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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
examples of pathology found in TDLU
fibrocystic condition fibroadenomas (most common benign tumor of breast) intraductal ca invasive ca
25
what occurs near the main duct of the nipple
intraductal papilloma
26
fat appears _____ whereas cooper's ligaments appear _____
hypechoic echogenic
27
retromammary layer is similar in ______ and _____ to the subcutaneous layer
echogenicity echo texture
28
postmenopausal parenchymal pattern
ducts atrophy | less fibrous tissue
29
generally, in young women, _____ tissue elements predominate, and the resulting pattern on mammogram and US reflects a _____ echogenic pattern of tissue
fibrous dense
30
in who does the glandular portions of the breast proliferate remarkably in both density and volume
pregnant or lactating women
31
as women age, the breast tissue becomes progressively replaced with _____, resulting in a mammographic and sonographic pattern with _____ echogenic fibrous tissue elements
fat less
32
the main arterial supply to the breast is provided by the _____ _____ artery
lateral thoracic
33
there is a lesser arterial supply provided by perforating branches of the _____ _____ artery, and a small contribution from _____ arteries
internal mammary intercostal
34
venous drainage is provided mainly by _____ veins that can be seen sonographically just under the skin
superficial
35
superficial veins will be enlarged in patients with...
superior vena caval syndrome chronic venous thrombosis of the subclavian vein arteriovenous shunts places in patients with chronic renal insufficiency
36
lymphatic drainage from all parts of the breast generally flows to the _____ _____ _____
axillary lymph nodes
37
part of the standard surgical therapy of invasive breast cancer involves _____ _____ _____ dissection
axillary lymph node
38
_____ status is an important part of assessing the patient's prognosis and guiding adjunctive therapy
node
39
primary function of the breast is...
fluid transport
40
what transports the fluid within the breast
ductal system
41
ductal system is affected by...
changing hormone levels during menstruation, pregnancy, and lactation
42
what is benign gynecomastia
when the male ductal elements hypertrophy during puberty or later in life under influence of hormonal fluctuations, disease processes, or medications
43
with the onset of maturity, the _____ and _____ portions of the breast develop
lobular and acinar
44
when does the acinar development accelerate to enable milk production by a cascade of hormones
during pregnancy
45
what 3 things aid in milk production
placental lactogen prolactin chorionic gonadotropin
46
at the end of lactation, the breast tissue _____
involutes mammo's can resume 6 mos after lactations ends
47
clinical assessments of the breast
famil/personal history palpable lump/mammographic findings discharge/pain
48
3 general categories of breast imaging
breast cancer screening diagnostic breast imaging diagnostic and interventional breast procedures
49
breast cancer screening involves what 3 things/steps
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
_____ is more specific in identifying the signs of breast cancer
mammography
51
common primary signs of breast cancer on mammo
irregular (spiculated), high-density mass clustered microcalcifications focal distortion
52
less common signs of breast cancer on mammo
focal asymmetric density | developing density
53
_____ of the breast is safer and more accurate in young dense breasts
ultrasound
54
US can see the deep _____ tissues not visible on mammo and can evaluate those areas where _____ may occur that mammo cannot image
juxtathoracic masses
55
on mammo, FCC may cause diffuse benign _____, _____, and _____
microcalcifications adenosis multiple round masses
56
US of the breast will show round masses as _____ _____
multiple cysts
57
US is better than mammo in what 3 ways
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
who established guidelines for standardized description and reporting breast lesions identified with mammo
ACR
59
Guidelines are contained within what system
breast imaging reporting and data system BIRADS (0-5 scale; 0 negative - 5 malignant)
60
_____ procedures are necessary for definitive diagnosis
invasive
61
what is often the reason for patient referral for breast US
dominant breast lump
62
what clinical information should be provided by the referring physician
size of lump and location within breast onset and duration of the breast problem relation to the menstrual cycle
63
the sonographer, in the process of scanning the breast, often can _____ the mass of concern
palpate
64
breast cancer is generally...
painless lobular or irregular in shape uneven in surface contour poorly movable
65
US can also reveal other pertinent findings like...
``` surface nipple erosion nipple or skin retraction skin thickening (edema, scarring, peau d'orange) scars inflammation contusion ```
66
patients usually are scanning in the _____ position using a _____ resolution transducer
supine high
67
how is the patients arm positioned while being scanned and why
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
for the medial breast, a _____ position works well
supine
69
for the lateral breast, the patient can be positioned how
rolled slightly toward the opposite side (30-45 degrees angle) and stabilized with a cushion under her shoulder and hips
70
study images on slides 56-63
study images on slides 56-63
71
what do pseudomasses include
retroareolar ducts costal cartilage prominent areas of fibroglandular tissue
72
________ are usually similar in shape, but are often quite firm and rubbery in consistency, as well as homogeneously solid on US
fibroadenomas - well defined, circumscribed, smooth walls
73
know slide 66
image is a rib
74
what is a main indication for a breast US
evaluation of smooth round or oval benign - appearing mammographic masses
75
______ are the most common breast lesion
cysts
76
what % of solid masses are benign? malignant?
benign 96-98% malignant 2-4%
77
______ are easily removable
cysts
78
clinical signs and symptoms of fibrocystic condition
lumps and pain that the patient feels, which fluctuates with every monthly cycle **no caffeine
79
________ represents normal physiological processes of breast tissue that fluctuate under the influence of the normal female hormonal cycles
fibrocystic condition (FCC)
80
benign/malignant solid mass shapes and orientation on sonography
benign - rounded or oval, large loculations malignant - sharp, angular, microlobulations, TALLER THAN WIDER, radial growth suspicious for intraductal lesions
81
types of lesions
nonproliferative lesions proliferative lesions without atypical cells proliferative lesions with atypical cellular changes
82
benign/malignant solid mass characteristics of internal echo patterns and attenuation effects
benign - isoechoic, hyperechoic, posterior enhancement malignant - hypoechoic, weak internal echoes, clustered microcalcifications, strongly attenuating
83
bengin/malignant solid mass characteristics of mobility, compressibility, and vascularity
benign - some mobility, fatty tumors usually compressible malignant - firmly fixed, rigid, noncompressible, hypervascular (feeder vessel)
84
what is fremitus
power Doppler is used when a patient hum's to define the area better...is it a solid or a cyst
85
5 benign pathologies of the breast
``` cysts fibrocystic condition fibroadenoma lipoma fat necrosis ```
86
what is DCIS
ductal CA in situ cancer in the ducts
87
what is ILC
invasive lobular cancer cancer in the lobule
88
name 4 other types of CA in the breast
scirrhous medullary colloid tubular
89
US is the primary tool in breast imaging in all women under the age of _____
30
90
what is mastitis
inflammation of the breast most often due to duct obstruction and inflammatory breast cancer
91
no mammo's under the age of _____, and in some centers, under _____
20 25
92
why no mammo's before 25
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
mammo or US for pregnant women
US - safer
94
which quadrant does breast cancer occur more often
upper outer quadrant - by armpit
95
when doing a biopsy, what is the key in visualization of the needle
keeping the needle oriented as nearly parallel to the transducer face as possible
96
what need gage is used when doing a cyst aspiration
25 G
97
_______ _______ is still the preferred method for evaluation of clustered microcalcifications
stereotactic guidance **look at image on slide 104
98
benign bilateral minimal multiple duct discharge is quite ______ and mainly related to ______ ______
common ductal ectasia
99
what is sentinel lymph node analysis
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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