Ch 9 Physiology of the Breast Flashcards by Sarah Anderson

List the 2 hormones during puberty?

-Estrogen
-Progesterone

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What does estrogen do?

-Stimulates stromal + ductal growth and development
-Alters body fat distribution

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What does estrogen + progesterone do when combined?

-Skin pigmentation of nipple + areolar region
-Activity of montomgery’s glands

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What 2 hormones effect pregnancy?

-Estrogen
-Progesterone

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What does estrogen do in pregnancy?

-Increased vascularity
-Growth of ductal system

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What does progesterone do in pregnancy?

-Increased activity of montomery’s glands
-Growth of alveoli

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What 2 hormones effect lactation?

-Prolactin
-Oxytocin

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What does prolactin do during lactation?

Stimulates alveoli to produce milk

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What does oxytocin do during lactation?

Triggers milk ejection

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What hormone effects menopause?

Estrogen

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What does estrogen do during menopause?

It decreases ovarian function, therefore decreasing estrogen levels

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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

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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)

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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

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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

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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

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How many quadrants of the breast are there?

4:
-UOQ
-UIQ
-LOQ
-LIQ

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What are the scan planes for the breast?

-TRV/SAG
-Radial/Anti-Radial

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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