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MIDS 227 (neck + breast) > Ch 8 Intro to Breast > Flashcards

Ch 8 Intro to Breast Flashcards

1
Q

The BC cancer breast screening program is available for women over ___ years old?

A

40

(the program uses mammography to screen for breast cancer)

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2
Q

What is the #1 screening modality for breast cancer?

A

Mammography

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3
Q

What is mammography?

A

-An x-ray of the breast
-It’s the m/c + most effective screening tool

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4
Q

Why is mammography used?

A

For screening:
-typically asymptomatic pt’s

For diagnostic:
-typically symptomatic pt’s
-or to further assess an abnormality found on a screening mammogram

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5
Q

Mammography is capable of detecting suspicious patterns of ___?

A

Microcalcifications

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6
Q

What is typically the 1st imaging sign of a developing malignancy?

A

Microcalcifications

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7
Q

List 5 limitations to mammography?

A

-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

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8
Q

What is the medical term for dense breast tissue + fatty breast tissue?

A

Dense: radiopaque
Fatty: radiolucent

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9
Q

When is breast u/s used?

A

-In adjunct/addition to a mammogram
or
-Alone (ex. with pt’s who have breast trauma, inflammatory changes, etc.)

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10
Q

List advantages to a breast u/s?

A

-Usually painless
-Low cost
-Non ionizing
-Cystic vs solid differentiation
-Mass localization
-Biopsy guidance

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11
Q

List indications for a breast u/s?

A

-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

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12
Q

3 limitations of a breast u/s?

A

-Operator + equipment dependent
-Benign vs malignant features are similar
-Microcalcifications detection (better to detect this with mammography)

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13
Q

List advancements with breast u/s?

A

-Automated whole breast scanners
-3D + 4D u/s
-Elastography
-Contrast enhanced u/s
-AI programs

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14
Q

Are mammary glands exocrine or endocrine glands?

A

Exocrine - meaning produces milk through ducts

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15
Q

What is the primary function of mammary glands?

A

To produce milk

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16
Q

What is the composition of mammary glands?

A

Glandular, fatty + fibrous connective tissues, blood vessels, lymphatics and nerves

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17
Q

What 2 main factors play a role in mammary gland composition?

A

Age + hormonal status

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18
Q

What do the glandular elements primarily do in the mammary glands?

A

Function to produce + convey milk

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19
Q

What do the stromal elements consist of in the mammary glands?

A

Fat, fibrous connective tissues, blood vessels, lymphatics + nerves

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20
Q

What 2 elements compose the mammary glands?

A

Glandular + stromal elements

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21
Q

How do the breasts develop?

A

Paired sets of breasts grow from the mammary ridges in the thoracic region, along the ectodermal milk lines in utero

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22
Q

What is another term for “unilateral early ripening”

A

Unilateral premature thelarche

(thelarche = start of breast growth)

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23
Q

What is unilateral early ripening?

A

-Development of 1 breast before the other, before 8 years old
-By puberty both breasts should become comparable in size

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24
Q

What is precocious puberty?

A

Development of both breasts before 8 years old

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25
Q

Are breast anomalies common?

A

No

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26
Q

Is congenital nipple inversion normal or abnormal?

A

Normal variant

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27
Q

What is the m/c variant?

A

Polythelia (accessory nipple)

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28
Q

List 6 breast anomalies?

A

-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)

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29
Q

What are the 3 external breast anatomy structures?

A

-Skin (hair follicles, sebaceous + sweat glands)
-Nipple (fibromuscular projection)
-Areola (encircles nipple)

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30
Q

What does the areola contain?

A

Montgomery glands (sebaceous glands which secrete oil during breast feeding)

31
Q

Where is the pectoralis major + minor in regards to the breast?

A

Major: posterior to upper portion of breast
Minor: posterior to pectoralis major

32
Q

Where is the serratus anterior in regards to the breast?

A

The lateral portion

33
Q

Where is the external oblique in regards to the breast?

A

Posterior to lower outer breast

34
Q

Where is the rectus abdominus in regards to the breast?

A

Lower inner portion of breast

35
Q

There are muscles + ___ around the breast?

A

Ribs

36
Q

What arteries supply the medial + lateral part of breast?

A

Medial: branches of internal thoracic artery

Lateral: branches of the axilla (lateral thoracic artery + thoracoacromial artery)

37
Q

What arteries contribute to supplying the entire breast?

A

Branches from intercostal arteries

38
Q

___ of arteries exist beneath the areola?

A

Anastomoses

(is apart of the main arterial blood supply to breast)

39
Q

Explain how venous drainage of the breast works?

A

-Veins follow the artery
-They drain into the axilla, internal thoracic + 2-4th intercostal veins

40
Q

Do networks of veins exist superficially in the breast?

A

Yes! Contributes to venous drainage

41
Q

Anastomosis of veins occurs in a ___ patter around the areola?

A

Circular - this contributes to venous drainage

42
Q

___ exist along the skin + within the glandular tissue?

A

Nerves

43
Q

Explain the lymphatics of the breast?

A

-Extensive
-Deep to superficial networks

44
Q

Starting in the breast lobules near the lactiferous ducts, lymph flows through the intramammary nodes + lymph vessels into a ___ ___?

A

Subareolar plexus (it has a few main drainage routes that run parallel to the veins)

45
Q

Intramammary lymph nodes are located within the breast, m/c where?

A

In the UOQ (upper outer quadrant) near the axilla

46
Q

Are intramammary nodes or axillary nodes more commonly seen on u/s?

A

Axillary nodes (b/c they are larger)

47
Q

How big are intramammary nodes?

A

<1cm

(only see them on u/s when they are abnormal + enlarged)

48
Q

List the subareolar plexus lymphatic drainage routes?

A

-Axillary nodes (m/c)
-Internal mammary (parasternal) + interpectoral (rotter) nodes
-Supraclavicular nodes

49
Q

What accounts for most of lymph drainage?

A

Axillary nodes

50
Q

List 3 lymphatic drainage pathways?

A

-To the opposite breast
-Towards the diaphragm
-To abdominal nodes

51
Q

What is the SLN?

A

-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)

52
Q

The SLN is typically a ___ ___ lymph node?

A

Low axillary

53
Q

How can we find the SLN?

A

-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

54
Q

What is coppers ligaments?

A

-Fibrous tissue
-Suspensory ligaments which provides support to the breast
-Encloses fat lobules

55
Q

Where do coopers ligaments run?

A

From posterior fascia, subcutaneous tissue + then attaches to the skin

56
Q

Do males + females have coppers ligaments?

A

No! Only in women

57
Q

There are 3 breast layers divided by fascial planes, what are they?

A

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

58
Q

The mammary layer consists of how many overlapping lobes?

A

15-20

(they exist in the radial pattern around the nipple)

59
Q

Portions of mammary tissue extended into the axilla is called the ___ ___?

A

Axillary tail (aka tail of spence)

60
Q

Each lobe in the mammary layer contains ___ terminal ductolobular units (TDLUs)?

A

20-40

61
Q

TDLUs are composed of what 2 things?

A

A lobule + an extralobular terminal duct

62
Q

____ are the functional units of the breast?

A

TDLUs

63
Q

The terminal duct continues into the lobule to become the ___?

A

Intralobular terminal duct (this drains numerous small terminal ductules)

64
Q

Ductules turn into ___ during pregnancy?

A

Acini (aka alveoli)

65
Q

What are the smallest functional units of the breast?

A

Acini

66
Q

What is acini?

A

Tiny sacs that produce milk + will involute after the breast feeding period ends

67
Q

Most pathology (benign + malignant) arises from the ___?

A

TDLUs

68
Q

TDLUs are m/c found in which breast layer?

A

Mammary layer

(can extend through a cooper ligament into the pre or retromammary layers)

69
Q

List the sequence of the ductal system on how milk gets secreted?

A

-Alveoli/acini/terminal ductules (produces milk)
-Intralobular terminal duct
-Extralobular terminal duct
-Lactiferous duct
-Lacctiferous sinus
-Nipple

70
Q

What does the male breast consist of?

A

-Mostly fatty tissue + small amounts of fibrous connective tissue
-Has a small amount of a rudimentary subareolar duct

71
Q

How does the male breast differentiate from the female breast?

A

-Males have thicker skin + larger muscles
-Males m/c do not develop breast lobules
-Males have no coopers ligaments

72
Q

What are the 2 most significant breast conditions in men?

A

Gynecomastia (m/c) + cancer

73
Q

What breast layer contains the functional tissues of the breast?

A

Mammary/parenchymal layer

74
Q

Which layers of the breast contain fat?

A

Premammary + retromammary layer

MIDS 227 (neck + breast) (14 decks)

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