mammo
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— | mammo [2017/07/07 18:30] (current) – created - external edit 127.0.0.1 | ||
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+ | ====== 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, | ||
+ | * 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 -> :?: |
mammo.txt · Last modified: 2017/07/07 18:30 by 127.0.0.1