Terms in this set (104)
MRI guided biopsy technique
The trocar (curved arrow) , plastic cannula (black wide arrow), and needle guide (black thin arrow) are shown. Note the rubber stopper at the calculated depth of lesion using measurements on the cannula. The trocar is advanced into the breast to calculated depth. The needle guide fits in grid box at target location. The trocar is replaced by obturator, and patient is imaged.
shrinking breast on mammo
loses compressibility (doesn't flatten out on mammo so it looks smaller)
axillary lymph node levels
what is a rotter node
level 1= lateral to pec
level 2 = under pec (rotters is between pec major/minor)
level 3= medial to pec
mimics posteromedial mass
may be asymmetric
only SEEN ON CC (not MLO)
best time in cycle for mammo or MR?
follicular phase (7-14 days)
complication of biopsying lactating breast
stop breast feeding to stop the fistula
seen at cessation of lactation
mass that occurs during lactation
will spontaneously resolve after breastfeeding
consider follow up
looks like a fibroadenoma
when is LMO used instead of MLO?
kyphosis or pectus excavatum
what causes image blur on mammo
1. patient moved
2. exposure too long
3. exposure too short
which mammo views use a grid?
all use grids except mag views
how does true lateral view help localize masses
"muffins rise, lead sinks"
medial will move up
lateral will move down
(relative to MLO)
how do CC rolled views work
superior breast lesions will move the direction of the rolling
inferior lesions will be opposite
BIRADS mass description possibilities?
-round, oval, irregular
-circumscribed, obscured, microlobulated, indistinct, spiculated
-fat, low, equal, high
what is MRI background parenchymal enhancement
FIRST POSTCON SEQUENCE
graded as non, minimal, mild, moderate, marked
how are enhancing things described on MRI (size)
how is non-mass enhancement described on MRI
focal, linear, segmental, regional, diffuse
clustered ring enhancement on MRI
buzzword for DCIS
most worrisome distribution of calcs on mammo
linear or segmental
cigar shaped, "dashes no dots"
fat necrosis or oil cysts
milk of calcium
teacupping on true lateral
fluid-fluid level due to fibrocystic change
suspected milk of calcium biopsied, calcs on mammo specimen, but not seen on path
use birefringent light to view calcs by path
scenarios where BR-3 can be used?
grouped or clustered round calcs
something that looks like a fibroadenoma
asymmetry with interspersed fat
which types of calcs are suspicious
amorphous, coarse heterogeneous, fine linear, fine pleomorphic
calcs with greatest association with DCIS?
fine linear branching calcs
superficial venous thrombosis
breast within a breast
ultrasound and MRI features of fibroadenoma
-central hyperechoic band
vascular solid breast mass on ultrasound
Invasive ductal carcinoma
-most common type
-best prognosis type? what does it look like?
-type with highest BRCA association
common: NOS type
best prognosis: tubular, looks spiculated
medullary often in BRCA mutations
multifocal vs multicentric breast cancer
multicentric (like multi-center) is in different areas of breast (quadrants)
multifocal is all same quadrant
1. fine linear or pleomorphic calcs
2. NME on MRI
3. intraductal masses on galactography
comedo type is more aggressive
most likely cancer to present as distortion on mammo
dark star distortion
distortion without central mass
inflammatory breast cancer
paget's disease of breast
carcinoma in situ at nipple basically
associated with high grade DCIS
NOT considered T4 disease despite skin involvement
high risk lesions on breast biopsy
consider excising (definitely for ADH)
bloody nipple discharge
typically around 50 years old
solitary filling defect on galactography
multiple bilateral circumscribed masses without suspicious features
on audit, what do PPV 1,2, and 3 mean?
-%cancer in callbacks (goal ~ 4%)
-% cancer of recommended biopsies (goal ~ 25%)
-how often a performed bx was cancer (goal ~ 30%)
milky nipple discharge
NOT WORRISOME FOR CANCER
workup pituitary or drug causes
upper limit cortical thickness for axillary lymph nodes
extensive dense calcifcation in an axially lymph node
consider prior gold therapy (for rheumatoid)
snow storm axilla
silicone leak or implant rupture
flame shaped subareolar
do males with gender reassignment on estrogen therapy get screening mammo
only women get screening
how is saline implant rupture diagnosed
could do mammo, not other imaging needed
silicone implant intracapsular rupture
radial fold in silicone implants
thick folds which all attach to the shell
NOT A RUPTURE
location of implants
what is silicone gel bleed
porosity of silicone without implant rupture
get snow storm axilla despite no rupture
imaging features of reduction mammoplasty
flattened inframammary fold
fat necrosis on MRI
T1/T2 bright lesion which drops on fat sat
post-excision specimen radiograph
confirm it contains the mass/calcs and that the margins seem ok
breast cancer staging
T2 2-5 cm
T4 any size with chest wall/skin invasion
contraindications to breast preserving surgery
very large cancers
prior XRT to that breast
who qualifies for MRI breast screening
20Gy of chest radiation as a kid, screen MRI at 25 years old or 8 years after XRT
BRCAs or 1st degree relative with BRCA also get MRI screening
any syndromes (Li Fraumeni, etc)
when is normal parenchymal enhancement seen on MRI
luteal phase of cycle, posterior breast (upper outer)
tamoxifen effect on breast enhancement on MRI
reduces background enhancement
which enhancement MRI kinetics are bad?
wash-in then wash-out kinetics are bad
DCIS on MRI
clumped or linear non-mass enhancement
fibroadenoma on MRI
T2 bright with dark nonenhancing septations
T2 bright breast cancers
colloid or mucinous cancers can be T2 bright
chromosomes of BRCA 1 and BRCA 2
BRCA 1 - Chrom 17
BRCA 2 - Chrom 13
lhermitte-duclos in brain
follicular thyroid cancer
cyclic breast pain
NO IMAGING, regardless of age
MEN with palpable abnormality? what is the age cutoff for pure ultrasound vs. doing mammo
start mammo for palpables at 25 years old (only US before then)
WOMEN with palpable abnormality? what is the age cutoff for pure ultrasound vs. doing mammo
start mammo for palpables at 30 years old (only US before then)
US bx technique
14 gauge needle
always go for smaller/harder to see lesion first
parallel to chest wall
which portion of lymph node should be biopsied
which cyst aspirate is suspicious for cancer and should be sent to PATH?
anything with blood, all others can be discarded (unless its infected, can get cultures)
cyst aspiration performed and bloody fluid is collected. NEXT STEP?
PLACE A CLIP
SEND FLUID TO PATH
Minimum compressible thickness to perform stereotactic bx?
at least 3 cm compressed thickness (thinner gives negative stroke margin, will go through the breast during bx)
goal recall rate for mammo
less than 10%
time frame in which patients get their mammo results by MQSA rules?
required resolution of line pairs in the ...
anode to cath direction?
left to right?
ANODE to CATHODE
13 line pairs per mm
LEFT TO RIGHT
11 line pairs per mm
to pass image quality, an image must show how many fibers, microcalcs, masses?
4 fibers (F is for 4)
characteristics of mammo ghost phantom
4.2 cm thick
dose less than 3mGy per image (+grid)
is there a dose limit for patients on each view
only a limit on the phantom
recurrent breast abscess in smokers
ASSOC WITH SMOKING
in pregnant/breastfeeding women (20-40 years old)
target number of cancers found per 1000 women screened
Mammo tasks, when are these performed?
localization/accuracy for stereo?
optimal kVp for mammograms
16-23 keV ... which requires kVp of 25-30
remember average keV is about 1/3 to 1/2 of kVp
which anode/filter combos can be used for mammo
binding energies of Mo and Rho
Mo - 18 keV
Rho - 20 keV
focal spots for mammograms
0.1mm for mags
0.3mm for regular mammo
what other parameters must change in mammo when using a small focal spot (ex. mag views)
lower the mA (small focal spot can't take the heat)
longer exposure time
how should the cathode and anode be positioned relative to the breast? why?
cathode on chest wall side
anode on nipple side
heel effect issues, chest wall is denser, beam will be denser along cathode side
what type of tube window is used in mammo systems
glass is used for normal diagnostic XR (not mammo)
Why is the breast compressed for mammo?
less scatter, can decrease kVp --> improved contrast
less mAs needed because of reduced thickness
less motion artifact
when is a grid used in mammo
what is grid ratio? what number used for mammo?
Grid used in all normal mammograms
Grid REMOVED for mag views
ratio 5:1 for mammo (around 10:1 for normal diagnostic XR studies)
grid ratio is height/width between grids
how is a breast mag view done
increased source to detector distance (move it closer to source
air gap (reduce scatter)
what is an air gap
for mag views, an air gap allows errant xrays to scatter before hitting detector (kind of acting like a grid)
a grid IS NOT used for mag views because it would lead to increased dose
what are the MQSA line pair requirements for digital mammo
there are no digital requirements
you go by manufacturer specifications
what are the MQSA line pair requirements for analog mammo
12 lp/mm average
who oversees MQSA nationally?
how often is accredidation?
every 3 years accredidation is done
biopsy reveals invasive lobular carcinoma
breast MRI, due to propensity for multicentric and bilateral disease (10-15%)
CALCS ASSOCIATED WITH WHICH DISEASE?
pleomorph, linear, branch?
milk of calcium?
eggshell or rim?
MLO views often exclude which part of the breast?
upper inner portion
Other name for secretory breast calcs
Plasma cell mastitis
how frequently does MQSA require inspection of facilities for accredidation
cancer with prominent lymphoid infiltration on path
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