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mammo [2017/07/07 18:30] (current)
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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,​ 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 -> :?:
mammo.txt ยท Last modified: 2017/07/07 18:30 (external edit)