Breast WB & IMAGES Flashcards
glandular (milk-producing) component of the breast lobule.
acinus (acini)
overgrowth of the stromal and epithelial elements of the acini within the terminal ductal lobular unit (TDLU) of the breast; a component of a fibrocystic condition
adenosis
without echoes
anechoic
plane of imaging on ultrasound of the breast that is perpendicular to the radial plane of imaging.
antiradial
the pigmented skin surrounding the breast nipple
areola
without symptoms
asymptomatic
abnormal proliferation of cells with atypical features involving the TDLU, with an increased likelihood of evolving into breast cancer
atypical hyperplasia
armpit
axilla
differentiated apocrine sweat gland with the functional purpose of secreting milk during lactation
breast
involves two main types of cells: ductal and lobular
breast cancer
screening for breast cancer involves annual screening mammography (starting at age 40), monthly breast self-examination (BSE), and regular clinical breast examination (CBE)
breast cancer screening
trademark system created by the American College of Radiology (ACR) to standardize mammographic reporting terminology; to categorize breast abnormalities according to the level of suspicion for malignancy; and to facilitate outcome monitoring
breast imaging reporting and data system (BI-RADS)
part of breast cancer screening; every woman is encouraged to perform breast self-examination monthly starting at age 20; BSE is usually best performed at the end of menses
breast self-examination
examination of the breast by a health care provider as part of breast cancer screening
clinical breast examination
connective tissue septa that connect perpendicularly to the breast lobules and extend out to the skin; considered the fibrous “skeleton” supporting the breast glandular tissue
Cooper’s ligaments
fluid-filled sac of variable size
cyst
common diagnostic and interventional breast procedure that involves placing a needle through the skin of the breast into a cystic mass and pulling fluid out of the cyst through the needle.
cyst aspiration
also called consultative, workup, or problem-solving mammography or breast imaging; this type of breast imaging examination is more intensive than routine screening mammography
diagnostic breast imaging
most common benign solid tumor of the breast, consisting predominantly of fibrous and epithelial (adenomatous) tissue elements.
fibroadenoma
also called fibrocystic change or fibrocystic breast, this condition represents many different tissue processes within the breast that are all basically normal processes, which in some patients become exaggerated to the point of raising concern for breast cancer.
fibrocystic condition
refers to vibrations produced by phonation and felt through the chest wall during palpation; a technique used in conjunction with power Doppler to identify the margins of a lesion
fremitus
hypertrophy of residual ductal elements that persist behind the nipple in the male
gynecomastia
echo texture that is more echogenic than the surrounding tissue
hyperechoic
having relatively weak echoes.
hypoechoic
cancer of the ductal epithelium; most common general category of breast cancer, accounting for approximately 85% of all breast cancers
infiltrating (invasive) ductal carcinoma
cancer of the lobular epithelium of the breast, arises at the level of the TDLU; accounts for 12% to 15% of all breast cancers
infiltrating (invasive) lobular carcinoma (ILC)
echo texture that resembles the surrounding tissue. In the breast, isoechoic masses can be difficult to identify
isoechoic
near the chest wall (thorax)
juxtathoracic
the middle of three layers of breast tissue recognized on breast ultrasound between the skin and the chest wall that contains the ductal, glandular, and stromal portions of the breast
mammary layer
breast cancer that occurs in different quadrants of the breast at least 5 cm apart.
multicentric breast cancer
cannot be felt on clinical examination; a _____breast mass is one that is usually identified on screening mammogram and is too small to be felt as a breast lump on BSE or CBE
nonpalpable
surface erosion of the nipple (reddened area with flaking and crusting) that results from direct invasion of the skin of the nipple by underlying breast cancer
Paget’s disease
can be felt on clinical examination; a palpable breast lump is one that is identified on CBE or BSE
palpable
French term that means skin of the orange; descriptive term for skin thickening of one breast that, on clinical breast examination, resembles the skin of an orange.
peau d’orange
plane of imaging on ultrasound of the breast
radial
deepest of the three layers of the breast noted on breast ultrasound
retromammary layer
a normal extension of breast tissue into the axillary or armpit region
tail of Spence
smallest functional portion of the breast involving the terminal duct and its associated lobule, containing at least one acinus
terminal ductal lobular unit (TDLU)
most superficial of the three layers of the breast identified on breast ultrasound
subcutaneous layer
represents the first lymph node along the axillary node chain
sentinel node
finger-like extension of a malignant tumor
spiculation
Form of fibrocystic change in which the epithelial cells of the acini undergo alteration
aporine metaplasia
shows some, but not all, of the features of lobular carcinoma in situ
atypical lobular hyperplasia
the pathologist recognizes some, but not all, of the features of ductal carcinoma in situ
atypical ductal hyperplasia
neither considered a true cancer nor treated as such
lobular carcinoma in situ
term preferred by many authers to replace LCIS and atypical hyperplasia
lobular neoplasia
breast cancer occurring in different quadrants of the breast at least 5 cm apart
multicentric breast cancer
The breast is a modified ________ gland located in the superfical fascia of the anterior chest wall.
sweat
sonographically the breast is divided into three layers located between the skin and the pectoralis major muscle on the anterior chest wall. These layers are the ________ layer, the _________ layer, and the _________ layer.
subcutaneous, mammary, retromammary
Fat is the least ________ tissue within the breast.
echogenic
The fatty tissue appears _______, whereas the ducts, glands, and supporting ligaments appear echogenic.
hypoechoic
The ________ quadrant of the breast contains the highest concentration of lobes.
upper outer
Each lobe contains _______ (milk-producing glands) that are clustered on the terminal ends of the ducts like grapes on a vine.
acini
The ________ muscle lies posterior to the retromammary layer.
pectoralis major
The _________ tissue can situate itself in and among the areas of glandular tissue, and in some scanning planes it can mimic isoechoic or hypoechoic masses.
adipose or fatty
Sonographically, cancers can be difficult to differentiate in the fatty breast because most cancers appear _______ and can be difficult to differentiate from the normal breast tissue.
hyopechoic
The main arterial supply to the breast comes from the internal ________ and the lateral ________ artery.
mammary, thoracic
Lymphatic drainage from all parts of the breast generally flows to the _______ lymph nodes.
axillary
The primary function of the breast is _______ transport .
fluid
The _______ system is critical in the transport of fluids within the breast.
ductal
An important function during the reproductive years is for the breast to make ______ from nutrients and water taken from the bloodstream.
milk
Milk is produced within the ________ and carried to the nipple by the ducts.
acini
Breast development begins before _________ and continues until the patient is approximately 16 years old.
menarche
During pregnancy, acinar development is accelerated to enable milk production by estrogen, _________, and prolactin.
progesterone
During this time of development, the ductal system proliferates under the influence of ________.
estrogen
The hormone produced by the pituitary gland that stimulates the acini to produce and excrete milk is called _______.
prolactin
The expulsion of the placenta after birth of a baby causes a drop in circulating progesterone, initiating ______ production within the breasts.
milk
The physical stimulation of suckling by the baby initiates the release of ________ (produced by the hypothalamus and released by the pituitary gland), which further incites prolactin secretion, stimulating additional milk production.
oxytocin
Full maturation of the acini occurs during lactation and is thought to be mildly protective against the development of breast _______.
cancer
Ultrasound may be used for screening purposes in ______ breasts that are _______ and difficult to penetrate by mammography, to evaluate palpable masses that are not visible by mammogram, and to image the deep juxtathoracic tissues not normally visible by mammography.
young, dense
Ultrasound is also useful in __________ structures within uniformly dense breast tissue where mammography is limited (e.g., in differentiating solid, round masses from fluid-filled cysts and visualizing tissue adjacent to implants or other structures that limit visualization by mammography).
differentiating
A(n) ) _______ aspiration can be performed to determine whether a lesion is a complex cyst or truly a solid mass.
cyst
Pertinent clinical information that should be provided by the referring physician includes size and location of the lump, when it was noticed, and its relation to the _______.
menstrual cycle
A dominant cyst is frequently ________ or ______ (long axis toward nipple), smooth, soft (some cysts under tension cab be firm and usually very tender), and easily movable.
round, oval
Fibroadenomas are usually similar in shape, but they are often quite firm and rubbery in consistency and _________ on ultrasound.
homogeneously solid
Breast cancer is usually lobular or _________ in shape, uneven in surface contour (sometimes gritty in texture), and fixed or poorly movable.
irregular
Most breast masses that arise during the adolescent years are ________.
fibroadenomas
A(n) __________ implant rupture occurs when there is a breach of the membrane surrounding an implant, but the silicone that leaks out is still confined within the fibrous scar tissue that forms a “capsule” around the implant.
intracapsular
As the implant collapses and the membrane folds inward, a series of discontinuous echogenic lines parallel to the face of the transducer may be seen and are referred to as the “stepladder sign” or “_________ sign.”
linguine
The use of _________ positions is unique to the breast and can often pick up subtle abnormalities extending toward the nipple along the ductal system from the mass.
radial/antiradial
________ tend to grow within the ducts and will often follow the ductal system in a radial plane, toward the convergence at the nipple.
malignances
A rounded or oval shape is usually associated with ______ lesions, whereas sharp, angular margins are associated with ________ lesions.
benign, malignant
The normal tissue planes of the breast are __________ oriented.
horizontally
Benign lesions tend to grow within the normal tissue planes, and their long axis lies ________ to the chest wall.
parallel
Malignant lesions are able to grow through the connective tissue and may have a(n) ________ orientation when imaging the breast from anterior to posterior.
vertical
If a mass measures longer in the anteroposterior dimension (________), than in either transverse or sagittal planes ( ______), the mass has a vertical orientation that is usually described as being “taller than wide” and is suspicious for malignancy.
height, width
Malignant masses will often demonstrate increased _________ within the lesion and often have a feeder vessel, which can be identified with careful evaluation.
vascularity
Lesions more common to younger women are _______ disease and fibroadenomas.
fibrocystic
Older or postmenopausal women are more likely to have _________ papillomas, duct ectasia, and cancer.
intraductal
Skin dimpling or ulceration and nipple retraction nearly always result from _______.
cancer
Benign tumors are rubbery, ________, and well defineated (as seen in a fibroadenoma), whereas malignant tumors are often stone hard and irregular with a gritty feel.
mobile
Clinical signs and symptoms of __________ include the lumps and pain that the patient feels that fluctuate with every monthly cycle. In most cases both breasts are equally involved.
fibrocystic condition
The growth of a fibroadenoma is stimulated ________.
estrogen
Sonographically, fat necrosis appears as an irregular, complex mass with low -level echoes, may mimic a(n) ________ lesion, and may appear as fat, but is separate and different from the rest of the breast parenchyma.
malignant
identify which image clearly identifies a simple cyst of the breast
A - simple cyst - well defined anechoic lesion with smooth borders and good through transmission
*image A shows the breast lesion w/out ocmpression, & image B shows lesion w/ comp. do you think breast lesion is benign or malignant/ why?
sonographic appearance ofa smooth benign -appearing mass w/ homogeneous echogenicity, wider than tall, whowing low level posterior enhancement.
B) same mass w/ compression, showing decreased anteroposterior dimension
*most benign masses are benign and compressible
*would you say this breast lesion is benign or malignant? why?
most likely malignant
heterogeneous mass w/ poorly defined and irregular borders. the lesion is higher than it is wide and this does not change with compression
*describe the following lesions of the Breast. A, B, C,D
A) cyst
B) complex
C) Fibroadenoma
D) Malignant solid mass w/ spiculation
_______ may result from infection, trauma, mechanicl obstruction in the breast ducts, or from other conditions. it often occurs during lactation, begining in teh lactiferous ducts & spreading via the lymphatics or blood
acute mastitis
an intraductal papilloma is a small _____ tumor that grows w/in the acini of the breast
benign
in ____ tissue, most cancer growth occurs along the borders
fibrotics
___ and ___ are frequently used as pathways for new tumor development.
lymphatics, blood vessels
if the tumor is ____ , it continues to grow in one area, compressing and distoroting the surrounding architecture
encapsulated
most cancer originates in the ____ ductal lobular units, whereas a smaller percentage originates in the glandular tissue
terminal
_____ refers to breast tumors that arise from the epithelium, in te ductal and glandular tissue and usually have tentacles
carcinoma
breast carcinomas are generally categorized by 2 factors; where the cancer cell originate(_______ or _____) and whether the cancer is prone to spreading (______ or______)
ductal, lobular, noninvasive, invasive
carcinomas that do not normally spread outside of th duct or lobule are called noninvasive, noninfiltrating, or ____ cancers, whereas cancers that spread into nearby tisue are said to be invasive or infiltrating
in situ
*ID # 5-7
- major duct
- duct orifice
- nipple
* ID #1-4
- Acini
- dense conective tissue
- loose connective tissue
- coopers ligaments
ID # 8-10
- areola
- Cooper’s ligaments
- subcutaneous layer
ID #13-15
- pectoralis major muscle
- Pectoralis fascia
- Fat
ID # 1-4
- main lymphatic drainage
2 periareolar
- sternm
- internal mammary nodes
ID # 11-13
- Rib
- Retromammary layer
- Pectoralis major muscle
ID # 8-10
- axillary vein
- pectoralis minor
- pectoralis major
ID # 5-7
- pectoralis major
- pectoralis minor
- interpectoral (Rotter’s ) nodes
