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