mammo guide to the boards
DESCRIPTION
MammoGuide.com presents an overview of breast imaging for the ABR oral board exam.TRANSCRIPT
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Oral Boards Simplified
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How to take a case
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Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Specific findings
Final Impression and BIRADS (2 or 4)
Systematic approach to every breast case
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Systematic approach to every breast case
Breast density
Fatty
Scattered
Extremely dense
Hetereogenously dense
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Systematic approach to every breast case
Breast density
Finding
Mass
Asymmetry / Focal asymmetry
Calcifications
Architectural distortion
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Systematic approach to every breast case
Breast density
Finding
BIRADS (0 or 2) ---------------------------------------------------------
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Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Systematic approach to every breast case
Additional views / modalities
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Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Specific findings
Systematic approach to every breast case
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Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Specific findings
Final Impression and BIRADS (2 or 4)
Systematic approach to every breast case
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What to say
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“The breasts are heterogenously dense”
“There is a focal asymmetry in the superior and central right breast”
“This is a BIRADS 0, additional evaluation is required”
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------------------------------------------------------------------------------------------------
“I would do a lateral view, spot compression and an ultrasound”
“The focal asymmetry persists on the lateral and spot
views. Ultrasound demonstrates an irregular hypoechoic mass with posterior acoustic shadowing”
“This is a suspicious mass. BIRADS 4, biopsy is recommended.”
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Final BIRADS at Boards
Avoid BIRADS 3
All cases will be BIRADS 2 Benign or
BIRADS 4 Suspicious
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Workups
1
2
3
4
5
Aunt Minnies
1
2
3
4
5
Special
1
2
3
4
5
15 Must-Know Cases
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Case 1
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Case 1: Solid mass
1. Specific diagnosis is not important 2. How to workup the finding is the key 3. Be consistent – Suspicious descriptors BIRADS 4 Benign descriptors BIRADS 2
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Mass Workup
Lateral
Spot Mag
Ultrasound
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Mass descriptors - Mammo
Shape (round, oval, lobular, irregular)
Margins (well-circumscribed, microlobulated, partially obscured, indistinct, spiculated)
Density (high density, isodense, low density, fat-containing)
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Mass descriptors - US Shape (oval, round, irregular)
Echogenicity (anechoic, hyperechoic, complex/mixed, hypoechoic, isoechoic)
Margins (well-circumscribed, indistinct, angular, microlobulated, spiculated)
Orientation (wider than tall, taller than wide)
Posterior features (shadowing, increased thru transmission, none)
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For the boards: We biopsy all new solid
masses
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Case 2
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You can use the mouse as a magnifying glass
during the exam
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Case 2: Suspicious calcifications
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Calcifications
Lateral
Mags in CC / 90
(Full or spot)
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Case 3
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Case 3: Suspicious focal asymmetry
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Focal asymmetry /
Architectural distortion
Lateral
Spot Compression
+/- Ultrasound
Same workup for architectural distortion as for focal asymmetry
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Case 4
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Rolled views
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Case 4: Suspicious asymmetry
Boards cases will not be this
subtle
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Asymmetry
Only on CC
Rolled CC’s
Spot compression
Only on MLO
Lateral
Spot compression
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Case 5
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Case 5: Suspicious palpable mass
Always look
for a BB on
the skin =
palpable
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Palpable Workup
Put BB on skin
Lateral
Spot in tangent
Ultrasound
* Any patient < 30 years old, start with ultrasound *
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Workups Mass
Calcs
Focal asym/arch dist
Asymmetry
Palpable
Aunt Minnies Special
15 Must-Know Cases
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Case 6
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Case 6: Skin Calcifications BIRADS 2
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How to do a skin localization
Remove from compression. Take image with BB in tangent to prove
calcs are in the skin
Keep patient in compression.
Place BB on skin directly over the calcs & image.
Place alpha-numeric grid
over calcifications &
image.
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Milk of Calcium
Hyalinized fibroadenoma
Skin calcifications
Secretory calcifications
Other Benign Calcifications
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Case 7
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Case 7: Breast Hamartoma BIRADS 2
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Lipoma Hamartoma Oil cyst
Fat containing breast masses = BIRADS 2
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Case 8
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Case 8: Bilateral intracapsular & left extracapsular implant rupture
Linguine or keyhole sign = Intracapsular rupture Free silicone = Extracapsular rupture
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Intracapsular Extracapsular
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Intracapsular Extracapsular Stepladder sign Snowstorm sign
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Case 9
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Case 9: Fat Necrosis BIRADS 2
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Fat Necrosis = oil cysts or coarse dystrophic calcs
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Case 10
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Case 10: Sternalis muscle BIRADS 2
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Workups Mass
Calcs
Focal asym/arch dist
Asymmetry
Palpable
Aunt Minnies Benign calcs
Fat containing
Implant rupture
Sternalis
Fat necrosis
Special
15 Must-Know Cases
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Case 11
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Case 11: Complex cyst BIRADS 4
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Simple Complicated Complex
BIRADS 2 BIRADS 3 BIRADS 4
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Case 12
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Case 12: Unilateral axillary adenopathy
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Bilateral DDx Unilateral DDx Lymphoma Rheumatoid/Autoimmune Granulomatous/Sarcoid Systemic processes
Mets – breast 1⁰ Mets – non-breast 1⁰ Infection
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Case 13
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Case 13: Multiple round masses BIRADS 2
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Multiple round masses = BIRADS 2 Must be:
Bilateral
At least 3 masses
Nonpalpable
No new or suspicious findings
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Case 14
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Case 14: Suspicious left breast mass w/ pec invasion + axillary nodes
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Mass NMLE
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Main MRI finding will be obvious Look for secondary findings - multifocal disease - contralateral disease - axillary or IM adenopathy - pectoralis or skin involvement
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Mass Shape
(round, oval, lobulated, irregular)
Margins (smooth, irregular, spiculated)
Enhancement (homo, hetero, rim, internal septations)
NMLE Distribution
(focal, linear, ductal, segmental, regional, diffuse)
Enhancement Pattern (homo, hetero, stippled, clumped)
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Case 15
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Case 15: Male IDC
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Gynecomastia Male IDC
Signs of Male IDC: - Eccentric mass - Skin thickening - Skin retraction
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Workups Mass
Calcs
Focal asym/arch dist
Asymmetry
Palpable
Aunt Minnies Benign calcs
Fat containing
Implant rupture
Sternalis
Fat necrosis
Special Cysts
Axillary adenopathy
Mult round masses
MRI
Male breast
15 Must-Know Cases
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Your Name Here
American Board of Radiology
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