Breast Flashcards
Indications
Used as an adjunct to mammography, a target rather than screening.
Second leading cause of cancer deaths in women next to lung cancer
Breast cancer.
Ultrasound vs Mammography
Mammo sees tiny micro Ca+
Mammo has hard time imaging dense breast
Ultrasound differentiates cystic vs solid
US characterizes a palp mass
US can assess with trauma,inflammation,augmentation
US guided cyst aspiration
Breast anatomy
Paired mammary glands containing fatty glandular and fibrous connective tissue
Parenchyma has 15-20 lobes, further divided into 20-40 lobules
Each lobe has a lactiferous duct 15-20 that converge at the nipple and enlg with lactation
Terminal duct lobular unit TDLU
< 2 mm, where most Breast pathology arises
Benign
Lesion won't cross fibrous plane Well defined Well circumscribed Smooth Mild lobulations Thin Echogenic pseudocapsule Round Ovoid Horizontal Wider than tall Uniform Hypoechoic Anechoic Homogeneous Non attenuating Enhancement with cyst Compressible Mobile Fluid-filled lacks flow Solid masses are hypovascular or lack a signal
Malignant
Can invade fibrous plane Finger-like projections in radial True shadow persists with pressure Ill defined May indicate invasion Spiculated Angular Many small lobulations Thick Echogenic halo Taller than wide Irregular Vertical Markedly hypoechoic Heterogeneous Attenuating Shadowing Non compressible Fixed Increased peripheral flow (feeding vessel) Increased internal flow (flow in tumor mosaic) Clustered microcalcifications
Layers
Skin
Subcutaneous fat
Fascial plane
Mammary zone/ Breast parenchyma, glandular tissue
Retromammary fat
Muscle
Ribs
Blood supply
Arteries: internal mammary, lateral thoracic, thoracocromial, intercostal
Veins: superficial and deep networks. Axillary intercostal vein, vertebral veins
Glandular tissue is supported by
Cooper’s ligaments
Tail of Spence
Mammary tissue which may extend into axilla
Montgomery’s Gland
Sebaceous glands in areola
Skin thickness
2-3 mm
Fat is affected by
Age, parity, and obesity
Fatty tissue is ___ Echogenic than parenchyma
Less
Gynecomastia
Ductal elements enlarge in males.
Ducts
< or = 3 mm
Course towards nipple
Lymph nodes
Seen near axilla
< 10-15 mm
Kidney bean, echogenic hilum
Rotter’s nodes
Interpectoral group
Breast function
Fluid transport
Milk secretion via acini cells due to prolactin. Prolactin is suppressed by progesterone which is high during pregnancy and low after placenta is delivered. Baby sucking on nipple makes oxytocin which also raises prolactin.
Patient position
Supine/oblique with ipsilateral arm above head.
Fremitus
Power Doppler. Presence of flow confirms solid lesions.
Hypoplasia
Underdeveloped breast
Hypertrophy
Overdeveloped breast
May cause back pain and skin problems due to bra strap
Polythelia
Accessory nipple
MC congenital anomaly
In milk line
(Embryos have breast buds that normally regress)
Black people
Can be confused with mole.
Assoc with renal cyst/duplication/unilateral agenesis
Polymastia
Accessory breast
May occur with athelia (no nipple)
Enlg with puberty, pregnancy, and lactation. Can have breast pathology
Cyst
MC breast lesion
Usually benign
35-50 yr old female
Pain, palp, mobile, compressible, no color flow within
Mammo: spherical or oval, low density, smooth margin, halo sign, eggshell with ca++
Fibroadenoma
Common solid benign
15-40 yr old, black women
May get bigger when pregnant. Hormone influenced
Palp, mobile, nontender, may have macrolobulations
Well circumscribed, hypo, smooth margins
Breast cancer
Affects 1 in 8 females
MC is invasive ductal carcinoma
Risk: female, fam hx, inc age
Fibroadenoma
Common solid benign
15-40 yr old
May get bigger when pregnant. Hormone influenced
Breast cancer
Affects 1 in 8 females
MC is invasive ductal carcinoma
Risk: female, fam hx, inc age, prolonged estrogen
Hard fixed painless mass, skin changes, nipple inversion
Amastia
No Breast tissue and no nipple
Amazia
No Breast tissue. Nipple is present.
Unilateral early ripening
One breast develops before the other
Precocious puberty
Breast develop before age 7
Galactocele
Milky cyst Due to obstruction of lactiferous ducts With pregnancy or lactation May progress to mastitis or abscess Usually subareolar Resolves
Sebaceous cyst
Mild to low level echoes. Oily cyst
Intracystic papilloma
Soft tissue mass projecting into cyst
Abscess
May result from mastitis
Affects lactating females
Often below nipple
Fever, pain, skin red and thick, palp, enlg nodes, purulent discharge, thick coopers lig, irregular, internal echoes, septations
Tx antibiotics, drainage
Hematoma
Due to trauma
Variable echogenicity
Ductal ectasia
Dilation of lactiferous ducts
Menopausal women
Prolonged nursing
Sticky thick discharge Subareolar nodularity Nipple inversion Intermittent pain Dilated tubes coursing towards nipple Usually bilateral
Cystosarcoma Phylloides
Rare, 50 yrs May be huge Benign May turn into Cancer. Similar to Fibroadenoma
Intraductal papilloma
Growth in duct. Older women. Usually benign.
Asymptomatic, bloody nipple discharge. Palp subareolar mass. Ductal dilatation, soft tissue mass in duct.
Lipoma
Encapsulated adipose tissue
Middle age and older women
> 2 cm usually
Compressible. Palp. May blend with breast.
Invasive Ductal Carcinoma
MC 70-80%
Ill defined, hetero hypo, tall, attenuating, micro Ca+
Infiltrating Lobular Carcinoma
8-15%
Lobulated borders, moderate attenuation.
Medullary Carcinoma
Rare, younger females.
Round/lobulated, irreg margins, may hemorrhage
Mucinous Carcinoma/Colloid Carcinoma
Rare, may be bilateral and multiple
Round/oval smooth wall hypo
Papillary Carcinoma
Rare, older, palp
retroareolar mass, bloody discharge. Small mass, dilated duct
Paget’s Disease
Eczema skin change of nipple
Assoc with underlying breast cancer 90%
Rash, bleeding, red areola, crust ulceration, itch, burn, discharge, nipple inversion.
Mets from breast
Nodes, liver, lung, bone, brain
Lymphadenopathy rounded and loss of fatty hilum.
Make breast cancer
Rare 1%
Risk: Kline Felters syndrome (extra X chromosome in males), transsexuals, orchitis tumors, liver disease
Cyst more common in
Premenopausal females, females on estrogen or estrogen-progesterone hormone replacement therapy.
Fat lobules
Hypo fat in area of dense tissue
