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DMST 295 Abdomen 2 > Breast Ultrasound > Flashcards

Breast Ultrasound Flashcards

1
Q

What are the risk factors for breast ultrasound? 3 (what increases it?)

A
  1. Lifestyle
  2. Hereditary factors
  3. Reproductive/ hormonal factors
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2
Q

What are some examples of lifestyle behaviours for breast ultrasound? 3

A
  1. Obesity
  2. Physical inactivity
  3. Alcohol intake
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3
Q

What are some reproductive/ hormonal factors for breast ultrasound? 5

A
  1. Older age at first brith
  2. Late menopause
  3. Menstruation at an early age
  4. BCP
  5. HRT
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4
Q

What are some indication for breast ultrasound? 10

A
  1. Complements mammography
  2. Identify and characterize an abnormality
  3. Dense breast tissue
  4. Equivocal mammogram or physical findings
  5. <30 years of age: initial
  6. Pregnant/ lactating breast
  7. Male breast
  8. Interventional guidance
  9. Breast implants
  10. Treatment planning for radiation therapy
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5
Q

What are some advantages for ultrasound for breast ultrasound? 6

A
  1. Non invasive
  2. Painless
  3. Non-ionizing
  4. Low cost
  5. Image chest wall
  6. Doppler
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6
Q

What is the anatomy of the mammary gland? 3

A
  1. Modified sweat gland
  2. Fat, glandular and fibrous tissue
  3. Three layers
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7
Q

What are the three layers of the mammary gland?

A
  1. Subcutaneous
  2. Mammary
  3. Retromammary
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8
Q

Label the image

A
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9
Q

Label the image

A
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10
Q

Where is the subcutaneous (premammary) area located?

A

Between skin and mammary fascia

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11
Q

What is the subcutaneous area?

A

Fat surrounded by connective tissue

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12
Q

Does the subcutaneous area have breast lesions?

A

No

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13
Q

What is the mammary fascia?

A

Connective tissue enveloping mammary zone

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14
Q

What is the mammary fascia continuous with?

A

Coopers ligaments

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15
Q

What supports and shape Breast?

A

Cooper’s ligaments

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16
Q

Which of the three layers is the functional layer?

A

Mammary layer

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17
Q

Which of the three layers is a fibroglandular tissue?

A

Mammary layer

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18
Q

Where is the mammary layer located?

A

UOQ and areolar region

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19
Q

How many lobes are in the mammary layer?

A

15-20 lobes

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20
Q

How is the 15-20 lobes in the mammary layer look like?

A

Variable

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21
Q

How is the 15-20 lobes of the mammary layer arranged?

A

Radially

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22
Q

What are the 15-20 lobules consistent of? 3 (What are they composed of)

A
  1. Ducts
  2. Stroma
  3. Acinus
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23
Q

How many lobules are located in the mammary layer?

A

20-40 lobules per lobe

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24
Q

Where are the acini located?

A

In the lobules

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25
What are the acini?
Milk producing glands
26
What does the ducts (lactiferous) in the mammary layer drain (what ducts)
Drain acini, lobules, lobes
27
What does the ducts (lactiferous) of the mammary layer converge towards?
Nipples > Lactiferous sinus
28
What is the TDLU?
Functional unit of the mammary layer
29
What does the TDLU consist of ?
Lobule and extralobular terminal duct
30
How big is the TDLU?
1-2 mm
31
What is the site of most major breast pathology?
TDLU
32
Label the image
33
What is the tail of Spence?
Mammary tissue extending into the axilla region
34
Label the image
35
What is the retromammary layer?
Deepest layer, thin
36
What does the retromammary layer consist of? 3
1. Fat 2. Blood vessel 3. Lymphatics
37
What is the nipple?
Fibromuscular papilla projecting form the center of the breast
38
What is a inverted nipple?
Normal variant
39
How many openings are in nipples?
Multiple openings
40
What is the areolas?
Pigmented area around the nipple with sebaceous glands (bumpy appearance)
41
What is the pectoral is major located in relation to th retromammary layers?
Posterior to retromammary
42
What is the pectoralis minor covered by?
Pec major
43
What is the vascular supply for the breast? 3
1. Lateral thoracic 2. Internal mammary 3. Intercostal arteries
44
What does the Venous drainage of the breast consist of? (For lymph)
Deep and superficial network
45
What is the lymph flow of the breast? (Where it flows to?)
Flows to axilla
46
Where does the lymph supply in the breast originate?
In the connective tissue of lactiferous ducts
47
What has frequent invasion with Br.Ca?
Lymph nodes
48
What is the primary function of breasts?
Produce and secrete milk
49
Age and stage of breast function influence what?
The amount of parenchyma and stroma
50
What hormones are found in the breast? 4
1. Estrogen 2. Progesterone 3. Prolactin 4. Oxytocin
51
What does progesterone do in the breasts?
Stimulates development of lobular cells
52
What does prolactin do in the breast?
Stimulates milk production
53
What does oxytocin do in the breast?
Causes milk ejection from lactating breast
54
What does estrogen do in the breast?
Promotes growth of ductal tissue
55
What is the physiology of prepubescent breasts?
1. Rudimentary ducts 2. Tissue developing under nipple, little fat
56
What is the physiology of the young adult? 2
1. Fibroglandular tissue (Dense) 2. Minimal fat
57
What is the physiology of the adult?
Fibroglandular = fat
58
What is the physiology of the pregnant/ lactating breast?
Mostly glandular/ prominent ducts
59
What is the physiology of the older breast?
Increase fat
60
What is the physiology of the menopause breast?
Parenchyma beneath nipple and UOQ
61
What is the physiology of the postmenopause breast?
Fatty tissue
62
What can ultrasound identify in the breast? 10
1. Skin 2. Nipple 3. Subcutaneous fat 4. Parenchyma 5. Lactiferous ducts 6. Cooper’s ligaments 7. Retromammary layer 8. Muscles 9. Ribs 10. Nodes
63
What is the sonographic appearance of the skin?
1. 2 thin echogenic lines 2. 2-3 mm
64
What is the sonographic appearance of the nipple? Does it shadow?
1. Homogenous medium level 2. Posterior shadowing
65
What is the sonographic appearance of the subcutaneous fat? Does it extend past the nipple? How much does one have?
1. Amount varies 2. Does not extend posterior to nipple 3. Hypoechoic, thin echogenic strands, edge artifact
66
What is the sonographic appearance of the parenchyma? 3 (compared to fat, what of the interspersed fat, ducts)
1. Homogenous, echogenic compared to fat 2. Interspersed hypoechoic zones (Fat) 3. Ducts - hypoechoic/ anechoic tubular structure
67
What is the sonographic appearance of the cooper ligaments?
Curved echogenic striations encasing hypoechoic fat lobules
68
What is the sonographic appearance of the retromammary layer?
Hypoechoic due to fat, anterior to muscle
69
What is the sonographic appearance of the pectoralis muscle?
Medium to low level echoes, striated
70
What is the sonographic appearance of the ribs? 2 (lateral, medial cartilage)
1. Lateral ribs - acoustic shadowing 2. Medial cartilage - hypoechoic
71
Where are the nodes located? How big are they? What is the sonographic appearance of the nodes?
1. In axilla and parenchyma 2. <1cm 3. Oval, hypoechoic, echogenic hilum
72
What transducer should we use for breast ultrasound?
Highest frequency tranducer
73
How should position the patient? 3
1. Supine or slightly obliqued 2. Prop patient with cushion of foam wedge 3. Ipsilateral arm placed above head
74
How much pressure should we use for breast exams? How should we adjust pressure?
1. Moderate pressure 2. Adjust to penetrate to breast wall
75
How many planes should we scan the breast?
2 planes
76
How should we measure lesions in the breast?
1. In two orthogonal planes 2. Sagittal and transverse 3. Radial/ anti radial
77
What does this image demonstrate?
1. Quadrant and clock-face annotation 2. Transducer scan planes
78
What doe we scan the axilla for?
Nodes
79
When scanning the nipple, what do we do? How do we angle?
1. Place probe adjacent to the nipple 2. Angle retroareolar
80
How should we label the breast exams? 4
1. Right or left 2. Quadrants 3. O’clock 4. Plane (sag/ trans, rad/ ARad)
81
Label the quadrants
82
What BIRADS stand for?
Breast imaging reporting and data system
83
What is BIRADS
1. A standardized form of reporting and documenting breast lesions 2. Risk categorization
84
What does BIRADS classifies?
Lesions according to suspicion of breast cancer
85
What are the different levels of BIRADS?
86
What are some abnormalities in the breast exams? 4
1. Benign 2. Malignant 3. Augmented Breast 4. Gynecomastia
87
Which demographic of individuals are affected by breast cyst?
35-50
88
How are cysts common formed in the breasts
Obstructed ducts
89
How does cysts feel like?
Palpable and round
90
How many cysts are commonly seen?
Single/ multiple
91
What is the size of cysts?
Variable size that can change with compression
92
What does this image demonstrate?
Simple cyst in a mammogram and a ultrasound
93
What does complex cysts look like sonographically? 3
1. Low level echoe s 2. Septations 3. Posterior enhancement
94
What are acorn cyst? (how they look?)
Cysts that display a non-dependent echogenic layer
95
What is the most common benign solid tumor in the breast?
FIbroadeomas
96
When does fibroadenomas form?
In adolescence
97
What is fibroadenomas stimulated from? What can make them grow
Estrogen and may increase in size with pregnancy and HRT
98
What is the size and shape of fibroadenomas? 2
1. Variable size 2. Variable shape
99
Are fibroadenomas unilateral or bilateral? And how do they feel?
1. Unilateral/ bilateral 2. Palpable, painless and mobile
100
What does this image demonstrate?
Fibroadenomas. Notice the
101
What is cystosarcoma phylloides referred to?
Giant fibroadenoma
102
How common is cystosarcoma phylloides?
Rare
103
Is Cystosarcoma phylloides benign or malignant?
Typically benign but malignant transformation possible
104
Which demographic of individuals are affected by cystosarcoma phylloides?
Individuals that are 40-50 years
105
What is cystosarcoma phylloides similar to?
Fibroadenomas except it is larger and more Lobulated
106
Which pathology rapidly increases in size?
Cystosarcoma phylloides
107
What is this an example of?
Cystosarcoma Phylloides
108
What are lipomas?
Asymptomatic benign fatty tumor
109
Which demographic of individuals are affected by lipoma?
Middle aged/ postmenopausal patient
110
Lipomas can be what type of mass? (what does it look like)
Hypoechoic mass
111
What are defined as margins?
Lipomas
112
What is this an image of?
Lipoma
113
What is fat necrosis?
Hemorrhage or liquefaction of fatty area
114
What does fat necrosis lead to?
Leads to necrosis
115
What causes fat necrosis? 3
1. Trauma 2. Surgery 3. Inflammation
116
Fat necrosis forms what?
Dense scar or cysts (lipid cysts)
117
The fat necrosis area may do what eventually?
Calcify
118
How might a fat necrosis feel? 3
1. Firm nodule 2. Skin retraction 3. Nipple inversion
119
How might a fat necrosis look like? 3
1. Irregular hpoechoic 2. Complex mass 3. May shadow
120
What does this image demonstrate?
Fat necrosis
121
What is a papilloma?
1. Benign solid masses in lining of ducts, can also develop in a cyst
122
What is the most common cause of blood nipple discharge?
Papilloma
123
Where is a papilloma located?
Near nipple
124
What kind of lesion is a papilloma?
Solid lesion in a duct or cyst
125
Papillomas are possible_______ near mass
Ductal ectasia
126
What are vascular stalks?
Papillomas
127
What does the arrows point to?
Papilloma
128
How common are fibrocycstic change?
Common
129
How do fibrocystic cyclic changes present like in breast tissue?
Exaggerated cyclic changes in breast tissue
130
What does the cells in fibrocystic changes do?
Cells proliferate and retain water
131
Which quadrant are fibrocystic changes located?
Typically UOQ
132
What does fibrocystic changes look like sonographically? 3
1. Multiple cysts 2. Echogenic tissue 3. Small nodules
133
What are some sign and symptoms of fibrocystic changes? 3
1. Lymph, swollen, painful breasts, modularity 2. Nipple discharge 3. Mammographies changes
134
What are galactocele? Where are they located in relation to the areola?
1. Obstructed lactiferous duct 2. Retroareolar
135
What does Galactocele often lead to?
Mastitis
136
H what does galactocele look like on U/S? 3
1. Well-defined cystic mass 2. Less posterior enhancement 3. Internal debris
137
What does this image demonstrate?
Galactocele
138
What is duct ectasia?
Asymptomatic tubular hypoechoic structure converging toward nipple (>8mm)
139
Who does duct ectasia usually affect?
Lactating patients and >50 years of age
140
What can duct ectasia lead to?
Mastitis
141
What is mastitis?
Breast inflammation (focal or diffuse)
142
When is mastitis common?
During lactation
143
Why is mastitis bad?
Obstruction leads to bacterial infection
144
What can develop due to mastitis?
Abscess?
145
What are some signs and symptoms of Mastitis? 3
1. Hot, red, tender breast, fever 2. Palpable mass 3. Nipple discharge
146
What does acute inflammation/ infections look like in breast tissue? 5
1. Irregular fluid collection with debris 2. Loss of tissue definition (edematous) 3. Complex collection/ shaggy wall 4. Septations 5. Posterior enhancement
147
What does this image demonstrate?
Acute inflammation/ infection
148
What does nipple discharge include in terms of ethologies?
Both low and high risk ethologies
149
What are some low risk nipple discharge ethologies? 3
1. Bilateral, multiple duct orifices 2. Milk or greenish 3. Fibrocystic change or duct ectasia
150
What are high risk nipple discharge? What is needed to analyze?
1. Unilateral, spontaneous, clear, bloody, serous 2. Galactogram procedure
151
What do we assess for breast malignancies?
Assess breasts lesions for malignant characteristics
152
What are some malignant lesions categorizations? 2
1. Location 2. Invasiveness
153
Where are locations of malignant lesions? 2 (location as in tissue)
1. Ductal 2. Lobular
154
What are malignancies invasiveness? 2
1. Non-invasive (in-situ) 2. Invasive (infiltrative)
155
What are the assessment criteria for breast exams? 8
1. Shape, size, number 2. Orientation 3. Location (UOQ common) 4. Margins 5. Echogenicity/ Echotexture 6. Internal echo content (cystic/ solid) 7. Shadowing or enhancement 8. Effect on surrounding tissue
156
What are some malignant characteristics? 9
1. Hypoechoic 2. Taller than wide 3. Angled margins/ speculations 4. Heterogenous 5. Posterior shadowing 6. Thick echogenic rim or halo 7. Ductal extension 8. Micorlobulations 9. Calcifications
157
What are some malignant characteristics? 9
1. Hypoechoic 2. Taller than wide 3. Angled margins/ speculations 4. Heterogenous 5. Posterior shadowing 6. Thick echogenic rim or halo 7. Ductal extension 8. Micorlobulations 9. Calcifications
158
What are some secondary findings examples? 6
1. Skin changes 2. Inverted nipple 3. Axillary or intramammary lymph nodes 4. Dilated ducts 5. Highly echogenic surrounding tissue 6. Thickened Cooper’s ligaments
159
What are some types of non invasive carcinomas? 2
1. DCIS 2. Lobular carcinoma in Situ
160
What does DCIS stand for?
Ductal carcinoma in Situ
161
What are examples of infiltrating (invasive) Carcinomas? 3
1. Infiltrating ductal 2. Infiltrating lobular 3. Intracystic papillary carcinoma in Situ
162
Where does ductal carcinoma in Situ arise from?
Ducts
163
What is the most common noninvasive tumor?
DCIS
164
When does DCIS typically arise?
Postmenopausal
165
What does DCIS usually present with? 2
1. **Microcalcifications in 80%** 2. Nipple discharge
166
Which non-invasive carcinoma is not a cancer?
Lobular carcinoma in Situ
167
When does lobular carcinoma in Situ have a increased incidence?
In reproductive years
168
How common is intracystic papilllary carcinoma in Situ?
Rare
169
Which demographic is usually afflicted with Intracystic papillary carcinoma in Situ?
Middle age females
170
What does intracystic papillary carcinomas in Situ look like sonographically?
Well defined, mobile mass
171
What is the most common type of invasive carcinoma?
Invasive ductal carcinoma
172
What does invasive ductal carcinomas present like? 4
1. Hard 2. Stationary 3. Painless 4. Palpable mass
173
Where is Invasive ductal carcinomas located commonly? (quadrant)
UOQ
174
What does Invasive ductal carcinomas present with? 2
1. Microcalcifications 2. Spiculations
175
How often is the incidence rate of invasive lobular carcinomas?
8-13%
176
What is the most frequently missed cancer?
Invasive lobular carcinoma
177
Invasive lobular carcinoma development is commonly where?
Secondary primary in opposite breast
178
What does the nipples look like with invasive lobular carcinoma?
Nipple retraction
179
Is it hard to detect invasive lobular carcinoma?
Difficult to detect with mammogram and clinically
180
What invasive tumor is rare, fast growing, affects middle aged women, and looks like a fibroadenoma?
Medullary
181
What is a mutinous tumor? How common is it? Who does it affect? 3
1. Rare 2. Slow growing invasive tumor 3. Affects older women
182
What are papillary tumours? Who’s does it affect? 2
1. Invasive tumours 2. Postmenopausal women
183
What is a common sign for papillary tumours?
Blood nipple discharge
184
Where is papillary tumours located? (area)
Central breast area
185
What is the prognosis like for papillary muscles?
Good
186
What are augmented/ implanted breasts made of?
Saline or silicone
187
Where are implants placed?
Placed anterior or posterior to pectoralis muscle
188
How easy is it to evaluate augmented breasts with mammography?
Difficult
189
If mammography has a hard time doing breast exams on implants what should we do?
Use ultrasound
190
What are come concerns with Implants? 3
1. Contracture 2. Obscures normal breast tissue on mammo 3. Leakage or rupture
191
What does implants look like sonographically? 2
1. Relative echo free oval posterior to breast tissue 2. Anterior reverberation Normal
192
Label the image
193
What are things we see in the normal implant? 2
1. Radial folds 2. Fill valves
194
Radial folds are dependent on what?
Anterior folds and patient position
195
When/ would we see fill valves? 2
1. With saline implants 2. Posterior to nipple typically
196
How do fill valves feel?
Palpable
197
What are two types of leakages with silicone implants? 2
1. Intra-capsular 2. Extra capsular
198
What does intravascular leaks look like? 3
1. Tear in shell 2. Gel between the capsule and shell 3. **Step ladder sign**
199
What is this an example of?
Intracapsular rupture
200
What is this an example of?
Extracapsular rupture
201
What does extra-capsular leaks look like?2
1. Tear through the shell and capsule 2. Snowstorm appearance
202
Where do silicone bleeds happen?
In silicone implants
203
What are silicone bleeds? Does it migrate anywhere?
1. Microscopic leak contained in fibrous capsule 2. Migrates to lymph nodes
204
What does silicone bleeds results in?
Lymphadenopathy
205
What is this an example of?
Silicone bleeds
206
What does contractures look like?
Capsule should be larger than the implant and flexible
207
With contracture, the fibrous capsule does what?
Contracts and constricts, disfiguring the breast
208
What is gynecomastia? 2
1. Male breast enlargement 2. Abnormal proliferation of glandular tissue and increased subcutaneous fat
209
What is gynecomastia linked to? 3
1. Estrogen and androgen use 2. Drugs for hypertension and depression 3. Estrogenic neoplasms
210
How solid is the link to breast cancer for gynecomastia?
Unclear
211
What does gynecomastia look like? 3
1. Enlarged breast 2. Palpable firm mass under nipple 3. Pain/ tenderness
212
What is the ultrasonic appearance of gynecomastia? 3
1. Triangular area of hypoechoic glandular tissue under areolar region 2. Ducts converging toward nipple 3. Increased fat
213
What is this an example of?
Gynecomastia

DMST 295 Abdomen 2 (8 decks)

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