2006 ORAL BOARD REVIEW: Breast
Diagnosis
Modality
http://www.rad.washington.edu:8080/breast/tf
Upgradable Lesions
CRAP
Information
Carcioma-in-Situ (LCIS, DCIS), Radial Scar,
Atypia (ADH, ALH), Papilloma.
Mammographic PPV
25-40% (31% at U of M)
False Negative Rate
10% Mammo. 1-3% Mammo + US
Abscess, Hematoma
DDx: Cancer. Will look irregular, and
septated.
Architectural Distortion
DDx: Cancer, Radial Scar, Post-Surgical
Scar.
Architectural Distortion
Wire Localization not core: assures
resection and any likely diagnosis would
require ultimate resection.
Bilateral Dense Enlarged
Axillary Lymph Nodes
Lymphoma/Leukemia, HIV, Sarcoid, RA,
Mets
Bilateral increased density
Estogen replacement therapy. Weight loss,
Edema for CHF, CRF -- look for skin
thickening.
Calcified Axillary Lymph
Nodes
DDx: RA s/p gold therapy, Sarcoid,
Silicosis, Mets
Breast
Other
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Could US to look for mass, but mgt is not changed.
CAT 4.
Don't ultrasound. Clinical Mgt.
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2006 ORAL BOARD REVIEW: Breast
Circumscribed Mass
DDx: Cyst, fibroadenoma, Cancer,
Phylloides (eriductal stromal tumor),
Papilloma, Galactocele, Seb. Cys,
Lymphoma, Mets, Abscess, Hematoma.
US to characterize. Look for subtle lobulation.
Cysts
US: Anechoic, imperceptible wall, well
defined far wall, increased through
transmission. Mamo: Layering Calcium is
diagnostic. - Get straight lateral.
CAT 2.
Dermatomyositis
Extensive Course Skin Calcifications
Extruded Silicone
Axillary somewhat linear distribution.
Focal Asymmetric Density.
DDx: Invasive Lobular, Hematoma,
Abscess, Focal fibrosis, Diabetic
Mastopathy (densely shadowing nodules),
Normal Tissue.
Fat-Fluid level. Relatively radiolucent or
mottled fat. Develop during or after
lactation.
FAT containing. Pseudocapsule, less
palpable than expected for size.
Cancer, Cyst, Giant Fibroadenoma (>10cm excise), Lymphoma, Abscess, Hematoma
US: look for unseen mass.
Layering Calcs
Benign
CAT 2
Lobulated Mass on US
Category 4 - Bx
Male Gynecomastia
Flame shaped without focal mass.
Liver Disease, Marijuana, HIV, Anti-Hypertensives.
Microlobulated Mass
Irregular Margins. DDx: Cancer,
fibroadenoma, focal fibrosis, abscess.
? Role of US as this should be biopsied. CAT 4.
Milk of Calcium
Layers on lateral view, smudgy on CC =
calcium layering in tiny cysts.
Look for other suspicious calcs. CAT 2.
Mondor's Disease
Superficial Thrombophlebitis. Category 2.
Clinical management.
Multiple Bilateral
Circumsribed Masses
DDx: Cysts, fibroadenoma, Pailloma(tosis),
Mets (melanoma, lung, gastric, GI),
Lymphoma, Lymph Nodes, Oil Cysts, or
less likely Invasive cancer.
Neurofibromatosis
Multiple skin lesions.
Nipple Discharge
Work-up of bloody nipple discharge:
1) Retroareaolar views,
2) Ultrasound,
3) Ductogram at the request of service.
4) Wire Localize the lesions at this
institution.
Green, Yellow, or White (Snot Colors) require no
work-up. Bloody requires work-up
Oil cysts
Form of fat necrosis. Weber-Christian numerous. +/- rim calcs. US appearance
variable - generally anechoic with
shadowing.
CAT 2. Don't US.
Palpable Mass, Imaging
Negative
Patient <30 -> US, Mammo as necessary.
>30, Mammo and ultrasound.
Clinical Management.
Sebaceous Cyst
Dermal Lesion - Cat 2
Secretory Calcs
Rod-Like NOT "linear"
Galactocele
Hamartoma
Large Circumscribed Mass
Breast
5/22/2007 2:59 PM
CAT 2.
US to characterize. Look for subtle lobulation.
Mgt: +/- Ultrasound. Biopsy most suspiscious.
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2006 ORAL BOARD REVIEW: Breast
Spiculated Mass
DDx: Cancer, radial scar, post-surg scar,
overlapping tissue
CAT 4-5. Bx
Sternalis Muscle
Medial breast on CC view.
Unilateral or Bilateral.
Stavros Criteria
Sonographic criteria for malignancy:
spiculation, angular margins, marked
hypoechogenicity, shadowing, calcification,
duct extensions, branching pattern, and
microlobulation.
Benign features: lack of malignant findings AND
either a) uniform hyperechogenicity, or b) thin,
echogenic pseudocapsule with an ellipsoid shape,
or fewer than four lobulations. The study showed
that sonography had a negative predictive value of
99.5% with a sensitivity of 98.4%.
Unilateral Dense Axillary
Lymph Nodes
DDx: BrCa mets, lymphoma, leukemia,
Other mets, mastitis, dermatitis, other
inflammation, CVD (RA, Sarcoid, Psoriasis).
Don't ultrasound. Clinical Mgt.
Unilaterally increaed density
DDx: Mastitis, inflammatory cancer, Edema,
Lymphedema, Radiation therapy,
Hematoma.
VERY Short Term Clincal Follow-up after Abx. (3
Days).
Breast
5/22/2007 2:59 PM
10-15% of population.
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