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SONOCAN ABD Review > Breasts Notes > Flashcards

Breasts Notes Flashcards

1
Q

What are the lifestyle risk factors for breast cancer? 3

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

What are the hereditary risk factors for breast cancer?

A

Hereditary factors.

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3
Q

What are the reproductive/hormonal risk factors for breast cancer? 5

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

What are the indications for breast ultrasound? 10

A
  1. Compliments mammography
  2. Identifies and characterizes an abnormality
  3. Dense breast tissue
  4. Equivocal mammogram or physical findings
  5. Patients < 30 years of age: initial screen
  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 the advantages of ultrasound? 6

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

What is the mammary gland? 2

A
  1. A modified sweat gland composed of fatty, glandular, and fibrous tissue
  2. Three layers or zones: subcutaneous, mammary, and retromammary.
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7
Q

What is the subcutaneous (premammory) zone? Is there breast lesions that originate in this zone?

A
  1. Located between the skin and mammary fascia, containing fat surrounded by connective tissue.
  2. No true breast lesions originate in this zone.
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8
Q

What is the mammary zone? Where is this area mostly found?

A
  1. The functional layer made up of fibroglandular tissue
  2. Mostly found in the upper outer quadrant (UOQ) and areola region.
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9
Q

What are lobes in the mammary zone? How many lobes are there in the mammary zone? 2

A
  1. 15 to 20 in each breast, arranged radially
  2. Containing ducts, stroma, and acinus.
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10
Q

What are lobules in the mammary zone?

A

20 to 40 per lobe, containing individual milk-producing glands called acini.

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11
Q

What are lactiferous ducts and sinuses?

A

They drain acini, lobules, and lobes, converging toward the nipple and enlarging to form the lactiferous sinus.

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12
Q

What is TDLU? What are they the site of?

A
  1. Terminal ductal lobular unit, the functional unit consisting of a lobule and extralobular terminal duct
  2. Site of most major breast pathology.
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13
Q

What is the retromammary zone? 2

A
  1. The deepest layer, quite thin
  2. Containing fat, blood vessels, and lymphatics.
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14
Q

What is the nipple?

A

A fibromuscular papilla projecting from the center of the breast, with multiple openings and an areola surrounding it.

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15
Q

What is the vascular supply of the breast?

A

Lateral thoracic artery, internal mammary artery, and intercostal arteries.

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16
Q

What is the lymphatic drainage of the breast?

A

Flows to axillary nodes, originating in connective tissue, ducts, and under the skin.

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17
Q

What is the physiology of the breast? What is it influenced by?

A
  1. Produces and secretes milk
  2. Influenced by age and stage of breast function, with estrogen promoting ductal tissue growth and prolactin stimulating milk production.
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18
Q

What is the sonographic appearance of skin?

A

Two thin echogenic lines, 2-3 mm in thickness.

19
Q

What is the sonographic appearance of the nipple?

A

Homogenous with medium level echoes and posterior acoustic shadowing.

20
Q

What is the sonographic appearance of parenchyma?

A
  1. Homogenous
  2. Echogenic compared to fat, with interspersed hypoechoic areas of fat.
21
Q

What is the scanning technique for breast ultrasound? 3

A
  1. Use the highest frequency transducer possible
  2. Position the patient supine or slightly oblique
  3. Scan in two planes: clock face and quadrant approach.
22
Q

What is BIRADS?

A

Breast Imaging Reporting and Data System, a standardized form of reporting and documenting breast lesions, classifying them according to suspicion of breast cancer.

23
Q

What are common benign abnormalities in breast ultrasound? 7

A
  1. Cysts
  2. Fibroadenomas
  3. Cystosarcoma phyllodes
  4. Lipomas
  5. Fat necrosis
  6. Papillomas
  7. Fibrocystic changes.
24
Q

What are the characteristics of cysts?

A

Common in women 35-50 years, palpable and rounded, single or multiple, with variable size.

25
Q

What are the characteristics of fibroadenomas? 5

A
  1. Most common benign tumor in women of childbearing years
  2. Palpable
  3. Painless
  4. Mobile
  5. Various shapes and sizes.
26
Q

What is fat necrosis?

A

Hemorrhage or liquefaction of fatty area leading to necrosis, often due to trauma or surgery.

27
Q

What is a papilloma?

A

Benign solid masses in the lining of the ducts, most common cause of bloody nipple discharge.

28
Q

What are fibrocystic changes?

A

Exaggerated cyclic changes in breast tissue, typically affecting the UOQ of the breast.

29
Q

What is a galactocele? Typically located in which region? What can they lead to?

A
  1. Obstruction of a lactiferous duct in a pregnant or lactating woman
  2. Typically located in the retro-areolar region
  3. Can lead to mastitis.

Sonographically, it appears as a well-defined cystic mass with less posterior enhancement than a cyst and may contain internal debris.

30
Q

What characterizes ductal ectasia? typically in patients of what age? Is it symptomatic?

A
  1. It presents as tubular hypoechoic structures converging towards the nipple
  2. Typically in lactating patients and those over 50 years of age.
  3. Usually asymptomatic but can lead to mastitis.
31
Q

What is mastitis? 5

A
  1. Breast inflammation that typically occurs in lactating females due to obstruction of duct by milk, allowing bacteria to enter via the nipple.
  2. Trauma
  3. Radiation therapy
  4. Diabetes
  5. Immunocompromised states.

Symptoms include hot, red, tender breast, fever, palpable mass, and nipple discharge. Sonographically, it shows irregular fluid collection with debris and loss of tissue definition.

32
Q

What are the characteristics of nipple discharge? 8

A
  1. Nipple discharge can have multiple etiologies.
  2. Low-risk discharge is bilateral
  3. Involves multiple duct orifices
  4. Is milky or greenish, likely related to fibrocystic change or duct ectasia.
  5. High-risk discharge is unilateral
  6. Spontaneous
  7. Clear
  8. Bloody, or serous, warranting further investigation.
33
Q

How are malignant breast lesions categorized?

A

Malignant lesions are categorized by location (ductal or lobular) and invasiveness (non-invasive or invasive).

34
Q

What are the assessment criteria for a breast mass? 10

A
  1. Criteria include shape
  2. Size
  3. Number
  4. Orientation
  5. Location (commonly UOQ)
  6. Margins
  7. Echogenicity/echotexture
  8. Internal echo content
  9. Posterior shadowing or enhancement
  10. Effect on surrounding tissue.
35
Q

What are common sonographic characteristics of malignancy? 9

A
  1. Common characteristics include being markedly hypoechoic compared to breast tissue
  2. Taller than wide
  3. With angled irregular margins (spiculated)
  4. Heterogeneous texture
  5. Posterior shadowing
  6. Thick echogenic rim
  7. Ductal extension
  8. Microlobulations
  9. Calcifications.
36
Q

What are secondary findings associated with breast malignancy? 6

A
  1. Secondary findings may include skin changes (thickening, flattening, or retraction)
  2. Inverted nipple
  3. Axillary or intramammary lymph nodes
  4. Dilated ducts
  5. Highly echogenic surrounding tissue
  6. Thickened Cooper’s ligaments.
37
Q

What is ductal carcinoma in situ? How common is it? Typically found in which demographic? What are two symptoms?

A
  1. It arises in the ducts and is the most common non-invasive breast cancer
  2. Typically found in postmenopausal women.
  3. Symptoms may include nipple discharge and microcalcifications.
38
Q

What is lobular carcinoma in situ? When does it have an increased incidence?

A

It has an increased incidence in reproductive years and is not considered a ‘true’ cancer, but it indicates a high risk for breast cancer.

39
Q

Most common breast cancer? What is it characterized by? Where is it frequently located?

A
  1. Infiltrating (invasive) ductal carcinoma. 2. 2. Characterized by a hard, stationary, painless palpable mass
  2. Frequently located in the UOQ of the breast, often with microcalcifications and spiculations.
40
Q

What is gynecomastia? What is it linked to?

A
  1. Male breast enlargement due to abnormal proliferation of retroareolar glandular tissue and increased fat
  2. Linked to estrogen and androgen use, certain medications, and estrogenic neoplasms.

Symptoms include enlarged breast, palpable firm mass under the nipple, and pain or tenderness.

41
Q

What are the concerns with augmented breasts (implants)? How do they appear sonographically? 4

A

Concerns include
1. Leakage or rupture
2. Contraction of the capsule
3. Obscuring normal breast tissue in mammography.
4. Sonographically, implants appear oval in shape and relatively echo-free.

42
Q

What is a silicone leak (rupture)? 3

A
  1. Occurs when silicone leaks outside the implant shell
  2. With intra-capsular rupture showing a ‘step ladder’ sign
  3. Extra-capsular rupture showing a ‘snowstorm’ appearance.

Symptoms may include change in breast shape or consistency and chronic burning.

43
Q

What is silicone bleed? 2

A
  1. It occurs in all silicone implants due to microscopic leakage through an intact implant, contained in the fibrous capsule,
  2. Leading to silicone migration to lymph nodes and resulting in lymphadenopathy.
44
Q

What is contracture in relation to breast implants? What is the risk of contracture in posteriorly placed implants?

A
  1. Contracture occurs when the fibrous capsule forms around an implant but constricts, disfiguring the breast.
  2. There is a lower risk of contracture in posteriorly placed implants.

SONOCAN ABD Review (32 decks)

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