Breast US

Question 1

zones of breast tissue

Answer 1

subcutaneous/premammary zone
mammary zone (ducts/TDLU, fat, fibrous tissue, cooper’s ligament)
retromammary zone: fat

Question 2

epidermal inclusion cyst

Answer 2

arise from hair follicle (keratinous debris)

circumscribed lesion with variable echotexture depending on debri; can be confidently diagnosed when within the echogenic dermis

Question 3

sebaceous cyst

Answer 3

arise from outer sheath of hair follicle

identical to epidermal inclusion cyst; can be confidently diagnosed when within the echogenic dermis

Question 4

hypodermis lesions (subcutaneous fat)

Answer 4

papilloma, fibroadenoma, breast cancer

Question 5

US findings that can help determine if it is a dermal lesion

Answer 5

1) claw of dermal tissue around lesino

2) tract connecting lesion to epidermal skin surface

Question 6

parechymal breast fat is _____ on US

Answer 6

hypoechoic

Question 7

scan planes in breast US

Answer 7

radial/antiradial scanning

transverse/longitudinal

Question 8

mandatory annotations on breast US

Answer 8

side, clock face position, d-stance from nipple, orientation (radial/antiradial; transverse/longitudinal) or graphic notations

Question 9

BIRADS lexicon for US mass shape

Answer 9

oval, round, irregular

Question 10

orientation for US mass

Answer 10

parallel or non-parallel (taller than wide)

Question 11

BIRADS lexicon for US margins

Answer 11

circumscribed, indistinct, angular (sharp corners), microlobulated (serrated edges), spiculated

Question 12

BIRADS lexicon for internal echo pattern

Answer 12

anechoic, hypoechoic, isoechoic, hyperechoic, complex

Question 13

BIRADS lexicon for lesion boundary

Answer 13

abrupt interface: clean demarcation between lesion/tissue

echogenic halo: echogenic transition zone (cancer, abscess)

Question 14

BIRADS lexicon for US mass, posterior aoustic features

Answer 14

enhancement/posterior through transmission: column of increased echogenicity deep to mass (common with simple cyst)

shadowing: attenuation of sound beam as it passes through lesion (fibrosis, neoplastic desmoplastic reaction, surgical scar)

no posterior acoustic features

combined pattern (adenoma with coarse shadowing calcifications)

Question 15

US features of benign mass

Answer 15

lack of malignant findings
marked hyperechogenicity (relative to fat)
circumscribed margins
parallel orientation to skin (wider than tall)
ellipsoid shape
few gentle macrolobulations
thin echogenic pseudocapsule

Question 16

US features of malignant mass

Answer 16

spiculated margins
non-parallel/taller than wide 
angular/microlobulated margins
posterior shadowing
markedly hypoechoic echotexture
associated calcifications
lesion boundary with wide zone of transition

Question 17

US features of indeterminate ultrasound features

Answer 17

lesion size
iso/mild hypoechogenicity
posterior acoustic enhancement
heterogenous/homogenous texture

Question 18

BIRADS 3 US lesions

Answer 18

complicated cyst/clustered microcysts

oval, hypoechoic, circumscribed parallel mass (fibroadenoma)