Screening for Breast Cancer 5/17/16 – Flashcards

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question
Discuss imaging modalities of the breast
answer
MAMMOGRAPHY- workhorse exam ULTRASOUND- usual secondary, sometimes primary study (if pregnant or lactating) MRI-problem solving or special study Nuclear Medicine Breast Imaging Others(Thermoscan, Breast light scan)
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Understand the Bi-Rads categories and their implications (mammogram, ultrasound also uses this)
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0 - Needs ADDITIONAL assessment Cone compression/magnification views/ US 1 - NORMAL 2 - BENIGN 3 - PROBABLY Benign Usual recommendation for 6 month f/u 4 - SUSPICIOUS Biopsy is recommended: approx 30 % + 5 - MALIGNANT Biopsy recommended/needed -approx 90 % +
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Two categories: mammograms
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SCREENING: Patient has NO breast complaints and is following ACR guidelines DIAGNOSTIC: Patient either has breast SYMPTOMS or palpable MASS OR has an ABNORMAL finding on screening mammogram.
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What are views of screening mammogram?
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*Craniocaudal and medolateral of each breat *COMPARISON WITH PREVIOUS EXAM *Computer assosicated diagnosis is oten used to improve accuracy
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What is role of COMPUTER ASSISTED DIAGNOSIS (CAD)?
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*Can improve ACCURACY as much as 10-15% *Is very useful in DETECTING subtle CALCIFICATIONS *Identifies potential ABNORMALITIES *Will often OVER CALL masses (Remember cant make diagnosis but brings your attention to it)
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What to look out for?
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Symmetry/Asymmetry** Nodule margins-regular vs irregular** Irregular clustered microcalcification** Interval nodule development or growth Skin thickening or nipple retraction(peau d' orange)
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ULTRASOUND what you are lookign for?
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*CYSTIC or SOLID( If its cytsti no more wokroup or biopsy) *TALL vs wife *Border definition *Shadowing *Through transmission *Vascular flow (malignant you would see abndomral blood flow it would also be tall and irregular borders)
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Cyst/benign
Cyst/benign
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Thru transmission sharp border, wide not tall
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Solid-likley malignant
Solid-likley malignant
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NO THRU transmission IRREGULAR border complex Tall not wide
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Understand the role of radiology in breast tissue sampling
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*Mammography Primary screening modality Bi-Rads Classification Tomosynthesis-now coming available *Ultrasound-most common secondary study Commonly used for biopsy *MRI-if indications are present Nuclear medicine imaging-inconsistently applied, not commonly used
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Proper sequence and ordering/indications of various modalities
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MAMMOGRAPHY-primary imaging method for both screening and diagnostic mammo ULTRASOUND-most common follow up study; is a common biopsy guide. Also used for evaluation of clinically palpable lesion(i.e. cyst vs solid) MRI-problem solving and workup-evolving also used for biopsy of occult lesions not seen on mammo/US
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