Breast Pathology Flashcards
What is fat necrosis of the breast?
Death of fatty tissue in the breast
What are the US appearances of fat necrosis?
Heterogenous, avascular, calcified rim (full or partial) within posterior acoustic shadowing, within subcutaneous layer, complex (solid and cystic)
What are the causes of fat necrosis?
Trauma, surgery, biopsy, patient on blood thinners, weight of large breasts.
What are four criteria associated with benign breast masses?
Hyperechogenicity, wider than tall, 3 or fewer lobulations, completely circumscribed within thin echogenic capsule
What are the US appearances of a breast abscess?
Uniform isoechoic thickened wall
Fluid-debris level
Hyperaemia of wall (vessels course parallel to wall)
What are the S+S of breast infection?
Tenderness
Erythema
Warmth in area
Fever
Leukocytosis
May have nipple discharge
What is mastitis and what is the main role of US during assessment?
Breast inflammation
Determine whether abscess is present
Age of abscess
Whether or not it is multilocular
What are the two types of breast mastitis?
Puerperal mastitis (mastitis associated with lactation)
Nonpuerperal mastitis (can occur in females and males)
What causes mastitis?
Pre-existing galactoceles
Inflamed cyst
Rupture of inflamed or affected duct (central abscess)
What are the US appearances of peripheral mastitis?
If formed from galactocele, thicker wall galactocele and often multilobulated or septated
Can be nonspecific - no fluid-filled underlying structures
What are the US appearances of central mastitis?
Arises from central ducts - walls of ducts are thick and isoechoic (rather than thin and echogenic)
What technical considerations apply to scanning patients with mastitis?
Use transducer with more penetration (breast becomes thicker with lactation and need to see to chest wall).
What are signs that are suspicious for malignancy (4x invasive, 3x DCIS, 3x both)?
Angular margins (greatest sensitivity)
Spiculation
Thick echogenic rim with antiparallel vascularity
Acoustic shadowing
Microlobulations
Calcifications
Duct changes
Hypoechogenicity
Taller than wide
Indistinct margins
What are indistinct margins (malignant breast lesion sign)?
Can’t distinguish margins, including when margins are the same echogenicity as surrounding tissue
What are spiculations or a thick, echogenic rim (malignant breast lesion sign)?
Spiculations - invasions into surrounding tissue that radiate from lesion
Thick echogenic rim - arises from spiculations which are too small to appreciate on US
What are microlobulations (malignant breast cancer sign)?
1-2mm lobulations that vary in number along the lesions surface.
What is duct extension a sign of?
Not specific sign of malignancy but suggests intraductal growth pattern.
What is acoustic shadowing in a breast lesion indicative of?
Invasive malignancy - occurs from the solid part of the lesion.
Do calcifications in a breast lesion indicate malignancy?
Malignant calcs lie within hypoechoic tumour substance (benign lie within a fairly hyperechoic background), so are able to be detected more easily.
What is architectural distortion (malignant breast cancer sign)?
Compression of surrounding tissues, obliteration of tissue planes, thickening or straightening of Coopers ligaments, changes in ductal patterns.
What classifies skin thickening (malignant breast cancer sign)?
> 2mm (skin in periareolar area can be >4mm)
What does oedema (malignant breast cancer sign) look like on US?
Appears as increased echogenicity of breast tissue and interdigitating hypoechoic lines (interstitial fluid or lymphatics).
What is skin retraction (malignant breast cancer sign)?
Concave skin surface that appears ill-defined and pulled in.
What is gynaecomastia?
Woman-like breasts seen in males.
What causes gynaecomastia?
Imbalance between estrogenic and testosterone effects at the level of the breast tissue.
What are the S+S of gynaecomastia?
Uni or bilateral subareolar thickening. or a lump.
What are the US appearances of gynaecomastia?
Retroareolar, triangular hypoechoic mass. Spider-leg branching pattern (chronic).
What is pseudogynaecomastia?
Breast enlargement from fat and not glandular tissue.
What is ductal ectasia?
Subareolar and intermediate sized ducts become dilated and filled with thick secretions.
Duct walls and periductal tissues become inflamed.
What are the S+S of ductal ectasia?
Nipple discharge
Nipple retraction
Can be asymptomatic in patients 60yo +
What are the US appearances of ductal ectasia?
Distended tubular structures with anechoic contents >2mm diameter (best demonstrated using the two-handed compression manoeuvre).
What is a galactocele?
Dilated cystic duct filled with milk
What are the S+S of a galactocele?
Painless lump that appears a few weeks/months after cessation of breast feeding (can occur during breast feeding/third trimester)
What are the US appearances of a galactocele?
Acute - anechoic from milk, simple uni or multiloculated, can have internal echoes
Older - hyperechoic or mixed solid/cystic
Where are galactoceles most commonly located?
Periphery of breast or in accessory tissue (no ducts to lead draining)
What are papillomas?
Wart-like tumours that grow in the ducts of the breast
What are the S+S of papillomas?
Unilateral nipple discharge
What are the US appearances of papilloma’s?
Isoechoic nodules that lie within ectatic fluid-filled ducts
CD present within
What are abnormal appearances of a breast implant?
Capsule becomes too thick/causes capsular contracture
Tear through the capsule
Inflamed or infected
Associated mass that’s benign or malignant
What may be the cause of a palpable lump in a patient with breast implants?
Radial folds when a patient is in a certain position
Fill valve of saline implants
What is a intracapsular breast implant rupture?
Implant shell tears and contents spills into the space between the shell and the capsule (capsule = normal fibrous capsule formed by the body to wall off foreign object)
What are the US features of an intracapsular rupture?
Stepladder sign (multiple linear hyperechoic lines stacked on top of one another)
What is an extracapsular rupture?
Tear in the capsule and the shell
What are the US features of an extracapsular rupture?
Silicone granuloma which creates a snowstorm appearance (hyperechoic and well-circumscribed anteriorly but dirty shadow posteriorly)
- Can spread over entire implant or just part of implant, or silicone can be picked up by LN’s and cause dirty shadowing
Acute - complex and cystic mass
What are US features of malignant LN’s?
> 1cm (not specific)
Abnormally round or oval
Hypervascularity
Eccentric cortical thickening
Absence of hilum
Cortical thickness difference (c/w surrounding LN’s)
What are S+S of breast malignancy?
Breast pain
Palpable abnormality
Nipple discharge which is unilateral and spontaneous
What colour is nipple discharge from ductal ectasia?
Greenish and milky
What pathology is bloody discharge associated with and why?
Periductal mastitis due to hyperaemia in duct wall and duct wall erosion