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Breasts Flashcards

1
Q

What kind of glands make up breast tissue?

A

Modified and highly specialised apocrine sweat glands

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2
Q

What is the vertical extent of the breast?

A

2nd/3rd-6th rib

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3
Q

What is the transverse extent of the breast?

A

Sternal edge to midaxillary line

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4
Q

What function does the retromammary space allow for?

A

Some degree of movement of the breast

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5
Q

What muscles do the breasts lie on?

A

Pectoralis major

Serratus anterior

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6
Q

What attaches the breast to the dermis?

A

Suspensory ligament of cooper

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7
Q

What is the areola?

A

Pigmented area around the nipple

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8
Q

How many lobules of glandular tissue are there in each breast?

A

15-20 lobules

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9
Q

What are the lobules of the breast drained by?

A

Lactiferous duct

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10
Q

What is the dilated portion of the lactiferous duct called?

A

Lactiferous sinus

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11
Q

What is the usual position of the nipple in males?

A

4th intercostal space

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12
Q

What types of tissue make up the nipple?

A

Collagenous dense connective tissue, elastic fibres and bands of smooth muscle

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13
Q

What glands are contained within the skin covering the nipple and areola?

A

Numerous sweat and sebaceous glands

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14
Q

What is the breast divided into for anatomical description?

A

Quadrants

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15
Q

When does temporary enlargement of male breast occur?

A

Newborn and Puberty

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16
Q

What do the breasts develop from?

A

Mammary crests/ridges appear during 4th week (from axillary to inguinal region) -» Primary mammary buds&raquo_space; Secondary buds

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17
Q

What arteries supply the breast?

A

Branches of axillary artery, internal thoracic, aome intercostal artieries.

(Thoraco acromial artery, lateral thoracic artery, internal mammary artery)

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18
Q

What are sensory/sympathetic nerves of the breast?

A

Anterior and lateral cutaneous branches of 4th-6th intercostal nerves

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19
Q

What lymph nodes drain the breast?

A

Axillary lymph nodes
(Supraclavicular/inferior cervical)
From medial quadrants ->parasternal or to opposite breast

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20
Q

What is used to locate the sentinel node in breast cancer?

A

A radolabelled colloid

Radioisotope and dye during surgery

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21
Q

What is the functional milk secretory component of the breast?

A

The terminal duct lobular unit

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22
Q

What surrounds the secretory lobules and branching ducts in the breast?

A

Connective tissue stroma (dense and fibrocollagenous)

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23
Q

What two types of cells line ducts and acini of the breasts?

A

Luminal epithelial cells

Myoepithelial cells

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24
Q

What changes happen to the breast in puberty?

A

Branching of lactiferous ducts
Development of alveoli (solid, spheroidal masses of granular polyhedral cells)
Accumulation of lipids in adipocytes

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25
Q

What changes happen to the breast post menopause?

A

Progressive atrophy of lobules and ducts

Fatty replacement of glandular tissue

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26
Q

What happens to the breast during pregnancy?

A

Enlarged lobules
Acini are dilated
Epithelium vary from cuboidal to low columnar

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27
Q

What happens to the breast during lactation?

A

Acini distended with milk

Thin septa between lobules

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28
Q

What diagnostic methods are used in breast pathology?

A

Imaging - mammograohy and ultrasound
Fine needle aspiration cytology
Core biopsy

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29
Q

What techniques are used in breast imaging?

A 
Mammography
Ultrasound
MRI
Nuclear Medicine
Image guided techniques
CT, molecular imaging, transillumination, termography
Breast Screening Programme
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30
Q

What standard views are used in mammography?

A

Mediolateral oblique

Craniocaudal

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31
Q

What patients are eligible for mammography

A 
Over age 40
Under 40 if
-strong suspicion of cancer
-family history risk greater than 40%
Radiation dose is 1mSv
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32
Q

What is the presentation of cancer on a mammogram?

A 
Mass
Asymmetry
Architectural distortion
Calcifications
Skin changes
33
Q

What does a malignant soft tissue mass look like on mammography?

A

Irregular, illdefined
Spiculated
Dense
Distortion of architecture

34
Q

What does a benign soft tissue mass look like on mammography?

A

Smooth/Lobulated
Normal density
Halo

35
Q

What are the benefits of using ultrasound in breast imaging?

A

Differentiate solid from cystic/benign from malignant
No radiation
Improves specificity of imaging

36
Q

What is first line breast imagine for women under 40?

A

Ultrasound

37
Q

What does a solid benign mass look like on ultrasound?

A

Smooth outline
Oval shape
Acoustic enhancement
Orientation

38
Q

What does a malignant mass look like on ultrasound?

A

Irregular outline
Interrupting breast architecture
Acoustic shadowing
Anterior halo

39
Q

What makes up the components of the triple assessment in breast examination?

A

Clinical examination
Imaging
FNA cytology

40
Q

What types of image guided needle biopsies are used in breast sampling?

A

Stereotactic (upright or prone table)
Ultrasound (guided or freehand)
FNA & Core biopsy

41
Q

List indications of breast MRI

A

Recurrent disease
Implants
Indeterminate lesion following triple assessment
Screening high risk women

42
Q

List some advantages of breast MRI

A

Sensitivity 94-98% for all breast density

Great problem solving tool

43
Q

List some disadvantages to breast MRI

A

Specificity is poor
Claustrophobic, noisy, lengthy, IV contrast
Expensive

44
Q

What is involved in sentinel node sampling?

A
  • Peritumoral injection of 99m Tc sulphur colloid +/- isosulphan blue dye
  • Lymphoscintigraphy
  • Intraoperative gamma probe
  • Single lymph node removal
45
Q

Which women are involved in breast screening?

A

Women 50-70 invited every 3 years for mammography

46
Q

How are cells obtained in breast cytology?

A

Fine Needle Aspiration
Direct smear from nipple discharge
Scrape of nipple with scalpel

47
Q

In what situations would cytology play a role in breast assessment?

A
  • As part of a ‘Triple Assessment’ in symptomatic clinic

- Breast screening in asymptomatic women

48
Q

How may a palpable breast mass present in a symptomatic patient?

A 
Discrete mass (solid/cystic)
Diffuse thickening
Nipple lesion (discharge, eczematous skin)
49
Q

List some important considerations for FNA

A

Patient
-Informed of procedure, comfort, chaperone
Safety
-Wear gloves/handwashing
Dispose of needle
Care handling fresh material/infection risk

50
Q

What are some histological features of a benign breast cytology?

A 
Low/ moderate Cellularity
Cohesive groups of cells
Flat sheets of cells
Bipolar nuclei in background
Cells of uniform size
Uniform chromatin pattern
51
Q

What are some histological features of a malignant breast cytology?

A 
High cellularity
Loss of cohesion
Crowding/overlapping of cells
Nuclear pleomorphism
Hyperchromasia
Absence of bipolar nuclei
52
Q

What system is used for cytology scoring?

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia (probably benign)
C4 - Suspicious (probably malignant)
C5 - Malignant
53
Q

In what situation may aspiration be curative?

A

Cysts

54
Q

What happens to the fluid in cyst aspiration?

A

Discarded unless bloodstained/residual mass

55
Q

What are the advantages of cytology?

A

Simple procedure - can be done at clinic
Well tolerated
Inexpensive
Immediate results

56
Q

What are the limitations of cytology?

A

Accuracy not 100%
-False negatives/positives

Invasion cant be assessed/grading cant be done

Small sampling (Lesion missed)

Technical - can get suboptimal smears

Interpretation

57
Q

List some complications of FNA?

A

Pain
Haemamtoma
Fainting
Infection, pneumothorax

58
Q

When would core biopsy of breast tissue be indicated?

A

All cases with clinical/radiological/cytological suspicion
Breast screening
Pre-op classification
Rarely open biopsy

59
Q

What is core biopsy used for?

A

Confirm invasion
Tumour typing/grading
Immunohistochem - receptor status

60
Q

What term refers to an extra breast?

A

Polymastia

61
Q

What term refers to an extra nipple?

A

Polythelia

62
Q

What term refers to an absence of breast?

A

Amastia

63
Q

What term refers to an absence of nipple?

A

Athelia

64
Q

What is colostrum?

A

Protein rich fluid, available few days after birth, rich in maternal antibodies

65
Q

What substances are contained in breastmilk and not formula?

A 
Immunoglobulins
Viral Fragments
White Cells
Enzymes
Oligosaccharides
Bifidus Factor
Hormones
Anti-inflammatory cells
Nucleotides
Transfer Factors
66
Q

What risks are increased in not breastfeeding for babies?

A 
Gastroenteritis
Respiratory Infections
Allergies
Obesity
Type 1 and 2 diabetes
SIDS
NEC
67
Q

Where may breast cancer spread to locally?

A

Skin

Pectoral muscles

68
Q

Where may breast cancer spread to lymphatically?

A

Axillary nodes

Internal mammary nodes

69
Q

Where may breast cancer spread to via blood?

A

Bone
Lungs
Liver
Brain

70
Q

What factors may help to indicate prognosis in breast cancer?

A
  • Tumour size/Node Status/Grade (Nottingham Prognostic Index)
  • Age
  • Lymphovascular space invasion
  • Oestrogen receptor status (Tends to be better prognosis)
  • Progesterone receptor status
  • HER-2 receptor status (Tends to be worse prognosis)
71
Q

What receptor types are good indicators of response to hormonal therapies in breast cancer?

A

Estrogen/Progesterone receptor
(If present, strong predictor of response.)

HER-2 - Herceptin response in 20-30% positive

72
Q

What are the five molecular subtype classifications in breast cancer?

A 
ER + luminal A
Luminal B
Basal-like
HER-2+
Normal
73
Q

What disciplines may be involved in management of breast cancer?

A
  • Breast surgeon
  • Radiologist
  • Cytologist
  • Pathologist
  • Clinical Oncologist
  • Medical Oncologist
  • Nurse counsellor
  • Psychologist
  • Reconstructive Surgeon
  • Patient and partner
  • Palliative care
74
Q

What are some complications of axillary treatments in breast cancer?

A 
Lymphoedema
Sensory disturbance
Decrease ROM of the shoulder joint
Nerve damage 
Vascular damage
Radiation-induced sarcoma
75
Q

What factors are associated with increased risk of disease recurrence in breast cancer?

A 
Lymph node involvement
Tumour grade
Tumour size
Steroid receptor status (ER/PR neg)
HER2 status (HER2 pos)
LVI-lymphovascular invasion
76
Q

What are some systemic adjuvant treatments in breast cancer?

A

Hormone therapy
Chemotherapy
Targeted therapies

77
Q

What are some complications of radiotherapy in breast cancer?

A

Skin telangiectasis
Radiation pneumonitis
Cutaneous Radionecrosis
Angiosarcoma

78
Q

What is the mechanism of action of Tamoxifen?

A

Blocks directly on ER receptor

79
Q

What is the mechanism of action of aromatase inhibitors (eg Arimidex) in breast cancer treatment?

A

Inhibits ER synthesis

Should only be used in postmenopausal women

Reproduction (15 decks)

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