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Summer 2014 - High Resolution ✔️ > Breast > Flashcards

Breast Flashcards

0
Q

what transducer will you use to do a breast US

A

high frequency linear

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1
Q

_____ detection is the key to breast cancer

A

early

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2
Q

gold standard technique for breast

A

mammogram

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3
Q

the breast is a…

A

modified sweat gland located in the superficial tissues of the anterior chest wall

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4
Q

breast extends deep toward the lateral upper margin of the chest into the axilla - ____ __ ____

A

tail of Spence

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5
Q

the surface of the breast is dominated by the _____ and surrounding _____

A

nipple

areola

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6
Q

the breast is divided into 3 layers located between the skin and the chest wall

A

subcutaneous
mammary (glandular)
retromammary

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7
Q

the _____ and _____ layers are usually quite thin, and are composed of fat surrounded by connective tissue

A

subcutaneous

retomammary

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8
Q

where does the breast cancer live within the breast

A

terminal ductal lobular unit

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9
Q

breast tissue is _____ echogenic tissue even though it is fatty

A

less

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10
Q

what do you generally look for when scanning a breast

A

disruption of the architecture

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11
Q

the volume and echogenicity of the mammary layer depends heavily on….

A

patients general hereditary pattern

hormonal state of the patient (puberty, lacating, etc.)

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12
Q

describe retromammary layer

A

similar to subcutaneous layer

boundary echoes resemble skin reflections

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13
Q

describe pectoral muscles

A

low level echo areas posterior to the retromammary layer

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14
Q

what are Cooper’s ligaments

A

connect perpendicularly to the fascia around the ducts and glands and extend to the skin

connective tissue septae within the breast forms a fibrous skeleton

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15
Q

the _____ is the site of origin of nearly all pathologic processes that occur in the breast

A

TDLU

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16
Q

young parenchymal pattern

A

fibrous tissue elements

dense echogenic pattern

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17
Q

pregnant or lactating parenchymal pattern

A

larger and denser glandular portions

less echogenic interfaces

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18
Q

mature parenchymal pattern

A

fatty tissue begins to replace glandular tissue

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19
Q

there are _____ to _____ lobes that contain the milk-producing glands and duct system that carries the milk to the nipple.

A

15-20

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20
Q

sonographic appearance of the mammary layer…

A

glandular layer lies between the subcutaneous fatty layer anteriorly and the retromammary layer posteriorly

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21
Q

describe ribs

A

hyperechoic rounded structures

dense posterior shadowing

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22
Q

each lobe of the breast resembles a _____ with a major duct corresponding to a main _____ of the bush, branching into smaller lobules that contain the _____ of the bush corresponding to the ______ (individual milk producing glands)

A

bush

stem

leaves

acini - 100’s of these within a breast

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23
Q

what is TDLU

A

terminal ductal lobular unit

terminal ducts and the acini form small lobular units

surrounds by loose and dense connective tissue

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24
Q

examples of pathology found in TDLU

A

fibrocystic condition
fibroadenomas (most common benign tumor of breast)
intraductal ca
invasive ca

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25
Q

what occurs near the main duct of the nipple

A

intraductal papilloma

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26
Q

fat appears _____ whereas cooper’s ligaments appear _____

A

hypechoic

echogenic

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27
Q

retromammary layer is similar in ______ and _____ to the subcutaneous layer

A

echogenicity

echo texture

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28
Q

postmenopausal parenchymal pattern

A

ducts atrophy

less fibrous tissue

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29
Q

generally, in young women, _____ tissue elements predominate, and the resulting pattern on mammogram and US reflects a _____ echogenic pattern of tissue

A

fibrous

dense

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30
Q

in who does the glandular portions of the breast proliferate remarkably in both density and volume

A

pregnant or lactating women

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31
Q

as women age, the breast tissue becomes progressively replaced with _____, resulting in a mammographic and sonographic pattern with _____ echogenic fibrous tissue elements

A

fat

less

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32
Q

the main arterial supply to the breast is provided by the _____ _____ artery

A

lateral thoracic

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33
Q

there is a lesser arterial supply provided by perforating branches of the _____ _____ artery, and a small contribution from _____ arteries

A

internal mammary

intercostal

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34
Q

venous drainage is provided mainly by _____ veins that can be seen sonographically just under the skin

A

superficial

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35
Q

superficial veins will be enlarged in patients with…

A

superior vena caval syndrome
chronic venous thrombosis of the subclavian vein
arteriovenous shunts places in patients with chronic renal insufficiency

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36
Q

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

A

axillary lymph nodes

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37
Q

part of the standard surgical therapy of invasive breast cancer involves _____ _____ _____ dissection

A

axillary lymph node

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38
Q

_____ status is an important part of assessing the patient’s prognosis and guiding adjunctive therapy

A

node

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39
Q

primary function of the breast is…

A

fluid transport

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40
Q

what transports the fluid within the breast

A

ductal system

41
Q

ductal system is affected by…

A

changing hormone levels during menstruation, pregnancy, and lactation

42
Q

what is benign gynecomastia

A

when the male ductal elements hypertrophy during puberty or later in life under influence of hormonal fluctuations, disease processes, or medications

43
Q

with the onset of maturity, the _____ and _____ portions of the breast develop

A

lobular and acinar

44
Q

when does the acinar development accelerate to enable milk production by a cascade of hormones

A

during pregnancy

45
Q

what 3 things aid in milk production

A

placental lactogen
prolactin
chorionic gonadotropin

46
Q

at the end of lactation, the breast tissue _____

A

involutes

mammo’s can resume 6 mos after lactations ends

47
Q

clinical assessments of the breast

A

famil/personal history
palpable lump/mammographic findings
discharge/pain

48
Q

3 general categories of breast imaging

A

breast cancer screening
diagnostic breast imaging
diagnostic and interventional breast procedures

49
Q

breast cancer screening involves what 3 things/steps

A

monthly breast self-examinations (BSE) - preform at end of menses starting at age 20

regular clinical breast examinations (CSE) - every 3 yrs until 40 then yearly thereafter

yearly screening mammography - beginning at 40

50
Q

_____ is more specific in identifying the signs of breast cancer

A

mammography

51
Q

common primary signs of breast cancer on mammo

A

irregular (spiculated), high-density mass
clustered microcalcifications
focal distortion

52
Q

less common signs of breast cancer on mammo

A

focal asymmetric density

developing density

53
Q

_____ of the breast is safer and more accurate in young dense breasts

A

ultrasound

54
Q

US can see the deep _____ tissues not visible on mammo and can evaluate those areas where _____ may occur that mammo cannot image

A

juxtathoracic

masses

55
Q

on mammo, FCC may cause diffuse benign _____, _____, and _____

A

microcalcifications
adenosis
multiple round masses

56
Q

US of the breast will show round masses as _____ _____

A

multiple cysts

57
Q

US is better than mammo in what 3 ways

A

differentiate structures within uniformly dense breast tissue
differentiate solid round masses from fluid filled cysts
can visualize tissue adjacent to implants or other structures

58
Q

who established guidelines for standardized description and reporting breast lesions identified with mammo

A

ACR

59
Q

Guidelines are contained within what system

A

breast imaging reporting and data system

BIRADS (0-5 scale; 0 negative - 5 malignant)

60
Q

_____ procedures are necessary for definitive diagnosis

A

invasive

61
Q

what is often the reason for patient referral for breast US

A

dominant breast lump

62
Q

what clinical information should be provided by the referring physician

A

size of lump and location within breast
onset and duration of the breast problem
relation to the menstrual cycle

63
Q

the sonographer, in the process of scanning the breast, often can _____ the mass of concern

A

palpate

64
Q

breast cancer is generally…

A

painless
lobular or irregular in shape
uneven in surface contour
poorly movable

65
Q

US can also reveal other pertinent findings like…

A 
surface nipple erosion
nipple or skin retraction
skin thickening (edema, scarring, peau d'orange)
scars
inflammation
contusion
66
Q

patients usually are scanning in the _____ position using a _____ resolution transducer

A

supine

high

67
Q

how is the patients arm positioned while being scanned and why

A

arm is behind her head on the side of the breast being examined

spreads the breast tissue more evenly over the surface of the chest and provide a more stable scanning surface

68
Q

for the medial breast, a _____ position works well

A

supine

69
Q

for the lateral breast, the patient can be positioned how

A

rolled slightly toward the opposite side (30-45 degrees angle) and stabilized with a cushion under her shoulder and hips

70
Q

study images on slides 56-63

A

study images on slides 56-63

71
Q

what do pseudomasses include

A

retroareolar ducts
costal cartilage
prominent areas of fibroglandular tissue

72
Q

________ are usually similar in shape, but are often quite firm and rubbery in consistency, as well as homogeneously solid on US

A

fibroadenomas - well defined, circumscribed, smooth walls

73
Q

know slide 66

A

image is a rib

74
Q

what is a main indication for a breast US

A

evaluation of smooth round or oval benign - appearing mammographic masses

75
Q

______ are the most common breast lesion

A

cysts

76
Q

what % of solid masses are benign? malignant?

A

benign 96-98%

malignant 2-4%

77
Q

______ are easily removable

A

cysts

78
Q

clinical signs and symptoms of fibrocystic condition

A

lumps and pain that the patient feels, which fluctuates with every monthly cycle

**no caffeine

79
Q

________ represents normal physiological processes of breast tissue that fluctuate under the influence of the normal female hormonal cycles

A

fibrocystic condition (FCC)

80
Q

benign/malignant solid mass shapes and orientation on sonography

A

benign - rounded or oval, large loculations

malignant - sharp, angular, microlobulations, TALLER THAN WIDER, radial growth suspicious for intraductal lesions

81
Q

types of lesions

A

nonproliferative lesions
proliferative lesions without atypical cells
proliferative lesions with atypical cellular changes

82
Q

benign/malignant solid mass characteristics of internal echo patterns and attenuation effects

A

benign - isoechoic, hyperechoic, posterior enhancement

malignant - hypoechoic, weak internal echoes, clustered microcalcifications, strongly attenuating

83
Q

bengin/malignant solid mass characteristics of mobility, compressibility, and vascularity

A

benign - some mobility, fatty tumors usually compressible

malignant - firmly fixed, rigid, noncompressible, hypervascular (feeder vessel)

84
Q

what is fremitus

A

power Doppler is used

when a patient hum’s to define the area better…is it a solid or a cyst

85
Q

5 benign pathologies of the breast

A 
cysts
fibrocystic condition
fibroadenoma
lipoma
fat necrosis
86
Q

what is DCIS

A

ductal CA in situ

cancer in the ducts

87
Q

what is ILC

A

invasive lobular cancer

cancer in the lobule

88
Q

name 4 other types of CA in the breast

A

scirrhous
medullary
colloid
tubular

89
Q

US is the primary tool in breast imaging in all women under the age of _____

A

30

90
Q

what is mastitis

A

inflammation of the breast most often due to duct obstruction and inflammatory breast cancer

91
Q

no mammo’s under the age of _____, and in some centers, under _____

A

20

25

92
Q

why no mammo’s before 25

A

breast cancer is rare in women under 25

breast tissue at this age is generally denser and more difficult to analyze by mammo

young breast tissue is more sensitive to radiation damage

93
Q

mammo or US for pregnant women

A

US - safer

94
Q

which quadrant does breast cancer occur more often

A

upper outer quadrant - by armpit

95
Q

when doing a biopsy, what is the key in visualization of the needle

A

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

96
Q

what need gage is used when doing a cyst aspiration

A

25 G

97
Q

_______ _______ is still the preferred method for evaluation of clustered microcalcifications

A

stereotactic guidance

**look at image on slide 104

98
Q

benign bilateral minimal multiple duct discharge is quite ______ and mainly related to ______ ______

A

common

ductal ectasia

99
Q

what is sentinel lymph node analysis

A

dye is injected so that the lymph node chain can be followed throughout the breast

good for finding metastases

Summer 2014 - High Resolution ✔️ (7 decks)

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