Ch 9 Physiology of the Breast Flashcards
List the 2 hormones during puberty?
-Estrogen
-Progesterone
What does estrogen do?
-Stimulates stromal + ductal growth and development
-Alters body fat distribution
What does estrogen + progesterone do when combined?
-Skin pigmentation of nipple + areolar region
-Activity of montomgery’s glands
What 2 hormones effect pregnancy?
-Estrogen
-Progesterone
What does estrogen do in pregnancy?
-Increased vascularity
-Growth of ductal system
What does progesterone do in pregnancy?
-Increased activity of montomery’s glands
-Growth of alveoli
What 2 hormones effect lactation?
-Prolactin
-Oxytocin
What does prolactin do during lactation?
Stimulates alveoli to produce milk
What does oxytocin do during lactation?
Triggers milk ejection
What hormone effects menopause?
Estrogen
What does estrogen do during menopause?
It decreases ovarian function, therefore decreasing estrogen levels
What is the set-up for a breast u/s?
-Review prior scans (MRI, mammo, u/s, etc)
-Review clinical history
-Use highest frequency linear probe capable of obtaining good penetration
What is the pt positioning for a breast u/s?
-Variable, depending on where mass is
-Position them to minimize the thickness of the portion of the breast being scanned (ex. oblique for lateral masses, supine for medial, etc.)
-Place arm overhead
(note: if a pt can only palpate a mass in a certain position, scan them in that exact position)
List history taking questions pertinent to a breast exam?
-Age
-Family history
-Hormonal status
-Palpable mass
-Previous u/s or mammo
-Injury or pain
-Nipple discharge
-Visual appearance
List the breast scanning procedure + techniques that can be used?
-Can scan whole breast or just a targeted area
-Can use palpation techniques (marking the skin, sonopalpation)
-Can use a stand off pad or extra gel for imaging superficial lesions
-Vary amount of pressure used
-Vary beam angles (heel-toe)
-Can turn off cross beam + spatial compounding if needed
What is the benefit of radial scanning?
-It follows lobar anatomy
-Best for assessing the major lactiferous ducts
-Best for documenting mass location according to nipple
How many quadrants of the breast are there?
4:
-UOQ
-UIQ
-LOQ
-LIQ
What are the scan planes for the breast?
-TRV/SAG
-Radial/Anti-Radial
Is radial + anti-radial scanning most similar to TRV or SAG?
Radial: think SAG (indicator points towards nipple)
Anti-radial: think TRV (indicator points towards pt’s right side)
What are the 3 current recommendations how to document our breast images?
Include in our annotation:
-Clockface position
-Distance from nipple (in cm)
-Probe orientation
What is the “123 - ABC” annotation documentation method?
SA: subareolar
1 = central ring
2 = middle ring
3 = outer ring
Ax: axillary segment
Depth of lesion:
A = superficial
B = middle 1/3rd
C = deep
How to document a breast lesion?
-Compressibility
-Mobility
-Size (3 dimensions)
-Location
-Doppler findings
(sometimes compare to contralateral side)
Is it necessary to scan into the axilla (armpit) during a breast u/s?
Yes!
SF of coppers ligaments?
-Thin, hyperechoic bands
-Ascends to skin + encases fat lobules
-May cause shadowing
SF of ducts?
-Anechoic tubes
-Echogenic walls
SF of fat?
-Hypoechoic
-Will elongate in orthogonal planes
SF of fibroglandular tissue?
This includes glandular, fibrous + fatty tissue
-Glandular tissue: isoechoic to fat
-Fibrous tissue: echogenic to fat
Where is the premammary layer?
-Layer b/w the skin + mammary layer
-Does not extend behind the nipple
Coopers ligaments (CL) are best seen in which breast layer?
Premammary layer
(note: CL can cause shadowing)
What does the premammary layer contain?
Fat lobules
What does the mammary layer contain?
Glandular tissue/breast parenchyma
The sonographic appearance of which breast layer varies the most?
The mammary layer (due to composition variations)
Major lactiferous ducts may be visible in which layer?
Mammary layer (usually <2mm)
Most glandular tissue is found in which quadrant of the breast?
UOQ
What does the retoromammary layer contain?
Retromammary fat + ligaments
Which layer of the breast is the thinnest?
Retromammary
Location of the retromammary layer?
Posterior to mammary fascia + anterior to the pectoralis major muscle
List 5 sonographic appearances of the chest wall?
-Pectoralis major muscle (seen posterior to majority of breast)
-Pectoralis minor muscle (seen posterior + superolateral to pec major)
-Ribs
-Intercostal muscle
-Lung
Sonographic variations of the breast occur depending on what factors?
-Age
-Parity
-Hormonal status
-Pregnancy status
-Lactating status
-Body habitus
How does a pre + post puberty breast appear?
Pre: small + fatty
Post: glandular (isoechoic to mildly hyperechoic to fat)
Fatty replacement of breast parenchyma occurs with ___ age?
Increasing
During ___, proliferation of glandular tissue + duct dilatation may be seen?
Pregnancy + lactation
A lesion sits at 10:00 in the right breast, which quadrant is this lesion in?
UOQ
A lesion sits at 7:00 in the left breast, which quadrant is this lesion in?
LIQ
Which hormone is responsible for stimulating the alveoli to secrete milk?
Prolactin
