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 -> :?: | ||
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