Question 1

Which of the following statements is NOT true of screening mammography?&#10;A) It typically involves an MLO and a CC view.&#10;B) The interpretation always includes a BI-RADS classification.&#10;C) It should be done for women with palpable breast lumps.&#10;D) It may be done by a radiological technologist without direct supervision by a radiologist.

Accepted Answer

Women with lumps must be referred for diagnostic, not screening, mammography (or ultrasonography for younger women). The other options are appropriate descriptions of screening mammography.

Question 2

Which of the following statements pertaining to breast tissue density is TRUE?&#10;A) Sensitivity for detecting cancer is higher in a fatty breast than in a breast with heterogeneously dense breast parenchyma.&#10;B) The designation of a breast as fatty or fibroglandular is the basis of the BI-RADS classification.&#10;C) The sensitivity of breast cancer diagnosis in mammography is highest with extremely dense breast parenchymal patterns.&#10;D) Breast density is an important descriptive term in breast ultrasonography.

Accepted Answer

Against the background lower density of fat, a mass is more conspicuous in a fatty breast. Radiographically denser breast tissue may have a complex radiographic pattern that makes it more difficult to perceive a small mass or architectural distortion. The official ACR nomenclature depends upon the ratios of fibroglandular tissue to fatty tissue. See the text for a description. Dense parenchyma may obscure a mass that is the same soft tissue radiographic density as the fibroglandular tissue. The density of parenchyma is a radiographic description. See Chapter 1 as well as discussions of this topic in Chapter 7.

Question 3

Which of the following statements about breast calcifications is TRUE?&#10;A) They are always benign and only significant when associated with a palpable mass.&#10;B) They are always malignant and should be biopsied.&#10;C) Those with a radiolucent center can be confidentially diagnosed as benign.&#10;D) They always require 6-month interval mammography.

Accepted Answer

One of the classic descriptions of a characteristically benign calcification is one with a radiolucent center. The fundamental reason for screening mammography is to detect potentially malignant calcifications long before there is any palpable mass. Benign calcifications are very common. The ACR promotes monitoring of BI-RADS 0 "call backs" and BI-RADS 3 results with follow-up mammography recommendations in order to avoid excessive imaging.

Question 4

A breast classified with a BI-RADS 0 after screening mammography means:&#10;A) definite malignancy and image-guided biopsy must be scheduled.&#10;B) completely negative (normal), and the patient can/will be reminded to attend yearly screening mammography.&#10;C) additional imaging is indicated, such as diagnostic mammography and/or breast sonography.&#10;D) the likelihood of malignancy is very low and 6-month interval mammography will be scheduled.

Accepted Answer

The meaning of each BI-RADS classification is specifically discussed in the text, including the BI-RADS 0 used for incomplete imaging evaluation of a potential breast problem; more imaging is clinically indicated. BI-RADS 4 or 5 would mean a finding that is highly suspicious for malignancy is present. A completely negative (normal) mammogram with the patient being reminded to attend yearly screening mammography would be a BI-RADS 1. BI-RADS 3 refers to the likelihood of malignancy being very low, and 6-month interval mammography or sonography should be scheduled.

Question 5

The tenderness of a palpable breast mass:&#10;A) has no bearing on the diagnostic workup.&#10;B) determines if ultrasonography should be done.&#10;C) is an indication for breast MRI.&#10;D) requires surgical referral.

Accepted Answer

Tenderness is not a sign of cancer, but it is also no guarantee that there is no cancer. All new breast lumps should be evaluated properly with appropriate imaging. The need for ultrasonography is generally decided upon by mammographic findings but may be the initial imaging procedure in younger women. Tenderness is not an indication for breast MRI. Surgical referrals are rarely needed prior to definitive radiologic diagnosis, either documentation of characteristically benign findings by published radiology criteria, or the diagnosis of breast cancer by image-guided biopsy.

Question 6

After palpating a tender lump in a breast that is suspicious for an inflamed cyst, you should:&#10;A) aspirate under manual guidance.&#10;B) refer the patient to a surgeon for excision.&#10;C) refer the patient to an imaging facility for diagnosis, with ultrasound-guided aspiration for symptomatic relief if a cyst is confirmed.&#10;D) prescribe antibiotics and get ultrasound if the patient does not improve.

Accepted Answer

Diagnosing a breast issue depends upon imaging in the vast majority of cases. A very rare exception, for example, would be an obvious inflammatory breast cancer. Aspirating under manual guidance is incorrect for several reasons, including the common occurrence of normal lumpy and tender breast tissue that can be shown to be normal by imaging and left untouched by a needle. Also many tender breast cysts resolve spontaneously and if they do not, aspiration is far more complete with ultrasound guidance. Referring the patient to the surgeon for excision is not appropriate given everything discussed in the chapter. Breast tenderness alone is not diagnostic of mastitis; additional physical findings such as erythema should be present.

Question 7

MRI of the breast:&#10;A) is widely used for screening women at average risk for breast cancer.&#10;B) is always used with an ultrasound exam.&#10;C) is highly sensitive for detecting suspicious breast calcifications.&#10;D) is typically done with gadolinium-based contrast agents.

Accepted Answer

The hallmark of a finding suspicious for cancer on breast MRI is an abnormally enhancing structure. MRI is used for screening women at high risk, not average risk. MRI is used only when needed. MRI is not necessarily highly sensitive for detecting suspicious breast calcification. MRI is not necessarily highly sensitive for calcifications, which has led to concerns that DCIS could be missed on MRI. However, as breast MRI improves, it is starting to show the ability to detect DCIS even though it cannot display associated calcifications.

Question 8

A definitive diagnosis of a benign breast fibroadenoma that is completely benign and has no malignant potential is typically made by:&#10;A) ultrasound-guided biopsy.&#10;B) gadolinium-enhanced MRI.&#10;C) CT-guided aspiration.&#10;D) dedicated breast PET scan.

Accepted Answer

Ultrasound-guided biopsy is the ideal way of establishing the diagnosis of a tumor that is benign, will never undergo malignant transformation, and is likely to never significantly enlarge enough to need elective resection.

Question 9

If one of your patients has a family history that includes a first-degree relative who was diagnosed with premenopausal breast cancer, then she should begin yearly screening mammography:&#10;A) at an age 10 years younger than the age at which her relative was diagnosed.&#10;B) at age 21.&#10;C) at 20 years past her age at first menses.&#10;D) immediately after her first pregnancy.

Accepted Answer

The standard recommendation cited in the text for patients with a family history of a first-degree relative who was diagnosed with premenopausal breast cancer is to start yearly screening mammography at an age 10 years younger than the age at which her relative was diagnosed.

Question 10

In general, for women with a lifetime risk for breast cancer higher than 20%, an ideal screening program would be:&#10;A) yearly diagnostic mammography.&#10;B) yearly breast MRI and screening mammography.&#10;C) yearly breast ultrasound and screening mammography.&#10;D) yearly breast thermography and screening mammography.

Accepted Answer

Screening program recommendations for this patient population are for yearly breast MRI and screening mammography.

Question 11

Thermography:&#10;A) is an effective means of detecting breast cancer in screening programs.&#10;B) is an effective technique for evaluating a palpable breast mass.&#10;C) can avoid the need for needle biopsy.&#10;D) is safe, but has low sensitivity and specificity for breast cancer diagnosis.

Accepted Answer

The answer of Thermography:&#10;A) is an effective means of detecting...

Deck 7: Breast