4.1 Breast Flashcards
Increase Breast Cancer Risks (3)
- Lifestyle behaviours (obese,inactive,alcohol)
- Hereditary factors
- Reproductive/hormonal factors (early menstruation, LMA with 1st pregnancy, late menopause, BCP, HRT)
* exposed to estrogen longer
Indications for Breast ultrasound (7)
Dense breast tissue (more fibroglandular than fatty)
Mammogram uncertain
can be initial test under 30 years of age (due to radiation)
Biopsy
Breast implants
Male breast
Help plan radiation treatment
What is the gold standard for examining the breast?
Mammography
Advantages of using sonography for examining breasts?
- noninvasive
- Painless
- Non-ionizing
- Low cost
- Image chest wall
- Doppler
The mammary gland is a?
modified sweat gland
The mammary gland is composed of 3 different types of tissue:
- Fat tissue
- glandular tissue
- fibrous tissue
Th mammary gland is divided into 3 different layers or zones.
- Subcutaneous zone (Premammary)
- Mammary zone
- Retromammary zone
Where is the Subcutaneous zone (Premammary) located?
between skin and mammary fascia
What does the Subcutaneous zone (Premammary) consist of?
fat surrounded by connective tissue (CT)
Because the Subcutaneous zone (Premammary) consists of fat and CT this means No __ __ ___ develop here
True breast lesions
*but could spread here from mammary zone
What is the mammary fascia?
CT enveloping the mammary zone
What is the mammary fascia continuous with?
Cooper’s ligaments
What are Coopers ligaments?
They support and shape the breast
think coopers droopers
Mammary zone is the ____ layer
Functional
Mammary zone is composed of?
Fibroglandular tissue (breast parenchyma)
predominately located Upper outer quadrant(UOQ) and areolar region
Mammary zones contains ____ & ____
Lobes and lobules
Mammary zone have approx ___ lobes arranged ____. They contain which 3 things?
15-20 lobes; radilally
variable in size and contain
Ducts, stroma and acinus
Mammary zone contains_-__ _____per lobe and contains
20-40 LOBULES
Acini (milk producing glands)
Mammary zone Ducts are called?
Lactiferous ducts
What do the Lactiferous ducts do?
Drain acini, lobules, lobes
and converge towards the nipple to the lactiferous sinus
What is the functional unit of the breast
TDLU
What does the TDLU consist of?
Lobule and extra-lobular terminal duct (more common in duct)
Each TDLU is about __ to ___ in size.
1-2mm
THE SITE OF MOST MAJOR BREAST PATHOLOGY IS?
TDLU
WHAT IS THE TAIL OF SPENCE?
Mammary tissue extending into the axilla region
Retromammary zone is the ___ layer and is ___.
deepest; thin
Retromammary zone consists of
Fat
BV’s and lymphatics
The Nipple is a ____ ___ projecting from the center of the breast with multiple openings
Fibromuscular papilla
A normal variant of the nipple is?
inversion of the nipple
can also be seen with certain types of breast cancer, ask if recent change
The pigmented area around nipple is called the?
AREOLA
The bumpy appearance around the nipple is the?
sebaceous glands (oil producing)
What are the 2 muscles related to the breast?
- Pectoralis Major
2. Pectoralis Minor
Pectoralis Major lies?
posterior to retromammary zone
Pectoralis Minor is covered by the?
Pectoralis Major muscle
What are the 3 arteries of the breast?
- Lateral thoracic arteries
- Internal mammary arteries (havested)
- Intercostal arteries
The venous drainage consists of both a ___ and ___ network?
deep and superficial network
Lymph flows from the breast to the ?
axilla
Lymph originates in the ____ and the ____
CT and lactiferous ducts
FREQUENT INVASION OF THE LYMP SYSTEM Occurs with?
breast cancer.
Note: When find suspicious mass in breast always scan axilla looking for abnormal lymph nodes
Physiology of the breast. What do they do?
Produce and secrete milk
Age and Stage of breast function influence amount of parenchyma and stroma
What are the 4 HORMONES ASSOCIATED WITH THE BREAST?
- Estrogen
- Progesterone
- Prolactin
- Oxytocin
What does Estrogen do?
Promotes growth of ductal tissue
What does Progesterone do?
Stimulates development of lobular cells
What does Prolactin do?
Stimulates milk production
What does Oxytocin do?
Causes milk ejection from lactating breast
PREPUBESCENT breast consists of?
Rudimentary ducts and tissue developing under nipple, little fat
YOUNG ADULT breast consists of?
Fibroglandular tissue (dense, hard to see with mammography, why US, 1st choice) very minimal fat
ADULT breast consists of?
Fibroglandular = fatty tissue
PREGNANT /LACTATING breast consists of?
mostly glandular/prominent ducts
OLDER breast consists of?
increase fat in breast, easier mammography
MENOPAUSE breast consists of?
Parenchyma beneath nipple and UOQ, mostly fat
POSTMENOPAUSE breast consists of?
Fatty tissue.
lobules and ducts atrophy
What do we identify with breast US? (10)
skin nipple Subcutaneous fat parenchyma Lactiferous Ducts Cooper's ligament Retromammary layer Muscles Ribs Nodes
Sonographic appearance of Skin
2 thin echogenic lines
2-3mm
(with radiation, can see skin thickening)
Sonographic appearance of Nipple
Homogenous, medium level echoes posterior shadowing ( hard to see pathology behind nipple)
Sonographic appearance of Subcutaneous fat
Amount varies, does not extend posterior to nipple
Hypoechoic lobules, thin, echogenic strands, edge artifact.
Sonographic appearance of breast parenchyma
Homogenous, echogenic compared to fat.
Interspersed hypoechoic zones (fat islant )
Sonographic appearance of Lactiferous DUCTS + SIZE
Hypoechoic/anechoic tubular
enlarges towards nipple (up to 8mm)
Sonographic appearance of Coopers ligament
Curved echogenic striations encasing hypoechoic fat lobules
Sonographic appearance of Retromammary layer
Hypoechoic due to fat content and anterior to pectoralis muscle
Sonographic appearance of Pectoralis muscle
Medium to low level echoes, striated
Sonographic appearance of Lateral Ribs
Acoustic shadow
Sonographic appearance of Medial cartilage
Hypoechoic
Sonographic appearance of Lymph Nodes + size
In axilla and parenchyma
Oval, hypo, echogenic hilum
should be < 1cm AP
What makes a lymph node suspicious
> 1cm , more round and no hilum
Before starting exam
Hx-family,gravida,meds, surgeries, discharge
Review previous
Physical assessment - check for skin changes and scars
palpate mass
What probe should you use for breast ultrasound?
12-18Mhz (highest possible)
What do we want to penetrate to always?
Chest wall/pectoralis muscle
What are the 2 methods/approaches we use to scan ?
Clock face or quadrant approach
orthogonal plames = 90 degree from each other
quadrant approach
RUOQ( right upper outer)
RUIQ (right lower inner)
RLOQ (right lower outer)
RLIQ (right lower inner). same 4 left
Clock face approach (more common)
9: 00-lateral in right, medial in left
3: 00- medial in right breast, lateral in left
Describe Radial and antiradial planes
Radial- rays of sun
Anti radial - 90 degrees to this
lobules are orientated in radial manner
Always scan axilla for nodes, why?
most likely place for breast cancer to metastasize
When scanning scan posterior to nipple, place adjacent to nipple and angle?
retroareolar
BIRADS stands for
Breast Imaging Reporting and Data System
What is BIRADS
Reporting form documents breast lesions
method of risk categorization
Classify according to suspicion of breast cancer
BIRADS rating
1= sonographically normal 2=benign finding 3=probably benign - 6 month f/o 4a=low suspicion 4b=intermediate 4c=moderate suspicion 5=highly suggestive of malignancy. - 4/5=biopsy 6=known cancer
