Breast Imaging — MCQs

Breast Imaging Indian Medical PG Practice Questions and MCQs

Question 51: What is not an advantage of USG over mammography?

A. Can be used for guided biopsy
B. Superior detection of microcalcifications (Correct Answer)
C. In young females with dense breasts
D. Can be used to differentiate solid VS cystic

Explanation: ***Superior detection of microcalcifications*** - **Mammography** is the gold standard for detecting **microcalcifications**, which can be a key indicator of **ductal carcinoma in situ (DCIS)** or early invasive breast cancer. - **Ultrasound (USG)** has limited sensitivity for detecting and characterizing microcalcifications. *Can be used for guided biopsy* - **USG-guided biopsy** is a common and advantageous technique for obtaining tissue samples from suspicious lesions in the breast or other organs. - This allows for **real-time visualization** of the needle, improving accuracy and reducing complications. *Can be used to differentiate solid VS cystic* - **USG** excels at distinguishing between **solid masses and fluid-filled cysts** due to differences in sound wave reflection. - This capability is crucial in characterizing breast lesions and often eliminates the need for further invasive procedures for benign cysts. *In young females with dense breasts* - **Dense breast tissue** in young females can obscure lesions on mammography, making interpretation difficult. - **USG** is particularly valuable in this population because it is not hindered by breast density and can provide a clearer view of underlying pathology.

Question 52: BIRADS stands for

A. Breast Imaging Reporting and Data System (Correct Answer)
B. Best Imaging Reporting and Data System
C. Blood Imaging Reporting and Data System
D. Brain Imaging Reporting and Data System

Explanation: ***Breast Imaging Reporting and Data System*** - **BIRADS** is a standardized system for reporting mammography, ultrasound, and MRI findings related to the breast. - It provides a **common lexicon** for radiologists to describe findings and assign a final assessment category, guiding patient management. *Best Imaging Reporting and Data System* - This option is incorrect because the "B" in BIRADS specifically refers to "**Breast**," indicating its application to breast imaging. - The term "**Best**" is a subjective adjective and not part of the official acronym used in medical imaging. *Blood Imaging Reporting and Data System* - This option is incorrect as BIRADS is exclusively used for **breast imaging** and does not pertain to blood-related diagnostic imaging. - Systems for reporting blood-related findings would fall under different medical specialties or laboratory medicine. *Brain Imaging Reporting and Data System* - This option is incorrect because BIRADS is specific to **breast imaging**, and there are other specialized reporting systems for brain imaging, such as **neuroradiology reporting guidelines**. - The acronym is directly tied to the anatomical region being examined, which is the breast.

Question 53: Which of the following features on mammogram would suggest malignancy?

A. Smooth borders
B. Well defined lesion
C. A mass of decreased density
D. Areas of spiculated microcalcifications (Correct Answer)

Explanation: ***Areas of spiculated microcalcifications*** - **Spiculated microcalcifications** are highly suspicious for malignancy due to their irregular shape, distribution, and association with rapid, uncontrolled cell growth. - These calcifications often represent **necrotic cells** within rapidly growing tumors, which can deposit calcium. *Smooth borders* - **Smooth borders** typically indicate a benign lesion, such as a cyst or fibroadenoma, as they suggest gradual, uniform growth rather than invasive spread. - Malignant lesions tend to have **irregular** or ill-defined borders due to their infiltrative nature. *Well defined lesion* - A **well-defined lesion** usually suggests a benign process, as it indicates a mass that is clearly demarcated from surrounding tissue and is likely encapsulated. - Malignancies, conversely, often exhibit **indistinct or irregular margins** as they invade adjacent structures. *A mass of decreased density* - A mass of **decreased density** is generally considered a benign finding, often representing a **cyst** or an area of normal fatty tissue. - Malignant tumors typically present as a **mass of increased density** due to their cellular proliferation and desmoplastic reaction.

Question 54: Which of the following features suggests a malignant lesion on mammography?

A. Macrocalcifications
B. Microcalcifications (Correct Answer)
C. Fat content
D. Round well defined borders

Explanation: ***Microcalcifications*** - **Fine, pleomorphic, branching, or linear calcifications** clustered together are highly suspicious for malignancy, particularly **ductal carcinoma in situ (DCIS)**. - They represent calcium deposits within the ducts or stromal calcifications related to tumor cells. *Macrocalcifications* - These are **larger, coarser calcifications** (typically >0.5 mm) which are almost universally benign. - They are often associated with benign conditions such as **fibroadenomas**, old trauma, or vascular calcifications. *Fat content* - Lesions predominantly composed of fat, such as **lipomas**, **oil cysts**, and **hamartomas**, are typically benign. - The presence of fat within a lesion on mammography generally indicates a **benign process**. *Round well defined borders* - A **smooth, rounded, and well-circumscribed margin** on mammography is a strong indicator of a benign lesion. - Malignant lesions typically have **irregular, spiculated, or ill-defined margins** due to invasive growth.

Question 55: According to the U.S. Preventive Services Task Force (USPSTF) guidelines, what is the recommended age to begin routine screening mammography for average-risk women?

A. 30 years
B. 40 years
C. 20 years
D. 50 years (Correct Answer)

Explanation: ***50 years*** - The **USPSTF recommends** starting biennial (every two years) screening mammography for women of **average risk** at age **50 years** (Grade B recommendation). - This recommendation balances the benefits of early cancer detection against the potential harms of false positives and unnecessary interventions in younger women. *30 years* - This age is **too early** for routine screening mammography in average-risk women according to most major guidelines, including the USPSTF. - Screening at this age could lead to a higher rate of **false positives** and associated anxiety and unnecessary follow-up procedures without significant mortality benefit. *40 years* - While some organizations, like the **American Cancer Society (ACS)**, recommend women begin screening at age 40, the USPSTF specifically advises against routine screening before age 50 for average-risk women due to a less favorable **risk-benefit profile**. - **Individualized decision-making** is considered for women aged 40-49, weighing personal values and potential benefits/harms. *20 years* - **No major health organization** recommends routine screening mammography for average-risk women at this age. - Breast tissue is typically **denser** in younger women, making mammographic interpretation more difficult and less effective, and the incidence of breast cancer is very low.

Question 56: Fat-containing breast lesions are seen in:

A. Galactocele
B. Fat necrosis
C. Hamartoma
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Galactocele**, **fat necrosis**, and **hamartoma** are all types of breast lesions that can contain fat, making this the correct comprehensive answer. - Understanding that various benign breast conditions can present with a fat component is important for differential diagnosis. *Galactocele* - A **galactocele** is a benign **milk-filled cyst** that can develop in lactating or recently lactating women. - While primarily fluid-filled, it can sometimes contain areas of fat due to the milk's content (fat globules). *Fat necrosis* - **Fat necrosis** is a benign condition that occurs due to **trauma** or **ischemia** to breast tissue, leading to the breakdown of fat cells. - Imaging often reveals **oil cysts** or **calcifications** within areas of necrotic fat. *Hamartoma* - A **hamartoma** (also known as a fibroadenolipoma) is a benign mixed tumor composed of varying amounts of **glandular tissue**, **fibrous stroma**, and **fat**. - The fat component is typically well-defined and can give it a characteristic appearance on imaging.

Question 57: Current gold standard to detect ductal carcinoma in situ breast is:

A. Mammography (Correct Answer)
B. CT/PET
C. MRI
D. USG

Explanation: ***Mammography*** - **Mammography** is the gold standard for detecting **ductal carcinoma in situ (DCIS)**, often visible as microcalcifications. - It plays a crucial role in early detection and has been a cornerstone of breast cancer screening for decades. *CT/PET* - **CT scans** are primarily used for evaluating tumor extent and metastasis, not for initial DCIS detection. - **PET scans** are not routinely used for DCIS due to their lower resolution for subtle changes and higher false-negative rates for small lesions. *MRI* - While **MRI** is highly sensitive for breast cancer, its specificity for **DCIS** is lower, often leading to false positives. - It is typically used as an adjunct to mammography for high-risk screening or for evaluating the extent of known cancer, not as a primary screening tool for DCIS. *USG* - **Ultrasound (USG)** is effective for evaluating palpable masses or specific areas of concern identified on mammography, but it is not sensitive enough to reliably detect **microcalcifications** characteristic of DCIS. - It is often used to differentiate between solid and cystic lesions or guide biopsies, but not as a primary screening tool for DCIS.

Question 58: Dose of radiation per study in mammography is

A. 3 cGy
B. 1 cGy
C. 4 cGy
D. 2 cGy (Correct Answer)

Explanation: ***2 cGy*** - The typical average glandular dose per **complete mammography study** is approximately **2 cGy (0.2 rad or 2 mGy)** for a standard two-view examination per breast. - With **modern digital mammography**, doses have been further reduced to approximately **0.4-0.8 cGy** per complete study, but **2 cGy** remains the commonly cited reference value for screening mammography in medical literature. - This dose is considered **safe for routine screening** with benefits far outweighing the minimal radiation risk. *4 cGy* - This value is **higher than the standard** radiation dose for modern mammography. - While older **film-screen mammography** systems delivered higher doses, **4 cGy** exceeds the typical exposure for a complete digital mammographic study. - This would represent an unnecessarily high dose with current technology. *3 cGy* - This value is **slightly higher** than the standard reference dose for mammography. - While closer than 4 cGy, **3 cGy** is still above the typical average glandular dose delivered in modern screening mammography. *1 cGy* - This value is **lower than the traditional reference** but actually closer to **modern digital mammography** doses (0.4-0.8 cGy per complete study). - However, in **standard medical literature and exam references**, **2 cGy** is the conventionally cited dose for mammography screening.

Question 59: All of the following are true about mammography except -

A. It is basically X ray imaging of the breast
B. It is a screening tool in breast cancer
C. It has a significant radiation risk (Correct Answer)
D. It can detect microcalcifications

Explanation: ***It has a significant radiation risk*** - While mammography involves **ionizing radiation**, the amount for a screening examination is very low, approximating that received from **natural background radiation** over a few weeks. - The benefits of early breast cancer detection significantly outweigh the extremely small theoretical risk of radiation-induced cancer. *It is basically X-ray imaging of the breast* - Mammography uses **low-dose X-rays** to create images of the breast tissue. - This imaging technique is specifically optimized to visualize dense and subtle changes within the breast. *It is a screening tool in breast cancer* - Mammography is a primary and highly effective **screening tool** used to detect breast cancer early, often before palpable lumps develop. - Regular screening significantly reduces breast cancer mortality by allowing for timely diagnosis and intervention. *It can detect microcalcifications* - Mammography is highly sensitive in detecting **microcalcifications**, which are tiny calcium deposits that can sometimes be an early sign of breast cancer, particularly ductal carcinoma in situ (DCIS). - The ability to visualize these small calcifications is crucial for early detection and diagnosis.

Question 60: Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants

A. Mammography
B. CT scan
C. USG
D. MRI (Correct Answer)

Explanation: ***MRI*** - **MRI** is considered the **gold standard** for breast cancer screening in patients with silicone breast implants due to its superior ability to visualize breast tissue through the implant and detect subtle lesions. - It offers **high sensitivity** in detecting both implant rupture and early malignancies, often providing better clarity than mammography in augmented breasts where implants can obscure tissue. *Mammography* - While a standard screening tool, **mammography** can be limited in patients with silicone implants because the implants can **obscure adjacent breast tissue**, making detection of small masses challenging. - Special views (e.g., **Eklund views**) can be used, but sensitivity is still reduced compared to MRI in augmented breasts. *CT scan* - **CT scans** are not routinely used for primary breast cancer screening due to their use of **ionizing radiation** and lower sensitivity for detecting early breast lesions compared to MRI. - CT is more commonly used for **staging** advanced cancers or evaluating complex masses detected by other modalities. *USG* - **Ultrasound (USG)** is a valuable complementary tool, especially for evaluating palpable lumps or clarifying findings from mammography, but it is **operator-dependent** and has a lower overall sensitivity for general screening compared to MRI. - It is particularly useful for differentiating between **cystic and solid masses** and detecting implant ruptures but is not the gold standard for comprehensive screening in augmented breasts.

Practice by Chapter

Breast Anatomy and Physiology

Practice Questions

Male Breast Imaging

Practice Questions

Mammography Techniques

Practice Questions

BI-RADS Classification

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Breast Ultrasonography

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Breast MRI

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Digital Breast Tomosynthesis

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Benign Breast Diseases

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Breast Cancer Detection and Diagnosis

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Interventional Breast Procedures

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Breast Cancer Screening

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Male Breast Imaging

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Post-treatment Breast Imaging

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