Breast Radiology & Cytology Flashcards
When someone has suspected breast disease we approach with Triple Assessment:
1) Clinical Exam
2) Imaging (Mammography or US)
3) Cytology (FNA or Core biopsy)
When would we do a mammograph?
If a patient is symptomatic & >40.
Under 40 the radiation dose is considered more risky than not scanning so we do US instead
Unless there is a strong suspicion of cancer or a strong FH
How do you tell a benign breast mass vs a malignant one (without cytology)?
Benign are smooth or lobulated, normal density and have a halo.
Malignant will be irregular/ill defined, speculated, dense and distort the natural breast architecture
We can do needle biopsies either image guided or freehand, what imaging do we use to guide?
US
How do we score cytology after a needle biopsy?
C1-5: 1 = Unsatisfactory 2 = Benign 3 = Atypia 4 = Suspicious 5 = Malignant
We can use a Fine Needle Aspiration on both solid masses and cysts, how is it different when used on cysts?
It’s often curative
You only need to actually test the fluid if its bloodstained or there’s a residual mass.
Pros and cons of an FNA?
Wide available, well tolerated, cheap and gives quick results.
But it can’t assess grade or invasion
Pros and Cons of a Core biopsy?
Can confirm invasion, assess typing and grading and oestrogen ; Progesterone receptor status
However its less easy to do and more unpleasant
What are the risks of a FNA?
Pain, haematoma and fainting
Very rarely can get infected or cause pneumothorax
When might we do an MRI for breast disease?
1) Recurrent Disease
2) Implants
3) Indeterminate lesion even after triple assessment
4) Screening in high risk women
What is sentinal node sampling and how do we do it?
Its so we can test the first lymph node from the tumour to see if it’s spread.
Do it by lymphoscintigraphy, a radioisotope dye is injected into lesion and followed to the first node
Explain the UK breast cancer screening programme?
Women invited for a mammograph every 3yrs from 50 to 70
What equipment do you need for FNA?
- 23G needle
- 10ml syringe +/- Cameco holder
- Alcohol swab
- Cotton wool, sticking plaster
- Glass slides, pencil
- +/-Vial with saline for needle washings
It what 2 situations is FNA carried out?
Symptomatic Clinic
Patient presents with symptoms and undergoes “triple assessment” by surgeon, radiologist and cytopathologist
Breast Screening
Asymptomatic women invited for mammographic examination – mostly get core biopsy
FNA of axillary nodes/ satellite lesions
Technique of FNA with palpable mass?
- Ensure patient comfortable
- Examine to locate lump
- Swab area
- Localise lump between fingers
1- Insert needle (45o)
2- aspirate using in and out action applying negative pressure on syringe
3- Release pressure and remove needle (nb. Non-aspiration technique)
4- Apply cotton wool to ensure haemostasis
5- Spread material onto glass slides - fix, air dry
