Breast Flashcards
What kind of transducer do you use for breast US?
High frequency 7.5 -15MHz
What is the most common type of cancer among women in the USA?
breast cancer
What is the gold standard for breast scanning?
mammogram
Where is the TAIL OF SPENCE?
in the axilla
what are the three layers of the breast?
subcutaneous layer
mammary layer (glandular)
retromammary layer
what layers are usually quite thin and are composed of fat surrounded by connective tissue?
the subcutaneous and retromammary layers
What is the terminal ductal lobular unit (TDLU)
This is where cancer live (in the tree looking part)
How does fat appear in the breast?
it is the least echogenic tissue within the breast
What are you looking for in the breast tissue?
the disruption of the architecture of the tissue
What is the volume and echogenicity of the mammary layer dependent on?
the patient’s general inherited breast tissue pattern as well as the functional state of the breast (pubertal, lactating, postmenopausal)
What is the sonographic appearance of the retromammary layer
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
What are Cooper’s ligaments?
the connective tissue septae within the breast that forms a fibrous skeleton
What branches from the terminal duct?
the acinar cells (individual milk producing glands)
What pathologies are found in the TDLU?
fibrocystic condition
fibroadenomas (most common benign tumor of the breast)
intraductal carcinomas
invasive carcinomas
Where is a solitary benign intraductal papilloma found?
in the main duct near the nipple
Fat appears ________whereas Cooper’s ligaments appear______
hypoechoic
echogenic
What are the different parenchymal patterns?
Young
pregnant or lactating
mature
postmenopausal
What is the parenchymal pattern of the young??
fibrous tissue elements
dense echogenic pattern
what is the parenchymal pattern of the pregnant or lactating?
larger and denser glandular portions
less echogenic interfaces
What is the main arterial supply to the breast?
lateral thoracic artery
mammary artery
intercostal arteries
lymphatic drainage from all parts of the breast generally flows to…
the axillary lymph nodes
What is gynecomastia?
a mass in the male breast
What hormones affect breast tissue?
placental lactogen
prolactin
chorionic gonadotropin
What are the three general categories of breast imaging?
breast cancer screening (mammogram)
diagnostic (consultative, problem solving, workup)
diagnostic and interventional breast procedures
What are the breast cancer screenings?
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)
What are the primary signs of breast cancer on mammography?
irregular (spiculated), high-density mass
clustered microcalcifications
focal distortion
less common:
focal asymmetric density
developing density
What does FCC cause on mammogram?
diffuse benign microcalcifications
adenosis
multiple round masses
Where do you find the standards for breast imaging?
BI-RADS (breast imaging reporting and data system)
found in the American college of radiology
Breast BIRAD Categories
1 - negative
2 - benign
3- probably benign
4a- mildly suspicious
4b - moderately suspicious
5 - malignant
a dominant _________ _________ is often the reason for patient referral for breast ultrasound
breast lump
What clinical information do you need to gather?
size of lump
location
onset and duration of the breast problem
relation to the menstrual cycle
What kind of focus do you want to use for breast imaging?
multifocus
linear, high frequency
What else do you inspect when doing a breast ultrasound?
the skin
Which layer includes the functional portion of the breast as well as the surrounding stromal tissues?
the mammary layer
how many lobes are there that contain the mild producing glands and duct system that carries the milk to the nipple?
15-20 lobes
What do the terminal ducts and the acini form?
small lobular units called the terminal ductal-lobular units (TDLU)
What is the parenchymal pattern of the mature?
fatty tissue begins to replace glandular tissue
what is the parenchymal pattern of the postmenopausal?
ducts atrophy
less fibrous tissue
What clinical assessments give rise to a breast study?
family/personal history
palpable lump/mammographic findings
discharge/ pain
How does breast cancer appear sonographically?
generally painless
lobular or irregular in shape
uneven in surface contour “gritty texture”
poorly moveable
What are the two views of a mammogram?
cranio-caudal (cc)
mediolateral - oblique (MLO)
What are the pseudomasses?
retroareolar ducts
costal cartilage
prominent areas of fibroglandular tissue
what is a fibroadenoma?
usually similar in shape
often quite firm and rubbery in consistency
homogeneously solid on US
well defined, circumscribed, smooth walls
What is the main indication for breast ultrasound?
evaluation of smooth round or oval benign appearing mammographic masses
What is the most common breast lesion?
cyst - must meet cyst criteria
2-4% prove to be malignant
What are the signs and symptoms of fibrocystic condition?
include lumps and pain that the patient feels
fluctuate with every monthly cycle
what dietary limitations might a doctor put a woman with fibrocystic condition be put on?
no caffeine or chocolate
What represents normal physiologic processes of breast tissue that fluctuate under the influence of the normal female hormonal cycles?
fibrocystic condition (FCC)
What are the sonographic characteristics of a solid mass?
shape:
benign: rounded or oval, large lobulations
Malignant: sharp, angular, microlobulations
Orientation:
malignant:
Taller than wide
radial growth suspicious for intraductal lesions
Proliferative means????
can have cellular changes
what are the characteristics of mobility?
benign: some mobility
malignant: firmly fixed
Characteristics of compressibility?
benign: fatty tumors, usually compressible
malignant: rigid, noncompressible
characteristics of vascularity
benign: avascular
malignant: hypervascular, feeder vessel
What is fremitus power doppler hum?
helps determine fat from true solid nodule
artifact shadowing vs true shadowing
multifocus vs unifocal disease
Which quadrant has the most occurrence of breast cancer?
Outer, upper, quadrant
what gauge needle is used for breast aspiration?
fine needle usually 25 G
What are nonproliferative lesions?
no increased risk of subsequent development of breast cancer
What are proliferative lesions without atypical cells?
mildly elevated risk of subsequent breast cancer
what are proliferative lesions with atypical cellular changes?
moderately increased risk of subsequent breast cancer
What are the internal echo patterns of solid masses?
benign:
isoechoic, hyperechoic
malignant:
hypoechoic, weak internal echoes, clustered microcalcifications
what are the attenuation effects of a solid mass?
benign:
posterior enhancement
malignant:
strongly attenuating
is a fibroadenoma benign or malignant?
benign - although solid appearing
see slide 78 for picture
What are the 5 benign pathologies of the breast?
cysts
fibrocystic condition
fibroadenoma
lipoma
fat necrosis
What is the primary tool in breast imaging in all women under age 30?
ultrasound
What are the two main causes of an enlarged, reddened, tender breast?
mastitis
inflammatory breast cancer
what is mastitis?
inflammation of the breast most often due to duct obstruction
What are the three main reasons mammography is not used in women under age 20-25?
cancer is rare for this age
tissue is too dense
tissue is more sensitive to radiation damage
What imaging modality is the primary tool for pregnant patients?
ultrasound
when doing an ultrasound guided process what is the key in visualization of the needle?
keep the needle oriented as nearly parallel to the transducer face as possible
what is a common interventional technique used in the breast?
cyst aspiration
What are the two main indications for a cyst aspiration?
symptomatic cyst
hypoechoic lesion that does not meet simple cyst criteria
What is FNAC?
fine needle aspiration cytology
What is the single greatest problem in FNAC?
inadequate specimen
Who should perform a FNAC but is rarely available?
experienced pathologist (cytopathologist)
What is the preferred method for evaluation of clustered microcalcifcations?
stereotactic guidance
