33

Do the calcificatons of lesion sometimes increase after chemotherapy

Back 33

yes (may be dystrophic rxn)

Front 34

If a mass is seen on US what is the biopsy modality

Back 34

US

Front 35

What is an area of common misses on mammography

Back 35

the posterior breast

Front 36

What is the mammographic appearance of the sternalis muscle

Back 36

it is located in the posteriomedial breast and looks like a sail (triangle) has sharp borders

Front 37

Can a MRI be done in a pt with cancer to exclude involvement of pectoral muscle

Back 37

yes (important to do bc involvment of tumor in the pectoral muscle is a bad prognostic indicator and requires the pt to have chemo)

Front 38

What is a sensitive and specific sign of pectoral muslce involvment on MRI

Back 38

enhancement

Front 39

What should always be analyzed on MRI besides the breast

Back 39

look for enlarged LNs

Front 40

Are angular margins on US highly suggestive of malignancy

Back 40

yes

Front 41

What are 2 categories of enhancing mass seen on MRI

Back 41

enhancing mass vs Non-mass enhancement

Front 42

What are coarse calcifications surrounding a breast implant likely the result of

Back 42

capsular calcifications (birads 2 )

Front 43

What is a special view that is aquired in women with breast implants

Back 43

implant displace views (basically pushing the implant away)

Front 44

What benign condition is often assoicatiated with cacifications

Back 44

fibroadenomas

Front 45

Is posterior shadowing and hypoechoic lesions on US suspicious

Back 45

yes

Front 46

What does skin thickening look like on mammography

Back 46

it is increased density along the outer margin of the breast (skin)

Front 47

What is a popcorn calcifications caused by

Back 47

fibroadenoma

Front 48

What are 2 findings of the skin suggestive of malignancy

Back 48

skin thickening and retraction

Front 49

Is linear branching calcifications suggestive of malignancy

Back 49

yes

Front 50

What type of cancer is skin thickening associated with

Back 50

inflammatory breast carcinoma

Front 51

What if a lesion is highly suggestive of malignancy on Mammo but benign appearing on US and histo demonstrated benign findings what is the next step

Back 51

rebiopsy or surgical excision

Front 52

Is a new or enlarging cyst in a postmenopausal women not on HRT worrisom

Back 52

yes