====== Techniques ======
  * Under age 30 w/ palpable abnormality -> start work-up with US rather than mammo
  * Breast MR should be done on days 7-17 of cycle
  * Regarding biopsy of developing densities -> regardless of a needle biopsy result, surgical excision is recommended


====== Cystic Masses ======
  * Inspissated Cyst
    * = Complex Cyst
    * has well-defined margin and no internal flow, but may contain debris in a nondependant portion
  * Apocrine Cyst
    * Multilobulated Appearance, but otherwise simple
  * Septated Hypoechoic Cyst
    * Suspicious for papillary CA
    * Black patients have higher risk of papillary CA
====== Fat containing masses ======
  * Lipoma
  * Fat necrosis
  * Galactocele
  * Hamartoma

====== BIRADS 3 Scenarios ======
  * First ever mammo with benign appearing lesion (such as a Focal Asymmetric Density)
  * Lesion identified which is also, in retrospect, seen on the old study, stable, and benign appearing
  * Status post concordant benign breast biopsy (1 year) or post-lumpectomy f/u (3 years)

====== Lobular Carcinoma ======
  * very slow growing
  * looks like breast tissue

====== Inflammatory Carcinoma ======
  * DDx is mastitis -> need clinical correlation and obtain U/S
    * if U/S shows a mass, then it's inflammatory CA
  * MR is useful for determining response to neoadjuvant therapy

====== Breast MRI ======
  * 

====== MRI Guidelines ======
  * Hormone Replacement Therapy - The patient should be off HRT treatments for at least 3 months or 6 months (optimal). Imaging may be done earlier but it must be known that the results may be compromised
  * Post Biopsy - The patient should wait at least two weeks or 30 days (optimal) after biopsy before having a breast MRI. 
  * Menstrual Cycle - Patients should be scanned 7-10 days after the onset of their menstrual cycle. Otherwise, results may be compromised.

====== Indications for MRI ======
  - Work-up of extent of disease of a known breast cancer, when the extent is in question on the mammogram or ultrasound, or if the patient is status post lumpectomy with positive margins
  - Neoadjuvant chemotherapy
  - Axillary metastases with unknown primary and negative mammogram and ultrasound
  - Lobular carcinoma
  - Recurrence monitoring
  - Evaluate for silicone implant rupture
  - The indications for MRI are growing, and have been somewhat controversial. Possible other indications for MR:
    * Problem-solving when mammogram and/or ultrasound are indeterminate
    * Screening for high-risk women

====== Types of Enhancement on MR ======
  * homogeneous
  * heterogeneous
  * stippled
  * clumped
  * reticular-dendritic

====== Enhancement Curves on MR ======
  * Progressive
  * Plateauing
  * Early/Rapid Washout

====== Clumped Enhancement ======
  * multiple foci of enhancement close together
  * diffuse clumped enhancement on MR with -MMG should raise suspicion for lobular CA

====== Fibroadenoma ======
  * well-defined, palpable mass
  * changes with cycle
  * dark septa on FS T1 CE MR (fatty septa)

====== Phylloides ======
  * if suspected on MMG, then surgical excision is recommended
  * path can be confusing
  * can be benign or malignant or have sarcomatous degeneration
  * has osseous, chondroid, or adipose matrix

====== Large Highly Vascular Mass in Young Patient ======
  * Think about other categories of masses
    * mesenchymal tumors -> fibromatosis (extra-abdominal desmoid)
    * systemic -> lymphoma
    * angiosarcoma
====== Types of DCIS ======
  * Comedo -> high-grade
    * dot-dash calcifications
  * Non-comedo -> cribriform, micropapillary and solid subtypes
    * punctate or granular calcifications

====== Extensive Intraductal Component DCIS ======
  * very aggressive, high nuclear grade
  * do not respond to XRT
  * need mastectomy

====== Inflamed Breast Post-Lumpectomy ======
  * need to know tumor type and surgical margins
  * MR may be useful
    * if there is enhancement in the skin, look at the curves
    * if the curves are suspicious, think inflammatory CA

====== DDx Axillary LAD ======
  * leukemia, lymphoma
  * HIV
  * scleroderma
  * mets (breast, ovary)
  * lupus

====== DDx Calcified Nodes ======
  * treated lymphoma
  * gold therapy
  * sarcoid
  * BCG therapy
  * histo
  * TB
  * mets (adenoCA, osteosarc)

====== Male Breast ======
  * gynecomastia is fan-like and retroareolar
  * real mass on breast U/S in a male -> should be considered highly suspicious (BIRAD 5)
  * most common cancer type in males -> :?: