Ch 8 Intro to Breast Flashcards
The BC cancer breast screening program is available for women over ___ years old?
40
(the program uses mammography to screen for breast cancer)
What is the #1 screening modality for breast cancer?
Mammography
What is mammography?
-An x-ray of the breast
-It’s the m/c + most effective screening tool
Why is mammography used?
For screening:
-typically asymptomatic pt’s
For diagnostic:
-typically symptomatic pt’s
-or to further assess an abnormality found on a screening mammogram
Mammography is capable of detecting suspicious patterns of ___?
Microcalcifications
What is typically the 1st imaging sign of a developing malignancy?
Microcalcifications
List 5 limitations to mammography?
-Can not detect dense breast tissue as well as fatty breast tissue
-Can not differentiate b/w cystic vs solid (u/s determines this)
-Localization in limited views
-Malignant vs benign features + similarities
-Human error
What is the medical term for dense breast tissue + fatty breast tissue?
Dense: radiopaque
Fatty: radiolucent
When is breast u/s used?
-In adjunct/addition to a mammogram
or
-Alone (ex. with pt’s who have breast trauma, inflammatory changes, etc.)
List advantages to a breast u/s?
-Usually painless
-Low cost
-Non ionizing
-Cystic vs solid differentiation
-Mass localization
-Biopsy guidance
List indications for a breast u/s?
-Young (<30 y/o)
-Pregnant or lactating
-Breast augmentation/implant evaluation
-Male (lump or gynecomastia, which is increased breasts)
-Post operation complications
-Interventional (needle localization, FNA, core biopsy)
-Treatment planning for radiation therapy
3 limitations of a breast u/s?
-Operator + equipment dependent
-Benign vs malignant features are similar
-Microcalcifications detection (better to detect this with mammography)
List advancements with breast u/s?
-Automated whole breast scanners
-3D + 4D u/s
-Elastography
-Contrast enhanced u/s
-AI programs
Are mammary glands exocrine or endocrine glands?
Exocrine - meaning produces milk through ducts
What is the primary function of mammary glands?
To produce milk
What is the composition of mammary glands?
Glandular, fatty + fibrous connective tissues, blood vessels, lymphatics and nerves
What 2 main factors play a role in mammary gland composition?
Age + hormonal status
What do the glandular elements primarily do in the mammary glands?
Function to produce + convey milk
What do the stromal elements consist of in the mammary glands?
Fat, fibrous connective tissues, blood vessels, lymphatics + nerves
What 2 elements compose the mammary glands?
Glandular + stromal elements
How do the breasts develop?
Paired sets of breasts grow from the mammary ridges in the thoracic region, along the ectodermal milk lines in utero
What is another term for “unilateral early ripening”
Unilateral premature thelarche
(thelarche = start of breast growth)
What is unilateral early ripening?
-Development of 1 breast before the other, before 8 years old
-By puberty both breasts should become comparable in size
What is precocious puberty?
Development of both breasts before 8 years old
Are breast anomalies common?
No
Is congenital nipple inversion normal or abnormal?
Normal variant
What is the m/c variant?
Polythelia (accessory nipple)
List 6 breast anomalies?
-Congenital nipple inversion (normal)
-Polythelia (m/c, accessory nipple)
-Polymastia (rare, complete accessory breast)
-Hypoplasia or hypertrophy (uni or bilateral)
-Amastia (rare, failure of breast tissue to develop + is m/c accompanied by congenital absence of the nipple/athelia)
-Amazia (acquired condition, absence of breast tissue but nipple is still present)
What are the 3 external breast anatomy structures?
-Skin (hair follicles, sebaceous + sweat glands)
-Nipple (fibromuscular projection)
-Areola (encircles nipple)
What does the areola contain?
Montgomery glands (sebaceous glands which secrete oil during breast feeding)
Where is the pectoralis major + minor in regards to the breast?
Major: posterior to upper portion of breast
Minor: posterior to pectoralis major
Where is the serratus anterior in regards to the breast?
The lateral portion
Where is the external oblique in regards to the breast?
Posterior to lower outer breast
Where is the rectus abdominus in regards to the breast?
Lower inner portion of breast
There are muscles + ___ around the breast?
Ribs
What arteries supply the medial + lateral part of breast?
Medial: branches of internal thoracic artery
Lateral: branches of the axilla (lateral thoracic artery + thoracoacromial artery)
What arteries contribute to supplying the entire breast?
Branches from intercostal arteries
___ of arteries exist beneath the areola?
Anastomoses
(is apart of the main arterial blood supply to breast)
Explain how venous drainage of the breast works?
-Veins follow the artery
-They drain into the axilla, internal thoracic + 2-4th intercostal veins
Do networks of veins exist superficially in the breast?
Yes! Contributes to venous drainage
Anastomosis of veins occurs in a ___ patter around the areola?
Circular - this contributes to venous drainage
___ exist along the skin + within the glandular tissue?
Nerves
Explain the lymphatics of the breast?
-Extensive
-Deep to superficial networks
Starting in the breast lobules near the lactiferous ducts, lymph flows through the intramammary nodes + lymph vessels into a ___ ___?
Subareolar plexus (it has a few main drainage routes that run parallel to the veins)
Intramammary lymph nodes are located within the breast, m/c where?
In the UOQ (upper outer quadrant) near the axilla
Are intramammary nodes or axillary nodes more commonly seen on u/s?
Axillary nodes (b/c they are larger)
How big are intramammary nodes?
<1cm
(only see them on u/s when they are abnormal + enlarged)
List the subareolar plexus lymphatic drainage routes?
-Axillary nodes (m/c)
-Internal mammary (parasternal) + interpectoral (rotter) nodes
-Supraclavicular nodes
What accounts for most of lymph drainage?
Axillary nodes
List 3 lymphatic drainage pathways?
-To the opposite breast
-Towards the diaphragm
-To abdominal nodes
What is the SLN?
-Sentinel lymph node
-It is the 1st lymph node which drains a cancerous tumor + is at most risk for metastasis
(a biopsy of the SLN will reveal very precise info regarding mets)
The SLN is typically a ___ ___ lymph node?
Low axillary
How can we find the SLN?
-With NM lymphoscintigraphy
-Blue dye + a radioisotope material gets injected around the tumor or deep in overlying skin, to map lymphatic drainage
1st = Nuclear medicine scan
2nd = Look for blue dye intraoperatively
3rd = Take biopsy
What is coppers ligaments?
-Fibrous tissue
-Suspensory ligaments which provides support to the breast
-Encloses fat lobules
Where do coopers ligaments run?
From posterior fascia, subcutaneous tissue + then attaches to the skin
Do males + females have coppers ligaments?
No! Only in women
There are 3 breast layers divided by fascial planes, what are they?
Premammary layer (subcutaneous fat layer):
-contains subcutaneous
Mammary layer (parenchymal layer):
-between ant/post mammary fascia
Retromammary layer (retromammary fat layer):
-contains fat, vessels + lymphatics
The mammary layer consists of how many overlapping lobes?
15-20
(they exist in the radial pattern around the nipple)
Portions of mammary tissue extended into the axilla is called the ___ ___?
Axillary tail (aka tail of spence)
Each lobe in the mammary layer contains ___ terminal ductolobular units (TDLUs)?
20-40
TDLUs are composed of what 2 things?
A lobule + an extralobular terminal duct
____ are the functional units of the breast?
TDLUs
The terminal duct continues into the lobule to become the ___?
Intralobular terminal duct (this drains numerous small terminal ductules)
Ductules turn into ___ during pregnancy?
Acini (aka alveoli)
What are the smallest functional units of the breast?
Acini
What is acini?
Tiny sacs that produce milk + will involute after the breast feeding period ends
Most pathology (benign + malignant) arises from the ___?
TDLUs
TDLUs are m/c found in which breast layer?
Mammary layer
(can extend through a cooper ligament into the pre or retromammary layers)
List the sequence of the ductal system on how milk gets secreted?
-Alveoli/acini/terminal ductules (produces milk)
-Intralobular terminal duct
-Extralobular terminal duct
-Lactiferous duct
-Lacctiferous sinus
-Nipple
What does the male breast consist of?
-Mostly fatty tissue + small amounts of fibrous connective tissue
-Has a small amount of a rudimentary subareolar duct
How does the male breast differentiate from the female breast?
-Males have thicker skin + larger muscles
-Males m/c do not develop breast lobules
-Males have no coopers ligaments
What are the 2 most significant breast conditions in men?
Gynecomastia (m/c) + cancer
What breast layer contains the functional tissues of the breast?
Mammary/parenchymal layer
Which layers of the breast contain fat?
Premammary + retromammary layer
