Term
| Breast Composition/Density, 4 types: |
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Definition
- Fatty
- Scattered fibroglandular densities
- Heterogeneously dense
- Extremely dense
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Term
BIRADS descriptors for Masses
1. Shape
2. Margin
3. Density |
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Definition
Shape - round, oval, lobular, irregular
Margin - circumscribed, microlobulated, obscured, indistinct, spiculated
Density - fat-containing, low, equal, or high |
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Term
| Round, oval, or lobular mass. DDx = ? |
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Definition
Cyst
FA
Papilloma
Sebaceous cyst
Other benign
Cancer |
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Term
| Well-circumscribed cancers on mammo: |
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Definition
Papillary
Medullary
Mucinous |
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Term
| You see multiple well-circumscribed masses on screening mammo. BIRADS? Management? |
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Definition
DDx = cysts, FAs
BIRADS 2 - Benign.
Physical, annual.
Do not ultrasound unless palpable.
DDx mets if masses very dense. |
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Term
| Mass on mammogram with spiculated margins. Benign and malignant DDx = ? |
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Definition
IDC
Tubular BrCa (small)
Radial scar
Post-op scar
Granular cell tumor
Extra-abdominal desmoid |
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|
Term
| Mass containing fat density, DDx = ? |
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Definition
Fat necrosis/oil cyst
Lipoma
Galactocele
Hamartoma |
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Term
| You see multiple bilateral oil cysts. Dx? BIRADS? Management? |
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Definition
Steatocystoma Multiplex
BIRADS 2
Physical, annual.
Treat cosmetic problems. |
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Term
True or false:
Architectural distortion must be biopsied even if stable. |
|
Definition
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Term
| Intermediate concern calcifications: |
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Definition
Amorphous or indistinct
Coarse heterogeneous |
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Term
True or False:
Amorphous/indistinct calcifications must always be biopsied |
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Definition
False.
Bx unless stable or diffuse bilateral. |
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|
Term
True or False:
Round calcifications are typically always benign and do not need follow-up or biopsy. |
|
Definition
False.
On 1st screening mammogram, BIRADS 3.
If new or increasing, must BIOPSY. |
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|
Term
True or False:
Coarse heterogeneous calcifications must be biopsied unless they are stable. DDx = fibroadenoma, fibrosis, dystrophic, and BrCa |
|
Definition
False.
They are intermediate concern and must be biopsied unless distribution is ok (bilateral or diffuse is less worrisome). |
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Term
| Higher Probability calcifications, DDx = ? |
|
Definition
Fine pleomorphic
Fine linear/branching
BIOPSY even if stable! |
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Term
| If you are clinically concerned about Paget's Disease what is the proper tissue diagnosis technique? |
|
Definition
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Term
| If you are clinically concerned about inflammatory BrCa what is the proper tissue diagnosis technique? |
|
Definition
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Term
| Types of calcification distribution: |
|
Definition
Grouped or clustered
Linear
Segmental
Regional
Diffuse/scattered |
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|
Term
| What is the definition of "grouped calcification"? |
|
Definition
At least 5 calcs in < 1cc tissue volume.
It is a BIRADS neutral distribution modifier. |
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|
Term
| What is the definition of "regional calcifications"? |
|
Definition
| Calcs scattered in large > 2cc tissue volume. |
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|
Term
True or False:
DCIS can present as diffuse UNILATERAL calcs. |
|
Definition
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|
Term
What are types of asymmetries?
How are they defined? |
|
Definition
Focal: similar shape on 2 views, lacks borders and conspicuity of mass
Global: greater volume of tissue over a "significant" portion of breast, >= 1 quadrant |
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Term
| If you see trabecular thickening, think about: |
|
Definition
- Inflammatory BrCa --> skin punch bx
- Radiation
- Mastitis
- Lymphatic obstruction
- Edema
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Term
| You see unilateral axillary adenopathy. What do you do? |
|
Definition
Ask clinical correlation for LAN.
BIRADS 0.
US both axillae to confirm and plan bx. May change workup.
Eval for primary BrCa.
Occult BrCa until proven otherwise.
MRI if bx-proven occult malignancy. |
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Term
| You see bilateral axillary adenopathy. What do you do? |
|
Definition
Clinical history, reason for LAN.
BIRADS 2 or 4.
Refer back to clinician for clinical correlation.
Clinician may request needle bx. |
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Term
| 1st screening mammogram. Well circumscribed, solid mass. BIRADS? Management? |
|
Definition
US and diagnostic views.
BIRADS 3. Probably benign.
6 mon fu |
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Term
| 1st screening mammogram. Cluster of round calcs. BIRADS? Management? |
|
Definition
Spot mag compression views.
BIRADS 3. Prob benign.
6 mon fu |
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Term
| 1st screening mammogram. Focal asymmetry. Non-palpable. BIRADS? Managment? |
|
Definition
Diagnostic views.
If US negative,
BIRADS 3. Prob benign.
6 mon fu |
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Term
| You see a complicated cyst on US. 1st exam. BIRADS? Managment? |
|
Definition
BIRADS 3. Prob benign.
-or-
Aspirate |
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Term
| You see a lesion that has well-circumscribed margins and benign appearing calcs, but it has gotten bigger. BIRADS? Management? |
|
Definition
BIRADS 4. Suspicious abnormality.
Consider biopsy. |
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Term
| Pt presents with a palpable lesion. Managment? BIRADS? |
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Definition
Mammo and ultrasound.
If cyst, BIRADS 2 aspirate.
otherwise
BIRADS 4, suspicious. Consider Bx. |
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Term
| Complex mass on US. DDx? Managment? |
|
Definition
IDC
Papillary lesions
Hematoma
Abscess
These should all be excised or core-biopsied of the solid component. |
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Term
| What are the worrisome characteristics of internal enhancement of a breast mass or non-mass-like enhancment on MRI? |
|
Definition
Heterogeneous or rim enhancement
Stippled or clumped
Linear, ductal, or segmental
Peak enhancement >80%
Time to Peak <2min; Washout Kinetics |
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Term
| What are the indications for Breast MRI? |
|
Definition
- Detect occult malignancy
- Local staging
- Contralateral screening
- High risk screening
- Response to therapy
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|
Term
| You see a developing asymmetry. What could it be? DDx |
|
Definition
Carcinoma
HRT
Lymphoma
Hematoma
PASH |
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