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19 Cards in this Set

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Features of benign solid masses by US
Hyperechoic

3 or fewer gentle lobulations

Thin echogenic sharply marginated pseudo capsule

Ellipsoid shape
Features of malignant masses by US
Spiculated margin

Taller than wide

Angular margins

Shadowing

Branching pattern

Calcifications

Microlobulated

Disruption of tissue planes
Silicone implant, extracapsular rupture on US
Snowstorm sign
Silicone implant, intracapsular rupture on US
Stepladder sign
Breast US indications
First line for patient < 30yo with palpable abnormality, breast feeding or pregnant

Further evaluation of mammographic findings

Identification of palpable and non-palpable clinical sx

Breast implant problem solving

Nipple discharge problem solving

US-guided bx

2nd look US following MRI

Less likely:
- Radiation tx planning
- monitoring tx response
- whole breast US screening
- metastatic dz, unknown primary, negative mammo
Indications for Breast MRI
Evaluate extent of disease in known CA

Metastatic LN with unknown primary

Screening for contralateral breast in newly diagnosed CA

Response to therapy

Screening in pt with >20-25% lifetime risk:
- BRCA1/2
- Untested primary relative of known BRCA1/2 carrier
- Strong family hx
- previous radiation tx <30yo
Horomonal enhancement on breast MRI:
- when is the best time to scan
Between days 3-14 of the menstrual cycle.
Fribroadenoma on MRI
high T1W

High T2W

Smooth enhancing mass

Pesistant (increasing) kinetics
BIRADS descriptors for MASS (4)
Round
Lobular
Oval

Irregular (suspicious)
BIRADS descriptors for MARGINS (5)
Circumscribed
Microlobulated
Obscured
Indisctinct/Ill-defined (suspicious)
Spiculated (suspicious)
BIRADS descriptors for DENSITY (4)
Density compared to an equaly volume of breast tissue

High
Isodense
Low (but w/o fat)
Fat-containing radiolucent
BIRADS descriptors for Typically-Benign CALCIFICATIONS (9)
Skin
Vascular
Coarse/Popcorn-like
Large rod-like
Round (> 1 mm)
Punctate (<0.5 mm)
Lucent-centered
Eggshell/Rim
Milk of calcium
Suture
Dystrophic
- post traumatic or XRT
BIRADS descriptors for Intermediate concern, suspicious CALCIFICATIONS (2)
Amorphous/Indistinct
Coarse Heterogeneous
- may represent elvolving dystrophic
BIRADS descriptors for higher probability of malignancy CALCIFICATIONS (2)
Fine pleomorphic
Fine linear/Fine linear branching
BIRADS descriptors for calcifications, DISTRIBUTION MODIFIERS (5)
Diffuse/scattered
Regional (> 2 cc, > 1 segment)
Grouped/clustered (> 5 calcs)
Linear (suspicious)
Segmental (suspicious)
BIRADS descriptors for SPECIAL CASES (4)
Assymetric tubular structure
- dilated duct

Intramammary LN

Global assymetry
- may be concerning if palpable

Focal asymmetry
- seen in 2 views but lacking characteristics of mass
BIRADS descriptors for ASSOCIATED FINDINGS (6)
Skin retraction

Nipple retraction

Skin thickening

Trabecular thickening

Skin lesion

Axillary adenopathy
Subareolar mass
Abscess

Montgomery gland cyst

Papilloma

Cancer
Breast mass in a pregnant patient
Galctocele

Abscess

Fibroadenoma

Lactating adenoma

Hematoma

Fibrocystic change