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Breast Flashcards

0
Q

What kind of transducer do you use for breast US?

A

High frequency 7.5 -15MHz

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1
Q

What is the most common type of cancer among women in the USA?

A

breast cancer

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2
Q

What is the gold standard for breast scanning?

A

mammogram

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3
Q

Where is the TAIL OF SPENCE?

A

in the axilla

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4
Q

what are the three layers of the breast?

A

subcutaneous layer

mammary layer (glandular)

retromammary layer

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5
Q

what layers are usually quite thin and are composed of fat surrounded by connective tissue?

A

the subcutaneous and retromammary layers

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6
Q

What is the terminal ductal lobular unit (TDLU)

A

This is where cancer live (in the tree looking part)

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7
Q

How does fat appear in the breast?

A

it is the least echogenic tissue within the breast

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8
Q

What are you looking for in the breast tissue?

A

the disruption of the architecture of the tissue

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9
Q

What is the volume and echogenicity of the mammary layer dependent on?

A

the patient’s general inherited breast tissue pattern as well as the functional state of the breast (pubertal, lactating, postmenopausal)

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10
Q

What is the sonographic appearance of the retromammary layer

A

similar to subcutaneous layer

boundary echoes resemble skin reflections

Pectoral muscles:

low level echo areas posterior to the retromammary layer

ribs:

hyperechoic rounded structures

dense posterior shadowing

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11
Q

What are Cooper’s ligaments?

A

the connective tissue septae within the breast that forms a fibrous skeleton

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12
Q

What branches from the terminal duct?

A

the acinar cells (individual milk producing glands)

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13
Q

What pathologies are found in the TDLU?

A

fibrocystic condition

fibroadenomas (most common benign tumor of the breast)

intraductal carcinomas

invasive carcinomas

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14
Q

Where is a solitary benign intraductal papilloma found?

A

in the main duct near the nipple

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15
Q

Fat appears ________whereas Cooper’s ligaments appear______

A

hypoechoic

echogenic

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16
Q

What are the different parenchymal patterns?

A

Young

pregnant or lactating

mature

postmenopausal

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17
Q

What is the parenchymal pattern of the young??

A

fibrous tissue elements

dense echogenic pattern

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18
Q

what is the parenchymal pattern of the pregnant or lactating?

A

larger and denser glandular portions

less echogenic interfaces

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19
Q

What is the main arterial supply to the breast?

A

lateral thoracic artery

mammary artery

intercostal arteries

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20
Q

lymphatic drainage from all parts of the breast generally flows to…

A

the axillary lymph nodes

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21
Q

What is gynecomastia?

A

a mass in the male breast

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22
Q

What hormones affect breast tissue?

A

placental lactogen

prolactin

chorionic gonadotropin

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23
Q

What are the three general categories of breast imaging?

A

breast cancer screening (mammogram)

diagnostic (consultative, problem solving, workup)

diagnostic and interventional breast procedures

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24
Q

What are the breast cancer screenings?

A

monthly self (starting age 20 BSE breast self exam)

doctor (CBE clinical breast exam, every 3 yrs until 40 - yearly)

mammogram (yearly screening beginning age 40)

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25
Q

What are the primary signs of breast cancer on mammography?

A

irregular (spiculated), high-density mass

clustered microcalcifications

focal distortion

less common:

focal asymmetric density

developing density

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26
Q

What does FCC cause on mammogram?

A

diffuse benign microcalcifications

adenosis

multiple round masses

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27
Q

Where do you find the standards for breast imaging?

A

BI-RADS (breast imaging reporting and data system)

found in the American college of radiology

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28
Q

Breast BIRAD Categories

A

1 - negative

2 - benign

3- probably benign

4a- mildly suspicious

4b - moderately suspicious

5 - malignant

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29
Q

a dominant _________ _________ is often the reason for patient referral for breast ultrasound

A

breast lump

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30
Q

What clinical information do you need to gather?

A

size of lump

location

onset and duration of the breast problem

relation to the menstrual cycle

31
Q

What kind of focus do you want to use for breast imaging?

A

multifocus

linear, high frequency

32
Q

What else do you inspect when doing a breast ultrasound?

A

the skin

33
Q

Which layer includes the functional portion of the breast as well as the surrounding stromal tissues?

A

the mammary layer

34
Q

how many lobes are there that contain the mild producing glands and duct system that carries the milk to the nipple?

A

15-20 lobes

35
Q

What do the terminal ducts and the acini form?

A

small lobular units called the terminal ductal-lobular units (TDLU)

36
Q

What is the parenchymal pattern of the mature?

A

fatty tissue begins to replace glandular tissue

37
Q

what is the parenchymal pattern of the postmenopausal?

A

ducts atrophy

less fibrous tissue

38
Q

What clinical assessments give rise to a breast study?

A

family/personal history

palpable lump/mammographic findings

discharge/ pain

39
Q

How does breast cancer appear sonographically?

A

generally painless

lobular or irregular in shape

uneven in surface contour “gritty texture”

poorly moveable

40
Q

What are the two views of a mammogram?

A

cranio-caudal (cc)

mediolateral - oblique (MLO)

41
Q

What are the pseudomasses?

A

retroareolar ducts

costal cartilage

prominent areas of fibroglandular tissue

42
Q

what is a fibroadenoma?

A

usually similar in shape

often quite firm and rubbery in consistency

homogeneously solid on US

well defined, circumscribed, smooth walls

43
Q

What is the main indication for breast ultrasound?

A

evaluation of smooth round or oval benign appearing mammographic masses

44
Q

What is the most common breast lesion?

A

cyst - must meet cyst criteria

2-4% prove to be malignant

45
Q

What are the signs and symptoms of fibrocystic condition?

A

include lumps and pain that the patient feels

fluctuate with every monthly cycle

46
Q

what dietary limitations might a doctor put a woman with fibrocystic condition be put on?

A

no caffeine or chocolate

47
Q

What represents normal physiologic processes of breast tissue that fluctuate under the influence of the normal female hormonal cycles?

A

fibrocystic condition (FCC)

48
Q

What are the sonographic characteristics of a solid mass?

A

shape:

benign: rounded or oval, large lobulations
Malignant: sharp, angular, microlobulations

Orientation:

malignant:

Taller than wide
radial growth suspicious for intraductal lesions

49
Q

Proliferative means????

A

can have cellular changes

50
Q

what are the characteristics of mobility?

A

benign: some mobility
malignant: firmly fixed

51
Q

Characteristics of compressibility?

A

benign: fatty tumors, usually compressible
malignant: rigid, noncompressible

52
Q

characteristics of vascularity

A

benign: avascular
malignant: hypervascular, feeder vessel

53
Q

What is fremitus power doppler hum?

A

helps determine fat from true solid nodule

artifact shadowing vs true shadowing

multifocus vs unifocal disease

54
Q

Which quadrant has the most occurrence of breast cancer?

A

Outer, upper, quadrant

55
Q

what gauge needle is used for breast aspiration?

A

fine needle usually 25 G

56
Q

What are nonproliferative lesions?

A

no increased risk of subsequent development of breast cancer

57
Q

What are proliferative lesions without atypical cells?

A

mildly elevated risk of subsequent breast cancer

58
Q

what are proliferative lesions with atypical cellular changes?

A

moderately increased risk of subsequent breast cancer

59
Q

What are the internal echo patterns of solid masses?

A

benign:

isoechoic, hyperechoic

malignant:

hypoechoic, weak internal echoes, clustered microcalcifications

60
Q

what are the attenuation effects of a solid mass?

A

benign:

posterior enhancement

malignant:

strongly attenuating

61
Q

is a fibroadenoma benign or malignant?

A

benign - although solid appearing

see slide 78 for picture

62
Q

What are the 5 benign pathologies of the breast?

A

cysts

fibrocystic condition

fibroadenoma

lipoma

fat necrosis

63
Q

What is the primary tool in breast imaging in all women under age 30?

A

ultrasound

64
Q

What are the two main causes of an enlarged, reddened, tender breast?

A

mastitis

inflammatory breast cancer

65
Q

what is mastitis?

A

inflammation of the breast most often due to duct obstruction

66
Q

What are the three main reasons mammography is not used in women under age 20-25?

A

cancer is rare for this age

tissue is too dense

tissue is more sensitive to radiation damage

67
Q

What imaging modality is the primary tool for pregnant patients?

A

ultrasound

68
Q

when doing an ultrasound guided process what is the key in visualization of the needle?

A

keep the needle oriented as nearly parallel to the transducer face as possible

69
Q

what is a common interventional technique used in the breast?

A

cyst aspiration

70
Q

What are the two main indications for a cyst aspiration?

A

symptomatic cyst

hypoechoic lesion that does not meet simple cyst criteria

71
Q

What is FNAC?

A

fine needle aspiration cytology

72
Q

What is the single greatest problem in FNAC?

A

inadequate specimen

73
Q

Who should perform a FNAC but is rarely available?

A

experienced pathologist (cytopathologist)

74
Q

What is the preferred method for evaluation of clustered microcalcifcations?

A

stereotactic guidance

High Resolution (11 decks)

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