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Breast Flashcards

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1
Q

US –> first line eval for breast abnormality –> who? (3)

A
  • <30yo
  • pregnant
  • lactating
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2
Q

MRI –> breast screen –> who?

A

high risk pt (>20% lifetime risk of breast CA)

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3
Q

MRI breast –> indications? (6)

A
  • screen in high risk pt
  • breast CA –> new dx –> eval extent of dz
  • eval neoadjuvant ctx response
  • positive surgical margins –> assess residual dz
  • eval tumor recurrence
  • axillary mets –> eval occult breast CA
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4
Q

invasive ductal breast CA –> stepwise progression?

A

1) flat epithelial atypia
2) atypical ductal hyperplasia
3) ductal carcinoma in situ (DCIS)
4) invasive ductal carcinoma

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5
Q

flat epithelial atypia (FEA) & atypical ductal hyperplasia (ADH) –> obligatory or non-obligatory precursor lesion for breast CA?

A

non-obligatory –> inc risk

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6
Q

breast CA –> RF? (7) which are most important RF?

A
  • # 1 F
  • # 1 age
  • BRCA1/2
  • 1st deg relative
  • chest radiation
  • long-term estrogen exposure (early menarche, late menopause, late first preg, nullipartiy, obesity)
  • bx high risk lobular lesion (ie atypical lobular hyperplasia, lobular CA in situ)
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7
Q

breast CA –> MC type?

A

invasive ductal CA (IDC) not otherwise specified

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8
Q

breast CA –> invasive ductal CA (IDC) –> MC clinical presentation?

A

palpable mass

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9
Q

breast CA –> invasive ductal CA (IDC) –> classic mammo appearance?

A
  • spiculated mass
  • architectural distortion
  • pleomorphic calcs
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10
Q

ductal breast CA –> subtypes? (5)

A
  • invasive ductal, not otherwise specified
  • tubular
  • mucinous (colloid/mucoid/gelatinous)
  • medullary
  • papillary
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11
Q

invasive ductal CA vs other ductal breast CA –> better prognosis –> T/F?

A

F –> other ductal breast CA have better prognosis than invasive ductal

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12
Q

breast CA –> tubular CA –> mammo appearance?

A

small spiculated mass

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13
Q

breast CA –> mucinous (colloid/mucoid/gelatinous) CA –> US appearance? T2 MRI?

A
  • US: low density circumscribed mass –> mimic fibroadenoma

- T2 –> hyper

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14
Q

breast CA –> medullary CA –> epidemiology?

A

young F –> BRCA1

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15
Q

breast CA: invasive lobular CA –> mammo appearance?

A

architectural distortion –> “dark star”

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16
Q

breast CA: what is inflamm CA?

A

tumor invasion of dermal lymphatics

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17
Q

breast CA: inflamm CA –> clinical presentation?

A

breast:
- erythema
- edema
- firm

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18
Q

breast CA: inflamm CA –> mammo appearance?

A
  • breast –> lrg, dense
  • trabecula thick
  • skin thick
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19
Q

what is Paget dz of nipple?

A

form of DCIS –> infiltrate nipple epidermis

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20
Q

Paget dz of nipple –> clinical appearance?

A

nipple:
- erythema
- ulcer
- eczematoid changes

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21
Q

breast CA –> prognosis –> most important factor?

A

axillary LN status

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22
Q

breast CA –> axillary LN involvemt –> how to detect?

A

sentinel LN bx

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23
Q

breast CA –> surgical axillary LN dissection –> indication? (2)

A

sentinel LN:

  • positive
  • not ID
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24
Q

estrogen receptor (ER) & progesterone receptor (HR) –> positive –> longer disease free survival –> T/F?

A

T

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25
ER, PR, HER2/neu negative --> triple neg CA --> poor prognosis --> MC epidemiology?
BRCA1
26
triple neg CA --> MC mammo appearance? MC location?
breast --> posterior --> round --> smooth margin --> no calcs
27
DCIS --> prognosis --> key factor?
presence of necrosis
28
DCIS --> which subtype gets sentinel LN bx?
DCIS w necrosis --> high grade
29
high grade DCIS --> MC mammo appearance?
calcs: - pleomorphic - fine linear branching
30
breast --> fibrocystic change --> epidemiology? clinical presentation?
pre-menopause: - cyclic breast pain - sometimes --> palpable lump
31
breast --> fibrocystic change --> imaging dx --> T/F?
F
32
sclerosing adenosis --> mammo appearance?
microcalcs --> can mimic DCIS
33
mastitis --> MC org?
Staph aureus
34
mastitis --> 2 MC epidemiology?
- nursing | - diabetes
35
mastitis --> clinical presentation?
breast: - pain - induration - erythema
36
mastitis --> imaging (mammo/US) appearance?
- skin thicken --> focal/diffuse - edema - adenopathy
37
breast abscess --> MC location?
subareolar
38
breast abscess --> mammo appearance?
irreg mass --> mimic carcinoma
39
breast abscess --> tx?
- US-guide aspiration | - abx
40
what is granulomatous mastitis? epidemiology?
young F --> after childbirth --> rare idiopathic --> breast inflamm --> noninfx
41
granulomatous mastitis --> assoc RF? (2)
- breastfeed | - OCP
42
granulomatous mastitis --> mammo/US finding? --> next step? why?
mimic breast CA --> bx
43
periductal mastitis (plasma cell mastitis) --> epidemiology?
post-menopause
44
periductal mastitis (plasma cell mastitis) --> MOA? classic mammo appearance?
intraductal lipids --> irritating --> large rod-like calcs
45
diabetic mastopathy --> MOA?
long term diabetes --> chronic hyperglycemia --> autoimmune rxn to matrix proteins --> firm mass --> can be painful
46
diabetic mastopathy --> mammo appearance? calcs?
- ill-defined asymm density | - no microcalcs
47
diabetic mastopathy --> US appearance? next step?
- hypoechoic mass - regional acoustic shadow --> mimic scirrhous breast CA --> bx
48
what is Mondor thrombophlebitis?
breast --> superficial V --> thrombophlebitis
49
Mondor thrombophlebitis --> MC vein?
thoracoepigastric V
50
Mondor thrombophlebitis --> clinical presentation?
- superficial mass --> cordlike/elongated | - pain/tender
51
Mondor thrombophlebitis --> US appearance?
dilated tubular struct --> "bead-like" --> no color flow
52
cleavage view --> purpose?
image medial breast tissue of both breasts
53
what is exaggerated CC (XCC) view?
pull lat/med tissue into image detector
54
what is online screening?
screen mammo --> pt wait for final read
55
online vs offline screen --> cons? (2)
online: - more imaging - more false pos - same cancer detection rate
56
image quality --> how determine if CC and MLO view have imaged adequate tissue?
posterior nipple line --> w/in 1 cm
57
image quality --> nipple?
nipple should be in profile in at least 1 view
58
mammo signs of malig? (4)
- mass - calc - architectural distortion - asymm
59
BI-RADS categories?
- 0: need additional imaging - 1: neg - 2: benign - 3: prob benign - 4: suspicious - 5: highly sugg malig - 6: known bx-proven malig
60
BI-RADS 3 --> next step?
short interval fu --> usu 6mo
61
screen mammo --> BI-RADS 3 --> T/F?
F can only be categorized 3 after dx mammo
62
BI-RADS 3 --> %malig?
<2%
63
BI-RADS 4 --> %malig?
2-95%
64
BI-RADS 4 --> next step?
bx or aspiration
65
breast abscess --> BIRADS?
4
66
BI-RADS 5 --> % malig?
>95%
67
BI-RADS 5 --> next step?
- bx | - surg
68
fibroglandular density --> categories? (4)
- almost entirely fatty - scattered - heterogeneous - extremely dense
69
almost entirely fatty vs extremely dense fibroglandular tissue --> which has inc risk of breast CA?
extremely dense fibroglandular --> 5x more risk --> than almost entirely fatty
70
inc fibroglandular density --> bilat --> ddx? (2)
benign: - hormone - edema
71
inc fibroglandular density --> unilat --> ddx? (1)
malig --> lymph obstruct
72
skin thickening --> benign cause? (3)
- radiation - acute mastitis - fluid overload (CHF, renal fail, liver fail)
73
what is "mass"?
2 projections --> space occupying lesion --> convex borders
74
asymm --> seen on how many views?
1
75
mass --> margins? (5)
- circumscribed - microlobulated - obscured - indistinct - spiculated
76
margin --> circumscribed --> % margin that must be well-defined?
75%
77
mass --> densities? (4)
- radiolucent (fat) - low density - equal density - high density
78
mammo: mass --> shape? (3)
- round - oval - irreg
79
mammo vs US --> preferred terminology for location?
- mammo: quadrants | - US: clockface
80
mammo --> quadrants? (4)
- upper outer - upper inner - lower outer - lower inner
81
assoc features? (7)
- architectural distortion - microcalc - skin retraction - nipple retraction - skin thick - trabecular thick - axillary LN
82
what is architectural distortion? concerning for CA?
radiating linear densities --> no definite mass highly concerning for CA
83
skin retraction --> ddx? (2)
- postsurg | - desmoplastic tumor rxn
84
calcs --> indeterminate or susp for malig --> require what view?
spot compression --> mag
85
skin calcs --> mammo appearance?
MC medial location: - punctate - lucent center
86
calcs --> how to determine if skin calcs?
tangential view
87
popcorn calc --> dx?
involuting fibroadenoma
88
large rod-like calc --> dx?
plasma cell mastitis (duct ectasia)
89
milk of calcium --> etiology
fibrocystic change
90
milk of calcium calc --> mammo appearance?
- CC view: fuzzy round amorphous | - lat: semilunar/crescent shape
91
what is suture calc?
suture material --> calcium (usu after radiation)
92
dystrophic calc --> etiology? (4)
sequela: - surg - bx - trauma - rad
93
punctate calc --> shape? size (mm)?
round --> <0.5mm
94
lucent-center calc --> size?
<1mm - >1cm
95
eggshell (rim) calc --> ddx? (2)
- fat necrosis | - cyst --> calc wall
96
benign calcs (BI-RADS 2)? (11)
- skin - vascular - suture - popcorn - lrg rod-like - milk of Ca - dystrophic - round - punctate - lucent-center - eggshell (rim)
97
interm concern calcs (BI-RADS 4)? (2)
- amorphous/indistinct | - coarse heterogeneous
98
amorphous calc --> appearance?
too small or hazy to ascertain morphology
99
amorphous calc --> diffuse vs focal --> benign vs suspicious?
- diffuse --> benign | - focal --> susp
100
coarse heterogeneous calc --> appearance?
- irreg | - >0.5mm but smaller than dystrophic calc
101
higher prob of malig (BI-RADS 4-5) --> calcs? (2)
- fine pleomorphic | - fine linear (branching)
102
fine pleomorphic calc --> appearance?
vary in shape & size --> "dot-dash" appearance
103
fine pleomorphic calc --> ddx? (2)
- DCIS | - invasive ductal CA
104
calc --> distribution? (5) which are usu benign? more suspicious?
usu benign: - diffuse/scattered - regional more suspicious: - linear - grped/cluster - segmental
105
calc --> what is regional distribution?
lrg vol (>2cc) breast tissue --> not conform to ductal distribution
106
calc --> grped/cluster --> definition?
at least 5 calc in <1cc of breast tissue
107
what is rolled view? purpose?
CC view --> roll top breast med (RCCM) or lat (RCCL) --> localize lesion seen only on CC --> lesion mv med on RCCM --> in sup breast
108
what is reduced compression view? purpose?
reduced compression --> image far post lesions that slip out when full compression applied
109
true lat view --> when LM preferred over ML?
medial lesion --> LM --> lesion closer to detector
110
MLO --> lesion --> superior on lat view --> lesion is located med or lat?
med (Medial: Muffins rise)
111
MLO --> lesion --> inf on lat view --> lesion is located med or lat?
lat (Lat: Lead sinks)
112
punctate or round calc --> grp/cluster --> BI-RADS?
3
113
amorphous calc --> cluster --> next step?
indeterminate --> bx
114
what is focal asymm?
nonpalpable non-mass lesion --> seen on 2 projections
115
focal asymm --> US --> no correlate --> BI-RADS?
3
116
what is developing asymm? benign or suspicious?
focal asymm --> inc in size suspicious
117
epidermal inclusion cyst --> US appearance?
circumscribed --> variable internal echotexture --> anechoic to heterogeneous
118
breast lesion --> dermis + hypodermis --> findings that dermal origin? (2)
- claw of dermal tissue --> wrap around lesion | - lesion --> tract to epidermal surface
119
what is mammary zone? contains what tissue/structures?
zone bw subcutaneous & retromammary: - ducts/TDLU - fat - fibrous tissue - Cooper's lig
120
ultrasound: mass --> shape? (3)
- round - oval - irreg
121
ultrasound: mass --> orientation? (2)
- parallel | - non-parallel
122
ultrasound: mass --> margin? (5)
- circumscribed - indistinct - angular - microlobulated - spiculated
123
ultrasound: mass --> what is lesion boundaries? 2 types?
transition bw mass & surrounding tissue: - abrupt interface - echogenic halo
124
ultrasound: mass --> echogenic halo --> ddx? (2)
- CA | - abscess
125
ultrasound: mass --> posterior acoustic features? (4)
- no post acoustic feature - enhancemt - shadowing - combined pattern
126
ultrasound: mass --> posterior acoustic shadowing --> ddx? (1)
fibrosis: - neoplastic desmoplastic rxn - surg scar
127
ultrasound: mass --> internal echo pattern? (5)
- anechoic - hypoechoic - isoechoic - hyperechoic - complex
128
benign mass --> ultrasound features? (5) - internal echo pattern - margin - orientation - shape
- marked hyperechoic - circumscribed --> thin echogenic pseudocapsule - parallel - oval/few gentle macrolobulation
129
malig mass --> ultrasound features? (7) which 2 are most specific for malig?
- #1 spiculated - #2 non-parallel - angular, microlobulated - post shadow - marked hypoechoic - assoc calcs - wide zone of transition
130
lipoma vs oil cyst --> margin?
- lipoma --> no peripheral cacl | - oil cyst --> peripheral calc
131
lipoma --> should be eval by US prior to dx --> T/F?
F can be dx w mammo alone
132
oil cyst --> MOA?
trauma or surg --> fat necrosis
133
what is hamartoma (fibroadenolipoma)?
benign mass --> fat & glandular tissue
134
hamartoma (fibroadenolipoma) --> classic mammo appearance?
breast w/in breast --> displace normal breast tissue
135
hamartoma (fibroadenolipoma) --> should be eval by US prior to dx --> T/F?
F mammo almost always diagnostic
136
what is galactocele?
lactating --> cystic collection of milk --> palpable mass
137
galactocele --> mammo appearance?
- circumscribed - macrolobulated - mixed high density + fat - true lat view --> fat-fluid level
138
intramammary LN --> MC location?
lat --> upper outer quad --> adj to vessel
139
medial breast --> lesion that look like intramammary LN --> benign or suspicious?
suspicious
140
fibroadenoma --> mammo XR --> density?
equal density
141
fibroadenoma --> US --> density?
- hypoechoic | - central hyperechoic band
142
fibroadenoma --> BI-RADS?
3
143
fibroadenoma --> variants? (3)
- complex - juvenile - giant
144
complex fibroadenoma --> characteristics? (2)
- prolif elements & internal cysts | - inc risk of breast CA
145
juvenile fibroadenoma --> characteristics? (2)
- adol | - very rapid growth
146
giant fibroadenoma --> characteristic? (1)
>8cm
147
fibroadenoma --> ddx? (1)
phyllodes tumor
148
what is intraductal papilloma? epidemiology?
30-50yo --> benign tumor of lactiferous ducts
149
intraductal papilloma --> clinical presentation?
nipple discharge: - bloody - serous - serosanguinous
150
bloody nipple discharge --> ddx? (2)
- intraductal papilloma | - DCIS
151
intraductal papilloma --> mammo XR --> shape? margin? MC location?
- round/oval - circumscribed/irreg - subareolar
152
intraductal papilloma --> galactography appearance?
intraductal filling defect
153
intraductal papilloma --> US --> appearance? solid/cyst? shape?
- solid - round/oval - mass in fluid-filled duct
154
intraductal papilloma --> dx by mammo/US alone --> T/F?
F --> dx by bx
155
bx --> intraductal papilloma --> next step? why?
surg excise papillary CA may appear same
156
what is pseudoangiomatous stromal hyperplasia (PASH)?
hormone --> stromal & epithelial prolif
157
pseudoangiomatous stromal hyperplasia (PASH) --> mammo appearance?
mass: - circumscribed - oval/irreg
158
pseudoangiomatous stromal hyperplasia (PASH) --> US appearance?
mass: - hypoechoic/mixed echogenicity - oval/irreg
159
pseudoangiomatous stromal hyperplasia (PASH) --> demonstrate slow growth --> next step? why?
excisional bx PASH can mimic low-grade angiosarcoma
160
mammo --> circumscribed round mass --> breast CA ddx? (2)
- medullary | - mucinous
161
phyllodes tumor --> epidemiology?
40-50yo
162
phyllodes tumor --> benign or malig?
- most benign | - 25% --> malig
163
lactational adenoma --> epidemiology?
- 2nd-3rd trimester | - postpartum
164
lactational adenoma --> benign or malig?
benign
165
lactational adenoma --> tx?
none --> regress when stop lactating
166
mult intraductal papillomas --> epidemiology?
younger
167
mult intraductal papillomas --> location?
bilat breasts --> peripheral
168
mult intraductal papillomas --> inc risk of breast CA --> T/F?
T
169
what is steatocystoma multiplex?
AD --> mult intradermal oil cysts
170
simple cyst --> BI-RADS?
2
171
new --> complicated cyst --> next step?
- BIRADS 3 | - aspiration
172
complicated cyst --> aspiration --> fluid is white/clear/yellow --> next step?
discard fluid
173
complicated cyst --> aspiration --> fluid is bloody --> next step?
send fluid to cytology
174
what is complex mass?
cyst w complex feature: - thick wall - septation - solid/nodular compont
175
complex mass --> BI-RADS?
4
176
complex mass --> cancer ddx? (4)
- intracystic CA - intracystic papilloma - cystic phyllodes tumor - solid CA w central necrosis
177
what is intracystic CA?
cyst wall --> CA
178
complex mass --> benign ddx? (5)
- hematoma - abscess - fat necrosis - galactocele - benign cyst w adherent debris
179
what is clustered microcyst?
apocrine metaplasia or fibrocystic change --> several tiny 2-5mm cystic spaces separated by thin septae
180
clustered microcyst --> BI-RADS?
2
181
MC breast CA?
invasive ductal CA (IDC)
182
invasive ductal CA (IDC) --> typical mammo appearance?
- spiculated mass --> high density | - often: pleomorphic or fine linear branching calcs
183
invasive lobular CA --> differences from invasive ductal CA (IDC)? (3)
invasive lobular: - rare calc - more often multifocal - more often bilat
184
tubular CA --> typical mammo appearance?
small spiculated mass --> slow growing
185
possible precursor lesion to tubular CA?
radial scar
186
what is radial scar?
uncertain etiology --> dense fibrosis around ducts --> spiculated mass or architectural distortion
187
what is complex sclerosing lesion?
radial scar --> >1cm
188
radial scar/complex sclerosing lesion --> tx?
surg excision
189
postsurgical scar --> can get larger over time --> T/F?
F
190
what is sclerosing adenosis?
benign --> lobular hyperplasia --> fibrous tissue envelop & distort glandular elements --> sclerosis --> breast lesion --> maybe microcalcs
191
what is diabetic mastopathy?
long-term insulin-dep diabetes --> inflamm lymphocytes & fibrosis --> large painless firm mass
192
diabetic mastopathy --> mammo appearance? US?
- mammo: ill-defined mass or asymm density | - US: hypoechoic shadowing mass
193
benign breast fibrosis conditions? (2)
- sclerosing adenosis | - diabetic mastopathy
194
LN metastasis --> suspicious US features? (5)
- round - thick cortex >3mm - eccentric thick cortex - focal outward cortical bulge - thick cortex --> indent or obliterate hilum
195
1ary breast lymphoma --> MC etiology?
diffuse lrg B-cell lymphoma
196
breast lymphoma --> calcs or no calcs?
no calcs
197
known lymphoma --> new breast mass --> most likely mets or breast CA?
breast CA
198
2ary angiosarcoma of breast --> etiology?
prior breast conservation --> rtx
199
2ary angiosarcoma of breast --> T2 appearance? enhancemt?
- T2 hyper | - intense enhance
200
new mult masses --> non-ductal distribution --> dx?
hematogenous mets to breast
201
mets to breast --> what 1ary cancers? (2)
- melanoma | - RCC
202
what is asymm?
1 view --> prominent breast tissue
203
asymm --> MCC?
superimposed gland tissue
204
what is global asymm?
1 breast --> majority (>1 quad) --> asymm density
205
global asymm --> MCC?
greater vol of parenchyma in 1 breast
206
what is focal asymm?
abnormality --> 2 views --> <1quad --> concave contour
207
what is sternalis muscle?
<10% --> access parasternal chest wall muscle
208
sternalis muscle --> MC location?
unilat --> med --> far-post --> only see on CC view
209
access nipple (polythelia) --> mammo appearance?
mammo crest --> round mass
210
what is Poland synd? (3)
congenital: - unilat --> pect major absent - ispilat breast absent - syndactyly
211
access (ectopic) breast tissue --> MC location?
axillary tail
212
breast MRI --> enhancemt kinetics --> enhancemt curve --> 2 parts (time)?
- early (2min) phase | - delayed
213
breast MRI --> early enhancemt --> 3 categories?
- slow - med - rapid
214
breast MRI --> delayed enhancemt --> 3 categories?
- type 1 persistent - II plateau - III washout
215
breast MRI --> delayed enhancemt --> what is type 1 persistent? assoc w benign/suspicious/malig?
continuous inc enhance (>10%) 83% --> benign
216
breast MRI --> delayed enhancemt --> what is type II plateau? assoc w benign/suspicious/malig?
level off (w/in 10%) susp --> PPV 64-77%
217
breast MRI --> delayed enhancemt --> what is type III washout? assoc w benign/suspicious/malig?
>10% dec in enhancemt malig --> PPV 87-92%
218
breast MRI --> delayed enhancemt --> type III washout --> benign ddx? (3)
- LN - adenosis - papilloma
219
morphology vs enhancemt kinetics --> which is more important to determine if lesion is benign or suspicious?
morphology
220
breast MRI --> internal enhancemt? (4)
- homogeneous - heterogeneous - rim enhance - dark internal septations
221
breast MRI --> dark internal septations --> highly specific for what condition?
fibroadenoma
222
breast MRI --> what is focus?
<5mm dot of enhancemt --> too small for accurate assess: - no mass effect - no correlate on precontrast seq
223
what is non-masslike enhancemt?
enhancing region --> not mass or focus
224
non-masslike enhancemt --> distribution? (6)
- linear/ductal - segmental - focal - regional - mult region - diffuse
225
non-masslike enhancemt --> what is focal distribution? regional?
- focal: <25% quadrant | - regional: >25% quadrant
226
non-masslike enhancemt --> internal enhancemt? (4)
- homogeneous - heterogeneous - clumped - clustered ring
227
non-masslike enhancemt --> int enhancemt --> clustered ring --> ddx? (2)
- DCIS | - invasive ductal
228
non-masslike enhancemt --> stippled/punctate enhancemt --> assoc w benign or malig?
benign
229
mass --> enhancing portion --> T2 hyper --> highly sugg benign or malig?
benign
230
breast MRI: type I kinetic curve + benign morphology --> BI-RADS? (3)
- 2 - 3 - 4
231
breast MRI: type II kinetic curve + benign morphology --> BI-RADS? (1)
4
232
breast MRI: type III kinetic curve + benign morphology --> BI-RADS? (1)
4
233
breast MRI: type I kinetic curve + malig morphology --> BI-RADS? (1)
4
234
breast MRI: type II/III kinetic curve + malig morphology --> BI-RADS? (2)
- 4 | - 5
235
high risk for breast CA --> definition?
>20% lifetime risk of develop breast CA
236
what is breast conservation therapy?
lumpectomy + rtx
237
status post lumpectomy --> enhancemt at lumpectomy site --> can be normal for how long?
6-18mo
238
MRI --> evaluate silicone or saline implants?
silicone
239
how differentiate silicone vs saline implant on screen mammo?
saline: - valve - wall is denser than center silicone: - uniformly dense - no valve
240
breast implant --> screen mammo --> special view?
Eklund (implant-displaced) view
241
saline implant --> rupture --> clinical presentation?
sudden collapse --> instant dec breast size
242
silicone implant --> rupture --> clinical presentation?
- subtle change in implant contour | - no change in size or shape
243
silicone implant --> rupture --> MRI sign?
linguine
244
silicone implant --> rupture --> US appearance?
snowstorm
245
reduction mammoplasty --> mammo findings? (2)
lower breast: - skin thick - curvilinear architectural distortion
246
gynecomastia --> clinical presentation?
subareolar palpable abnormality
247
gynecomastia --> mammo appearance?
subareola --> flame/triangle-shape density
248
male --> breast mass --> benign features --> benign or suspicious?
male --> any breast mass --> susp
249
breast bx --> path discordant --> next step?
repeat bx --> core or excision
250
benign-appearing cyst --> aspirate --> bloody --> next step?
send to cytology
251
benign-appearing cyst --> aspirate --> cloudy --> next step?
discard fluid
252
benign-appearing cyst --> aspirate --> clear --> next step?
send to cytology
253
benign-appearing cyst --> aspirate --> green --> next step?
discard fluid
254
calc --> MC bx technique?
stereotactic-guided core
255
stereotactic bx --> CI? (5)
- thin breast --> <3cm compressed - far post location - subareolar location - pt can't be positioned on stereotactic table - unctrl coag abnormal
256
breast --> asymmetric in size --> ddx? (1) buzzword?
"shrinking breast" --> invasive lobular breast CA
257
axillary lymph node drainage --> order?
level 1 (lateral) --> 2 --> 3 (medial) --> thorax
258
what are Rotter nodes?
nodes bw pec minor & major
259
Rotter nodes --> at same level as which axillary LN?
level 2
260
sternalis M --> seen only on what view?
CC
261
MC location for ectopic breast tissue?
axilla
262
CA --> MC quadrant?
upper outer
263
CA --> start in what unit?
terminal duct lobular unit (TLDU)
264
majority (60%) of blood flow to breast --> which vessel?
internal mammary
265
singular mets to internal mammary nodes --> common or uncommon?
uncommon
266
singular mets to internal mammary nodes --> indicate what about the CA?
medial location
267
sternalis M --> usu unilat or bilat?
unilat
268
breast tenderness --> greatest at day ___?
day 27-30 (near end of luteal phase - progesterone dominates -> lobules prolif --> breast density inc slightly)
269
mammography & MRI --> best performed in what phase of the breast/menstrual cycle?
follicular phase (day 7-14)
270
never bx a prepubescent breast --> T/F? why?
T --> can damage breast developmt
271
cyst formation --> greatest in pre/peri/post menopause?
perimenopause
272
breast pain --> greatest in pre/peri/post menopause?
perimenopause
273
fibroadenoma --> degenerate in pre/peri/post menopause?
(post)menopause
274
secretory calcs (rod-like) --> dev in pre/peri/post menopause?
10-20 yrs post menopause
275
lactating breast --> mammogram vs US --> which is more sensitive? why?
lactating breast --> more dense --> US more sensitive for mass
276
bilat breasts --> inc density --> ddx? (2)
- pituitary prolactinoma | - meds --> ie antipsych
277
lactating breast --> bx --> comp?
milk fistula
278
lactating breast --> bx --> milk fistula --> tx?
stop breastfeeding
279
galactocele --> aunt minnie finding?
fat-fluid level
280
galactocele --> typical seen when? typical location?
- cessation of lactation | - sub-areolar
281
lactating adenoma --> fu recommendation?
4-6mo postpartum/postdelivery/cessation of lactation --> US
282
lactating adenoma --> natural progression of dz?
stop lactation --> rapid regress
283
lactating adenoma --> usu single or multiple?
mult
284
when get LMO view? (3)
- kyphosis - pectus excavatum - avoid medial pacemaker/central line
285
which view contains most breast tissue?
MLO
286
spot compression view --> collimate or not?
leave collimator open --> larger FOV --> ensure get what you wanted
287
mag view --> which positional views are obtained?
- CC | - ML (true lat)
288
screener --> lat breast --> microcalcs --> mag view --> ML or LM view?
ML
289
screener --> med breast --> microcalcs --> mag view --> ML or LM view?
LM
290
screener --> MLO only --> suspicious finding --> additional views --> ML or LM view? why?
ML view --> most (70%) breast cancers occur laterally
291
what is "camel nose"?
MLO --> breast not pulled up and out --> looks saggy
292
advantage of CC view over MLO?
maximize visualization of post medial tissue
293
advantage of MLO view over CC?
maximize visualization of axillary & post tissue
294
adequate technique: MLO --> pectoral muscle --> should be seen at level of what struct?
level of nipple or below
295
adequate technique: MLO --> pectoral muscle --> should be convex or concave?
convex
296
CC view --> lack adequate coverage of post lat tissue --> next step?
exagg lat CC view (XCCL)
297
ML view --> which is closer to the detector --> medial or lat breast?
lat
298
mass seen only on CC view --> next step?
rolled CC
299
mass in far post medial breast --> next step?
cleavage view (CV)
300
breast implants --> what views?
Eklund view (implant displaced) --> MLOID, CCID
301
Cooper's ligaments appear thick --> ddx? (2)
- blur | - edema
302
mammo --> blur --> etiology? (3)
- motion (breathing, inadeq compression) - exposure --> too long - exposure --> too short
303
mag view --> use grid or no grid?
no grid
304
lesion seen only on MLO --> ML view --> how know if lesion is in med vs lat breast?
"Lead Sinks, Muffins Rise": - inf on ML view --> lat breast - sup on ML view --> med breast
305
screeners --> PPV? (anything other than BR1/2)
4% --> 3-8 cancers per 1000 mammos
306
mammo --> bilat --> mult circumscribed similar appearing masses --> BI-RADS?
2
307
grped round calcs --> BI-RADS?
3
308
screening mammo --> BI-RADS options?
- 0 - 1 - 2
309
diagnostic mammo --> BI-RADS options?
- 2 - 3 - 4 - 5
310
focal asymm --> compress --> less dense --> looks like breast tissue --> BI-RADS?
3
311
MRI --> background parenchymal enhancemt --> categories? (5)
- none - minimal - mild - mod - marked
312
MRI --> mass --> shape --> categories? (3)
ROI: - round - oval - irreg
313
MRI --> mass --> margin --> categories? (3)
- circumscribed - irreg - spiculated
314
MRI --> mass --> T2 hyperintense signal --> categories? (3)
- grter than parenchyma - grter than or equal to fat - grter than or equal to water
315
MRI --> non mass enhancmt (NME) --> distribution --> categories? (6)
- focal - linear - segmental - regional - mult regions - diffuse
316
complex cystic & solid mass --> BI-RADS?
4
317
complicated cyst (cyst w debris) --> BI-RADS?
2 or 3
318
calc --> "cigar shaped w lucent center" --> dx?
secretory (rod like) calcs
319
calc --> "dashes but no dots" --> dx?
secretory (rod like) calcs
320
milk of Ca --> bx --> no calcs visualized --> how to assess for milk of Ca?
view w polarized light --> birefringence
321
amorphous calc --> ddx? (4)
- #1 fibrocystic change - sclerosing adenosis - columnar cell change - DCIS (low grade)
322
coarse heterogeneous calc --> ddx? (4)
- fibroadenoma - papilloma - fibrocystic change - DCIS (low-interm grade)
323
fine pleomorphic calc --> ddx? (4)
- fibrocystic change - fibroadenoma - papilloma - DCIS (high grade)
324
Mondor dz --> tx?
- NSAID | - warm compress
325
lipoma --> enlrg --> next step?
bx
326
bx --> pseudoangiomatous stromal hyperplasia (PASH) --> fu?
12mo
327
young F --> MC palpable mass?
fibroadenoma
328
MRI --> fibroadenoma --> T2 signal? enhance?
- T2 bright | - type 1 enhance (progressive enhance)
329
phyllodes tumor --> epidemiology?
middle age to older F
330
phyllodes tumor --> recommend sentinel node bx --> T/F?
F if mets --> hematogenous --> lung & bone
331
phyllodes tumor --> rapid growth --> T/F?
T
332
ductal CA --> medullary subtype --> assoc finding?
lrg axillary LN (not necessarily mets)
333
ductal CA --> papillary subtype --> mass appearance?
complex cystic & solid
334
ductal CA --> #2 MC type?
papillary
335
breast CA --> multifocal vs multicentric?
- multifocal: same quad --> <4-5cm apart | - multicentric: mult quad
336
DCIS --> comedo vs non-comedo --> which is more aggressive?
comedo
337
galactography --> mult intraductal masses --> ddx? (1)
DCIS
338
Pagets dz of breast --> topic therapy --> skin lesion still not resolve --> next step?
wedge bx
339
invasive lobular CA --> US appearance?
ill-defined area of shadowing --> "shadowing w/o mass"
340
prognosis: IDC vs ILC --> which is better?
similar prognosis
341
ILC --> often only seen on CC view --> T/F?
T
342
ILC --> common to get axillary mets --> T/F?
F axillary mets is less common --> instead, like to go to strange places ie peritoneum
343
architectural distortion wo central mass ("dark star") --> ddx? (4)
- ILC - IDC-NOS - radial scar - surgical scar
344
breast --> red, swollen, thick skin --> next step?
US eval for focal lump to help target US
345
breast --> red, swollen, thick skin --> US --> no focal mass --> next step?
- punch bx | - abx --> see if it gets better (if IBC, will improve but not resolve)
346
compare: inflamm breast CA vs locally advance breast CA - rapid/prolonged onset - age of presentation - mets at presentation
inflamm breast CA: - rapid onset - younger (mid 50s) - 30% mets at presentation LABC: - prolonged onset - older (mid 60s) - 10% mets at presentation
347
inflamm breast CA (IBC) --> tx? why?
1) ctx --> high chance of positive margins | 2) mastectomy --> for local ctrl
348
bx --> 5 classic high risk lesions?
- radial scar - atypical ductal hyperplasia - atypical lobular hyperplasia - LCIS - papilloma
349
MCC bloody nipple discharge?
papilloma
350
1ary breast lymphoma --> what type of lymphoma?
non-Hodgkin (diffuse lrg B-cell)
351
1ary breast lymphoma --> require what type of stain to confirm dx?
IHC
352
1ary breast lymphoma --> mammo appearance?
hyperdense mass
353
2ary breast lymphoma --> typical mammo appearance?
inflamm thickening wo mass
354
inflamm breast CA --> painless or painful?
painless
355
nipple discharge --> suspicious features? (4)
- spontaneous - bloody - serous - from a single duct
356
nipple discharge --> milky --> possible etiology? (3)
- thyroid dz - pituitary adenoma --> prolactinoma - meds (ie antidep, neuroleptic, reglan)
357
nipple discharge --> suspicious --> possible etiology? (2)
- intraductal papilloma | - DCIS
358
nipple discharge --> benign --> possible etiology? (2)
- fibrocystic change | - ductal ectasia
359
galactography --> contraindication? (4)
- active infx (mastitis) - unable to express discharge at time of galactogram - contrast allergy - prior surg to nipple-areola complex
360
architectural distortion + calcs --> ddx? (1)
IDC + DCIS
361
architectural distortion, no calcs --> ddx? (1)
ILC
362
mammo --> architectural distortion --> no correlate on US --> next step?
bx
363
dx mammo --> suspicious spiculated mass --> US --> same thing --> next step?
US for axillary mets
364
axillary LN --> suspicious features? (3) which is most specific?
- #1 specific --> loss of central fatty hilum - cortical thick >2.3mm - irreg outer margins
365
male --> gender reassignmt --> hormone tx --> gynecomastia --> should get screening mammo --> T/F?
F
366
mammo --> dense LN --> US --> snowstorm appearance --> next step?
US --> eval for breast implant rupture
367
silicone breast implant --> intracapsular rupture --> US fiding?
"step ladder" appearance
368
breast implant --> contraindication for core needle bx --> T/F?
F
369
breast implant --> inc risk of breast CA --> T/F?
F
370
saline implant --> dx of rupture --> test of choice?
physical exam
371
breast implant --> MC comp?
capsular contracture
372
breast implant --> what is capsular contracture?
fibrous capsule --> contract --> cosmetic deformity
373
breast implant --> capsular contracture --> MC with... - silicone/saline? - subglandular/subpectoral?
subglandular silicone
374
silicone in axillary LN --> ddx? (2)
- breast implant rupture | - gel bleed (not a rupture)
375
breast implant rupture --> #1 RF?
age of implant
376
saline breast implant --> what imaging modality to see implant rupture?
mammo
377
bx --> excisional vs incisional?
- excision: remv entire lesion | - incision: bx portion of lesion
378
breast CA --> recurrence --> peak time? (yr)
4yr
379
breast CA --> breast conserving tx --> radiation vs no radiation --> %recurrence?
- radiation: 6-8% | - no radiation: 35%
380
breast CA --> lumpectomy --> immediate postop mammo demonstrates residual calcs --> Ok or not ok?
not ok residual calcs --> assoc w 60% local recurrence
381
DCIS --> lumpectomy --> new calcs --> benign vs recurrence --> timeline (yr)?
- benign calc --> 2 yr | - recurrent calc (DCIS) --> 4yr
382
breast CA --> radiation tx --> comp? (1)
2ary angiosarcoma
383
breast CA --> radiation tx --> 2ary angiosarcoma --> classic clinical presentation?
red plaques/skin nodules
384
MC CA that mets to breast?
melanoma
385
breast conservation tx --> contraindications? (5)
- inflamm CA - lrg cancer size relative to breast - multicentric - prior rtx to same breast - CI to rtx (ie collagen vascular dz)
386
breast MRI --> focus --> size criteria?
<5mm
387
breast MRI --> tamoxifen --> what happen to background parenchymal enhancemt?
dec --> then rebound
388
child --> chest radiation --> how much rad (Gy) for inc risk of breast CA?
20gy
389
child --> chest radiation --> 20gy --> when start screening mammo?
whichever is later: - 25yo - 8yr post exposure
390
Cowden synd --> synd? (4)
- breast CA - follicular thyroid CA - bowel hamartoma - Lhermitte-Duclos (brain hamartoma)
391
breast CA risk models --> all current risk models underestimate lifetime risk --> T/F?
T
392
breast CA risk models --> which is most comprehensive?
Tyrer-Cuzick
393
what meds that reduce incidence of ER/PR+ cancer? (2)
- tamoxifen | - SERMs (raloxifene)
394
BRCA1 vs BRCA2 --> which is more common?
BRCA1
395
men w BRCA1 vs BRCA2 --> who gets more CA?
BRCA2
396
>20% lifetime risk of breast CA --> when start screening?
- 25-30yo | - 10yr before 1st deg relative
CORE
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