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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
What changes happen to the breast post menopause?
Progressive atrophy of lobules and ducts | Fatty replacement of glandular tissue
26
What happens to the breast during pregnancy?
Enlarged lobules Acini are dilated Epithelium vary from cuboidal to low columnar
27
What happens to the breast during lactation?
Acini distended with milk | Thin septa between lobules
28
What diagnostic methods are used in breast pathology?
Imaging - mammograohy and ultrasound Fine needle aspiration cytology Core biopsy
29
What techniques are used in breast imaging?
``` Mammography Ultrasound MRI Nuclear Medicine Image guided techniques CT, molecular imaging, transillumination, termography Breast Screening Programme ```
30
What standard views are used in mammography?
Mediolateral oblique | Craniocaudal
31
What patients are eligible for mammography
``` Over age 40 Under 40 if -strong suspicion of cancer -family history risk greater than 40% Radiation dose is 1mSv ```
32
What is the presentation of cancer on a mammogram?
``` Mass Asymmetry Architectural distortion Calcifications Skin changes ```
33
What does a malignant soft tissue mass look like on mammography?
Irregular, illdefined Spiculated Dense Distortion of architecture
34
What does a benign soft tissue mass look like on mammography?
Smooth/Lobulated Normal density Halo
35
What are the benefits of using ultrasound in breast imaging?
Differentiate solid from cystic/benign from malignant No radiation Improves specificity of imaging
36
What is first line breast imagine for women under 40?
Ultrasound
37
What does a solid benign mass look like on ultrasound?
Smooth outline Oval shape Acoustic enhancement Orientation
38
What does a malignant mass look like on ultrasound?
Irregular outline Interrupting breast architecture Acoustic shadowing Anterior halo
39
What makes up the components of the triple assessment in breast examination?
Clinical examination Imaging FNA cytology
40
What types of image guided needle biopsies are used in breast sampling?
Stereotactic (upright or prone table) Ultrasound (guided or freehand) FNA & Core biopsy
41
List indications of breast MRI
Recurrent disease Implants Indeterminate lesion following triple assessment Screening high risk women
42
List some advantages of breast MRI
Sensitivity 94-98% for all breast density | Great problem solving tool
43
List some disadvantages to breast MRI
Specificity is poor Claustrophobic, noisy, lengthy, IV contrast Expensive
44
What is involved in sentinel node sampling?
- Peritumoral injection of 99m Tc sulphur colloid +/- isosulphan blue dye - Lymphoscintigraphy - Intraoperative gamma probe - Single lymph node removal
45
Which women are involved in breast screening?
Women 50-70 invited every 3 years for mammography
46
How are cells obtained in breast cytology?
Fine Needle Aspiration Direct smear from nipple discharge Scrape of nipple with scalpel
47
In what situations would cytology play a role in breast assessment?
- As part of a 'Triple Assessment' in symptomatic clinic | - Breast screening in asymptomatic women
48
How may a palpable breast mass present in a symptomatic patient?
``` Discrete mass (solid/cystic) Diffuse thickening Nipple lesion (discharge, eczematous skin) ```
49
List some important considerations for FNA
Patient -Informed of procedure, comfort, chaperone Safety -Wear gloves/handwashing Dispose of needle Care handling fresh material/infection risk
50
What are some histological features of a benign breast cytology?
``` Low/ moderate Cellularity Cohesive groups of cells Flat sheets of cells Bipolar nuclei in background Cells of uniform size Uniform chromatin pattern ```
51
What are some histological features of a malignant breast cytology?
``` High cellularity Loss of cohesion Crowding/overlapping of cells Nuclear pleomorphism Hyperchromasia Absence of bipolar nuclei ```
52
What system is used for cytology scoring?
``` C1 - Unsatisfactory C2 - Benign C3 - Atypia (probably benign) C4 - Suspicious (probably malignant) C5 - Malignant ```
53
In what situation may aspiration be curative?
Cysts
54
What happens to the fluid in cyst aspiration?
Discarded unless bloodstained/residual mass
55
What are the advantages of cytology?
Simple procedure - can be done at clinic Well tolerated Inexpensive Immediate results
56
What are the limitations of cytology?
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
List some complications of FNA?
Pain Haemamtoma Fainting Infection, pneumothorax
58
When would core biopsy of breast tissue be indicated?
All cases with clinical/radiological/cytological suspicion Breast screening Pre-op classification Rarely open biopsy
59
What is core biopsy used for?
Confirm invasion Tumour typing/grading Immunohistochem - receptor status
60
What term refers to an extra breast?
Polymastia
61
What term refers to an extra nipple?
Polythelia
62
What term refers to an absence of breast?
Amastia
63
What term refers to an absence of nipple?
Athelia
64
What is colostrum?
Protein rich fluid, available few days after birth, rich in maternal antibodies
65
What substances are contained in breastmilk and not formula?
``` Immunoglobulins Viral Fragments White Cells Enzymes Oligosaccharides Bifidus Factor Hormones Anti-inflammatory cells Nucleotides Transfer Factors ```
66
What risks are increased in not breastfeeding for babies?
``` Gastroenteritis Respiratory Infections Allergies Obesity Type 1 and 2 diabetes SIDS NEC ```
67
Where may breast cancer spread to locally?
Skin | Pectoral muscles
68
Where may breast cancer spread to lymphatically?
Axillary nodes | Internal mammary nodes
69
Where may breast cancer spread to via blood?
Bone Lungs Liver Brain
70
What factors may help to indicate prognosis in breast cancer?
- 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
What receptor types are good indicators of response to hormonal therapies in breast cancer?
Estrogen/Progesterone receptor (If present, strong predictor of response.) HER-2 - Herceptin response in 20-30% positive
72
What are the five molecular subtype classifications in breast cancer?
``` ER + luminal A Luminal B Basal-like HER-2+ Normal ```
73
What disciplines may be involved in management of breast cancer?
- Breast surgeon - Radiologist - Cytologist - Pathologist - Clinical Oncologist - Medical Oncologist - Nurse counsellor - Psychologist - Reconstructive Surgeon - Patient and partner - Palliative care
74
What are some complications of axillary treatments in breast cancer?
``` Lymphoedema Sensory disturbance Decrease ROM of the shoulder joint Nerve damage Vascular damage Radiation-induced sarcoma ```
75
What factors are associated with increased risk of disease recurrence in breast cancer?
``` Lymph node involvement Tumour grade Tumour size Steroid receptor status (ER/PR neg) HER2 status (HER2 pos) LVI-lymphovascular invasion ```
76
What are some systemic adjuvant treatments in breast cancer?
Hormone therapy Chemotherapy Targeted therapies
77
What are some complications of radiotherapy in breast cancer?
Skin telangiectasis Radiation pneumonitis Cutaneous Radionecrosis Angiosarcoma
78
What is the mechanism of action of Tamoxifen?
Blocks directly on ER receptor
79
What is the mechanism of action of aromatase inhibitors (eg Arimidex) in breast cancer treatment?
Inhibits ER synthesis | Should only be used in postmenopausal women

Reproduction (15 decks)

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