radcards mammography

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what percentage of malignancies are not seen on screening mammograms: 10-20%
what view is used to evaluate: - calcs - mass - axillary lesion - medial lesion - overlapping lesions: calcs: magnification
mass: spot compression
axillary lesion: exaggerated CC lateral view
medial lesion: rolled view
overlapping lesions
what are US characteristics of a malignant lesion: angular margins
hypoechogenicity
shadowing
microcalcs
extension into a duct
microlobulation
taller than wide
name 4 US features of a benign lesion: hyperechogenicity
wider than tall
macrolobulation
thin pseudocapsule
what percentage of carcinomas shadow on US: 50%
what nucs test can be used to evaluate the breast and when is it used: sestamibi can be used especially in the dense breast
name 4 uses of MRI in breast imaging: identify multifocal neoplasm
evaluate chest wall involvement
scar vs recurrence
implant evaluation

*pearl* MRI is NOT used for microcalcs
compare benign and malignant lesion enhancement on MR: cancer enhances early
benign disease enhances late (after 3 min)

*pearl* DCIS enhances in only 50% of cases
what characteristics of a mass are always assessed at mammography: shape, margin, density
what is the most common palpable mass in: - a woman < 35 y - a woman 35-50 y - a woman > 50 y: < 35 y : fibroadenoma
35-50 y : cyst
> 50 y : carcinoma
ddx: well defined mass: cyst
fibroadenoma
carcinoma (esp mucinous, medullary and high grade ductal)
phylloides tumor
mets
papilloma
hematoma
hamartoma
lipoma
lymph node
abcess
oil cyst
galactocele
skin lesion
ddx: ill defined mass: carcinoma
abcess
hematoma
scar
fibrocystic change
myoblastoma
ddx: spiculated mass: invasive carcinoma
radial scar
surgical scar
hematoma
what percentage of infiltrating ductal carcinoma presents as a well defined mass: 6%
name 4 characteristics used to assess calcifications: distribution
size
shape
stability
what are the calcification patterns for: - fibroadenoma - fibrocystic change - oil cyst - plasma cell mastitis - arteries - dermal lesion: fibroadenoma: popcorn
fibrocystic change: scattered, punctate
oil cyst: ring-like
plasma cell mastitis: needle-like
arteries: tram-track
dermal lesion: riny, round with lucent centres
what percentage of DCIS proceeds to invasive cancer: 30%
what is inflammatory breast cancer: spread of cancer in dermal lymphatics
describe the features of phylloides tumor: rare
rapid increase in size
older women
what percentage of phylloides tumors are malignant: 15-20%
where do phylloides tumors metastasize: lung
describe paget's disease of the breast: erosion of the nipple tissue associated with ductal ca
what are the two most important factors in prognosis of breast ca: lymph nodes
tumor size
what are the criteria for inoperability of breast ca: extensive skin edema
fixation to chest wall
tumor greater than 5cm
massive or fixed lymph nodes
distant mets
multifocal disease
what is the risk of developing invasive ca with LCIS: 30% in EITHER breast over 20 years
what are the criteria for a simple cyst by US: anechoic, well-defined, posterior wall acoustic enhancement with a thin wall
what are the indications for aspirating a breast cyst: enlarging
not simple at US
painful
why should air be injected into a cyst following aspiration: the risk of recurrence is halved
what is the most common cause of bloody nipple discharge: papilloma
name 3 criteria for normal lymph nodes: < 1.5 cm in size
well-circumscribed
fatty hilum
why are calcs significant in implant patients: leaking silicone may induce calcs
what is: - the linguine sign - a radial fold - an inverted tear drop sign: linguine sign: intra-implant linear signal abnormality due to intracapsular rupture
radial fold: normal redundancy in the implant wall
inverted tear drop sign: silicone leak into a radial fold due to focal implant rupture
what is the US appearance of an implant: anechoic

*pearl* any echogenic implant is abnormal
what is the US appearance of: - extracapsular rupture - intracapsular rupture: extracapsular rupture: snowstorm apparance - echogenic with shadowing
intracapsular rupture: stepladder appearance
US vs MRI for implant rupture: US: 70% accurate
MR: 95% accurate
what are complicatoins of breast implants (6): fibrous capsule contraction
infection
hematoma
leakage or rupture
collapse
herniation
ddx: well-defined breast mass - the short list: cyst
fibroadenoma
phylloides tumor
papilloma
hematoma
abscess
carcinoma (medullary, mucinous and any rapidly growing infiltrating ductal ca)
what types of carcinoma are well defined: medullary
mucinous
rapidly growing invasive ductal

*pearl* a well defined malignant mass is most likely an invasive ductal carcinoma because they are so common
ddx: fat containinglesion of the breast: GO FLY

galactocele
oil cyst
fibroadenolipoma (hamartoma)
lipoma
lymph node
what are changes seen in the postop breast: skin thickening
retraction
asymmetric glandular tissue
architectural distortion
hematoma
fat necrosis
scarring
calcification
sutures

*pearl* skin thickening and changes in architecture should not persist beyond 6 months
what are indications for breast conserving therapy: confined to breast and ipsilateral nodes
size < 4cm
no multicentric lesions
cosmetically acceptable result possible
ddx: solitary, focally dilated duct: PATCH

papilloma
adenoma
trauma
carcinoma
hyperplasia
ddx: male gynecomastia: drugs
cirrhosis
renal failure (chronic)
tumor
what drugs cause gynecomastia: PETPAD

pot
estrogen
tagamet and thiazides
phenothiazides
amphetamines
digitalis
ddx: skin thickening: 6 benign:
radiation
mastitis
trauma
CHF/fluid overload
lymphatic/venous obstuction
inadequate compression

5 malignant:
inflammatory breast cancer
recurrent carcinoma
lymphatic obstruction
metastasis
lymphoma
where do lesions seen on an MLO view move on an ML view: lateral moves lower (L-L)
medial moves upper
ddx: intraluminal filling defect on galactogram (6): papilloma
papillomatosis
ductal hyperplasia
blood clot
inspissated material
intraductal carcinoma
what features favor carcinoma on a galactogram: encasement
narrowing
abrupt duct termination
what are indications for a galactogram: unilateral discharge
single duct
bloody or serous discharge
what are the steps in a galactogram: identify the abnormal duct
sterile prep
cannulate abnormal duct with 27g or smaller
inject contrast until discomfort
obtain 2 view mammogram
what is the appearance of silicone on MR: T1WI: dark
T2WI: bright

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