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HNBS&ELM-Mammography
by headneckbrainspine.com and DrELM
| Question | Answer |
|---|---|
| Mammographic signs of malignancy | Spiculated mass. Pleomorphic microcalcifications. (40% of breast cancers) |
| Definition of breast mass | Space occupying lesion seen in two different projections. Convex borders. Distorts normal architecture. Increased central density. |
| Definition of breast focal asymmetry | Confined asymmetry with similar shape on two views. Lacks borders conspicuity of a true mass. |
| Definition of breast asymmetry | Space occupying lesion seen in only one view. |
| Descriptors of breast mass (5) | Size. Morphology. Associated calcifications. Associated findings. Location. |
| Descriptors of breast shapes (4) | Round. Oval. Lobular. Irregular. |
| Descriptors of breast margins (5) | Circumscribed (>75%). Microlobulated (undulated). Obscured. Indistinct (ill-defined). Spiculated. |
| Definition of circumscribed breast mass | >75% of mass is circumscribed (well-defined). |
| Definition of obscured breast mass | Border is likely circumscribed but hidden by normal tissue. |
| Descriptors of breast density (4) | High. Equal. Fat-containing radiolucency. Non-fat-containing radiolucency. |
| Differential for breast mass with spiculated margins and or architectural distortion (4) | Breast cancer. Fat necrosis. Scar. Radial Scar. |
| Definition of Radial Scar/Complex Sclerosing Lesion | Central sclerosis with varying degrees of epithelial proliferation (precancerous). |
| Differential for well-defined mass (6) | Cyst. Fibrosis. Fibroadenomas. Breast cancer. Lymphoma. Metestases. |
| Differential for multiple bilateral masses (5) | Cysts. Fibroadenomas. Multiple Papillomas. Metastises. Multifocal breast cancer. |
| Differential for ill-defined breast mass (3) | Breast cancer. Abscess (usually subareolar in lactating women). Spontaneous Hematomas (coagulopathy). |
| Differential for fat-containing radiolucent breast mass (5) | Oil cyst (result of trauma). Lipoma. Galactocele. Hamartoma. Fibroadenolipoma. |
| Description of a breast fibroadenoma | Most common well-defined homogeneous solid mass. Large, coarse and irregular calcifications. |
| Descriptors of calcifications (4) | Morphology (shape). Distribution. Associated findings. Location. |
| Benign breast calcifications (10) | Skin/lucent center. Vascular. Coarse/Popcorn. Large/Rod-like. Round (small less than 1 mm, punctuate less than 0.5 mm). Eggshell/Rim. Milk of calcium. Suture. Dystrophic. |
| Milk of calcium | Sedimented calcifications in macro/microcysts. Amorphous on cranial caudal view. Semilunar, crescent, tea cup shaped on medial lateral oblique view. |
| Coarse popcorn calcifications | Involuting fibroadenoma. |
| Large rod-like calcifications | Ductal ectasia and/or secretory calcifications. |
| Lucent centered calcification | Fat necrosis or calcified debris in ducts. |
| Eggshell/rim calcifications | Fat necrosis. Calcifications within wall of cysts |
| Dystrophic calcifications | Post trauma. Radiation changes. |
| Dot-dash or casting calcifications | Comedocarcinoma type of intraductal carcinoma. |
| Intermediate concern breast calcifications (2) | Amorphous/Indistinct. Coarse heterogeneous (>0.5 mm but not the size of dystrophic calcifications). |
| High probability breast calcifications (2) | Fine pleomorphic (varying in size and shapes, less than 0.5 mm). Linear or branching (suggests filling of involved duct). |
| Calcification distribution modifiers (5) | Diffuse/Scattered. Regional. Grouped/Clustered. Linear. Segmental. |
| Definition of regional distribution | Scattered in large volume (>2cc) of Breast tissue. Does not conform to duct distribution. Less likely to be malignant. |
| Definition of grouped/clustered distribution | At least 5 calcifications occupy small volume (less than 1 cc). |
| Definition of segmental distribution | Calcifications distributed in ductal distribution. Worrisome for malignancy. |
| Definition of architectural distortion | Distorted architecture without definite mass. Suspicious for malignancy or radial scar, if no prior trauma or surgery. |
| Significance of asymmetric tubular structure/solitary dilated duct | Little as long as no other findings. |
| Intramammary lymph node | Typically reniform with radiolucent notch. Typically within upper outer breasts. |
| Definition of global asymmetry | Greater volume of Breast tissue in one breast relative to the other. No mass, distorted architecture or associated suspicious calcifications. |
| Associated breast findings (6) | Skin retraction, Skin lesion, Skin thickening (>2 mm), Nipple retraction, Trabecular thickening, Axillary adenopathy (> 2cm, non-fatty replaced are worrisome) |
| Descriptors of mammography location (3) and depth (3) | Subareolar, Central, Axillary tail. Anterior, Middle, Posterior. |
| Descriptors of Breast composition (4) | Almost entirely fat (less than 25% glandular). Scattered fibroglandular densities (25-50%). Heterogeneously dense (51-75%). Extremely dense (>75%). |
| BIRADS Classification | 0, Incomplete. 1, Negative. 2, Benign Findings. 3, Probably Benign (3-94%). 4, Suspicious abnormality (A,B,C). 5, Highly suggestive (>95%). 6, Proven malignancy. |
| BIRADS 3 | Probably Benign. Less than 2% chance of malignancy. Low grade cancer if present. |
| Imaging decisionin patient less than 30 years with palpable abnormality | 1st: US. 2nd: Single oblique view (only if necessary). |
| Breast US, background echotexture descriptors (3) | Homogeneous: fibroglandular or fat. Heterogeneous: typically occurs in younger patients. |
| Breast US, Mass Shapes (3) | Oval. Round. Irregular. |
| Breast US, Orientation descriptors (2) | Parallel (wider than tall). Not Parallel. |
| Breast US, Margin descriptors (5) | Circumscribed. Indistinct. Angular. Spiculated. Microlobulated. |
| Breast US, Lesion boundary descriptors (2) | Abrupt. Echogenic: no sharp demarcation between mass and surrounding tissue. |
| Echo Patterns (5) | Anechoic. Hyperechoic. Complex. Hypoechoic. Isoechoic. |
| Posterior Acoustic Features (4) | None. Enhancement (echogenic deep to mass). Shadowing (echopenic deep to mass). Combined. |
| Breast US, Clustered Microcysts (2) | Fibrocystic changes. Apocrine metaplasia: Tiny anechoic foci (less than 2 to 3 mm) with thin (less than 0.5 mm) septations. |
| Differential for mass in or on skin (6) | Sebaceous or epidermal inclusion cysts. Keloids. Moles. Neurofibromas. Accessory nipples. |
| Breast US, Normal lymph node appearance | Reniform (hypoechoic cortex and echogenic fatty hilus). Axillary LN typically less than 2 cm. |
| Differential for abnormal lymph nodes (7) | Metastatic disease. Infectious. Connective tissue disorder (RA, Sarcoidosis). Lymphoma. Leukemia. Granulomatous disease (calcifications). |
| Breast US, BIRADS 3 | Solid mass with circumscribed margins, oval shape and parallel orientation. Likely fibroadenoma, nonpalpable complicated cysts, or cluster of microcysts. |
| Breast MR, Focus versus Foci | Small (less than 5 mm) isolated spot(s) of enhancement. Not seen on precontrast images. |
| Breast MR, Non-mass-like enhancement descriptors (7) | Focal area. Linear. Ductal. Segmental. Regional. Diffuse. Multiple areas of enhancement. |
| Breast MR, Focal area definition | Internal enhancement. Non-mass like. Occupies less than 25% of breast quadrant. |
| Breast MR, Difference between linear and ductal enhancement | Ductal: resembles a line on 2 views, points towards nipple. Linear: resembles a sheet rather than a line. |
| Breast MR, Difference between segmental and regional enhancement | Segmental: triangular enhancement with apex towards nipple, suggests ductal morphology. Regional: geographic enhancement, not conforming to a duct. |
| Breast MR, Internal MR enhancement patterns (5) | Homogeneous. Heterogeneous. Stippled/Punctate. Clumped. Reticular/Dendritic. |
| Breast MR, Kinetic Curve | Initial phase: Slow, Medium, Rapid. Delayed phase: Washout (malignant), Plateau (either), Persistent (benign). |
| Breast MR, Screening population selection criteria | >25% risk, based on family history, PMH, etc. |
| Risk factors for Breast cancer (6) | Personal History. Age. Mother, Sister, Daughter with breast cancer. Atypical or precancerous lesions on biopsy. Nulliparity or first child at or older than 30 years. |
| Expected outcomes in group of 1000 asymptomatic women | 80 require additional studies. 17 biopsied. 6 cancers. |
| Percent of breast cancer not detected at mammography. | 9-16%. |
| Percent of malignancies found with biopsy of mammographically suspicious abnormalities | 25-35%. |
| Mammography radiation risk | Life time risk of breast cancer from 1 mammogram. 40-49 y/o: 2/mil, 50-59 y/o: 1/mil. Risk of dying from Breast cancer, 40-49: 700/mil, 50-59: 1000/mil. |
| Convention labeling of Breast radiographs | Marker (l/r/cc/mlo) always placed by axillary tail/lateral breast. |
| MLO view | Depicts most tissue. Must visualize posterior nipple line (perpendicular line from pec through nipple) and inframammary fold. |
| CC view | Pec visualized central on the film (only occurs at 30%) with nipple in profile at 1 cm from image edge. |
| Associated with indeterminate calcifications | Fibrocystic Change. Fibrosis adenosis. Sclerosing adenosis. Epithelial hyperplasia. Cysts. Apocrine metaplasia. Atypical hyperplasia. |
| Differential for increased breast density | Hormone therapy (bilateral). Inflammatory cancer (skin thickening). Radiation therapy (at 6 months). Diffuse mastitis. Lymphatic/venous obstruction. |
| Intracapsular versus Extracapsular implant Rupture | Intravascular: contained. Extravascular: free. Mammography can't detect intracapsular silicone rupture (MR). |
| Description of Gynecomastia | Triangular or flame shaped area of subglandular tissue with interspersed fat. Unilateral more common than bilateral. |
| Causes of gynecomastia | Chronic liver disease. Meds (cimetidine, thiazides, digitalis). Marijuana. Testicular, adrenal, or pituitary tumor. |
Created by:
DrELM
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