Chapter 21 Flashcards
Connective tissue septa that connect perpendicularly to the breast lobules and extend out to the skin
Cooper’s ligaments
Most superficial of the three layers of the breast identified on breast ultrasound
Subcutaneous layer
Armpit
Axilla
Glandular (milk-producing) component of the breast lobule
Acinus (acini)
Middle layer of the breast tissue that contains the ductal, glandular, and stromal portions of the breast.
Mammary layer
Smallest functional portion of the breast involving the terminal duct and its associated lobule containing at least one acinus
Terminal ductal lobular unit (TDLU)
Differentiated apocrine sweat gland with a functional purpose of secreting milk during lactation
Breast
Deepest of the three layers of the breast noted on the breast ultrasound
Retomammary layer
The pigmented skin surrounding the breast nipple
Areola
Normal extension of the breast tissue into the axillary region
Tail of Spence
Plane of imaging on ultrasound of the breast
Radial
Part of breast cancer screening best done at the end of menses each month
Breast self-examination
Plane of imaging on ultrasound of the breast that is perpendicular to the radial plane of imaging
Antiradial
Echo texture that is more echogenic than the surrounding tissue
Hyperechoic
Type of breast imaging examination that is more intensive than routine screening mammography
Diagnostic breast imaging
Finger-like extension of a malignant tumor
Spiculation
Near the chest wall
Juxtathoracic
Part of breast cancer screening done by a health care provider
Clinical breast examination
Represents the first lymph node along the axillary node chain
Sentinel node
Refers to vibrations produced by phonation and felt through the chest wall during palpation
Fremitus
Without symptoms
Asymptomatic
Can be felt on clinical examinations
Palpable
Trademark system created by the American College of Radiology (ACR) to standardize mammographic reporting terminology, categorize breast abnormalities according to the level of suspicion for malignancy, and facilitate outcome monitoring
Breast imaging reporting and data system
Echo texture that resembles the surrounding tissue
Isoechoic
Having relatively weak echoes
Hypoechoic
Preventive care that includes annual screening mammography (starting at age 40), monthly breast self-examination, and regular clinical breast examination
Breast cancer screening
Cannot be felt on clinical examination
Nonpalpable
Without echoes
Anechoic
Common diagnostic and interventional procedure that involves placing a needle through the skin of the breast into a cystic mass and pulling fluid out of the cyst through the needle
Cyst aspiration
Descriptive term for skin thickening of a breast that resembles the skin of an orange
Peau d’orange
Abnormal proliferation of cells with atypical features involving the TDLU, with an increased likelihood of evolving into breast cancer
Atypical hyperplasia
Neither considered a true cancer nor treated as such
Lobular carcinoma in situ
Most common benign solid tumor of the breast, consisting primarily of fibrous and epithelial tissue elements
Fibroadenoma
Hypertrophy of residual ductal elements that persist behind the nipple in the male
Gynecomastia
Fluid-filled sac of variable size
Cyst
Overgrowth of the stromal and epithelial elements of the acini within terminal ductal lobular unit (TDLU) of the breast
Adenosis
Cancer of the lobular epithelium of the breast, arises at the level of the TDLU
Infiltrating lobular carcinoma
Breast cancer occurring in more than one site within the same quadrant of the same ductal system of the breast
Multifocal breast cancer
Condition that represents different, essentially normal, tissue processes within the breast that in some patients become exaggerated to the point of raising concern for breast cancer
Fibrocystic condition
The pathologist recognizes some, but not all, of the features of ductal carcinoma in situ
Atypical ductal hyperplasia
Brest cancer occurring in different quadrants of the breast at least 5cm apart
Multicentric breast cancer
Shows some, but not all, of the features of lobular carcinoma in situ
Atypical lobular hyperplasia
Echo texture that resembles the surrounding tissue
Isoechoic
Form of fibrocystic change in which epithelial cells of the acini undergo alteration
Apocrine metaplasia
Cancer of the ductal epithelium; most common general category of breast cancer, accounting for approximately 85% of all breast cancers
Infiltrating ductal carcinoma
Proliferation (hyperplasia) of epithelial cells lining the terminal duct-lobular unit
Epithelial hyperplasia
Term preferred by many authors to replace LCIS and atypical hyperplasia
Lobular neoplasia
Surface erosion of the nipple characterized by redness with flaking and crusting caused by direct invasion of the skin of the nipple by underlying breast cancer
Paget’s disease
Involves two main types of cells (ductal and lobular)
Breast cancer
The breast is a modified ____________ gland located in the superficial fascia of the anterior chest wall.
sweat
Sonographically the breast is divided into three layers located between the skin and the pectoralis major muscle on the anterior chest wall. These layers are the ________________ layer, the _______________ layer, and the _________________ layer.
subcutaneous; mammary; retromammary
Fat is the least ___________ tissue within the breast.
echogenic
The fatty tissue appears _____________, whereas the ducts, glands, and supporting ligaments appear echogenic.
hypoechoic
The ___________ quadrant of the breast contains the highest concentration of lobes.
upper outer
Each lobule contains __________ (milk-producing glands) that are clustered to the terminal ends of the ducts like grapes on a vine.
acini
The _____________ muscle lies posterior to the retromammary layer.
pectoralis major
The ________________ tissue can situate itself in and among the areas of glandular tissue, and in some scanning planes it can mimic isoechoic or hypoechoic masses.
adipose or fatty
Sonographically, cancers can be difficult to differentiate in the fatty breast because most cancers appear ____________ and can be difficult to differentiate from the normal breast tissue.
hypoechoic
The main arterial supply to the breast comes from the internal __________ and the lateral ____________ artery.
mammary; thoracic
Lymphatic drainage from all parts of the breast generally flows to the ______________ lymph nodes.
axillary
The primary function of the breast is _______________ transport.
fluid
The ____________ system is critical in the transport of fluids within the breast.
ductal
An important function during the reproductive years is for the breast to make __________ from nutrients and eater taken from the bloodstream.
milk
Milk is produced within the _____________ and carried to the nipple by the ducts.
acini
Breast development begins before ____________ and continues until the patient is approximately 16 years old.
menarche
During this time of development, the ductal system proliferates under the influence of _____________.
estrogen
During pregnancy, acinar development is accelerated to enable milk production by estrogen, _______________, and prolactin.
progesterone
The hormone produced by the pituitary gland that stimulates the acini to produce and excrete milk is called _______________.
prolactin
The expulsion of the placenta after birth of a baby causes a drop in circulating progesterone, initiating ______________ production within the breasts.
milk
The physical stimulation of suckling by the baby initiates the release of _______________ (produced by the hypothalamus and released by the pituitary gland), which further incites prolactin secretion, stimulating additional milk production.
oxytocin
Full maturation of the acini occurs during lactation and is thought to be mildly protective against the development of breast ____________.
cancer
Ultrasound may be used for screening purposes in ____________ breasts that are ____________ and difficult to penetrate by mammography, to evaluate palpable masses that are not visible on a mammogram, and to image the deep juxtathoracic tissues not normally visible by mammography.
young; dense
Ultrasound is also useful in _____________ structures within uniformly dense breast tissue where mammography is limited (e.g., in differentiating solid, round masses from fluid-filled cysts ans visualizing tissue adjacent to implants or other structures that limit visualization by mammography.)
differentiating
A(n) ______________ aspiration can be performed to determine whether a lesion is a complex cyst or truly a solid mass.
cyst
What basic clinical information must the sonographer have for any patient referred for breast ultrasound?
Patients age Risk factors for breast cancer Symptoms Location Clinical impression of breast lumps
Patient clinical information that should be provided by the referring physician includes size and location of the lump, when it was noticed, and its relation to the _______________.
menstrual cycle
A dominant cyst is frequently ____________ or __________ (long axis toward the nipple), smooth, soft (some cysts under tension can be firm and are usually very tender), and easily movable.
round; oval
Fibroadenomas are usually similar in shape, but they are often quite firm and rubbery in consistency and ________________ on ultrasound.
homogeneously solid
Breast cancer is usually lobular or _____________ in shape, uneven in surface contour (something gritty in texture), and fixed or poorly movable.
irregular
Most breast masses that arise during adolescent years are ______________.
fibroadenomas
A(n) _______________ implant rupture occurs when there is a breach of the membrane surrounding an implant, but the silicone that leaks out is still confined within the fibrous scar tissue that forms a “capsule” around the implant.
intracapsular
As the implant collapses and the membrane folds inward, a series of discontinuous echogenic lines parallel to the face of the transducer may be seen and are referred to as the “stepladder” sign or “_______________ sign.”
linguine
The use of the _______________ positions is unique to the breast and can often pick up subtle abnormalities extending toward the nipple along the ductal system from the mass.
radial/antiradial
_______________ tend to grow within the ducts and will often follow the ductal system in a radial plane, toward the convergence at the nipple.
Malignancies
To be considered a simple cyst a lesion must meet which three criteria on ultrasound?
Devoid of internal echoes
Smooth inner margins with capsule
Posterior acoustic enhancement
A rounded or oval shape is usually associated with __________ lesions, whereas sharp, angular margins are associated with _____________ lesions.
benign; malignant
The normal tissue planes of the breast are ______________ oriented.
horizontally
Benign lesions tend to grow within the normal tissue planes, and their long axis lies _____________ to the chest wall.
parallel
Malignant lesions are able to grow through the connective tissue and may have a(n) ____________ orientation when imaging the breast from anterior to posterior.
vertical
If a mass measures longer in the anteroposterior dimension (______________) than in either transverse or sagittal planes (_____________), the mass has a vertical orientation that is usually described as being “taller than wide” and is suspicious for malignancy.
height; width
Malignant masses will often demonstrate increased _____________ within the lesion and often have a feeder vessel, which can be identified with careful evaluation.
vascularity
Lesions more common to younger women are _____________ disease and fibroadenomas.
fibrocystic
Older or postmenopausal women are more likey to have _________ papillomas, duct ectasia, and cancer.
intraductal
Skin dimpling or ulceration and nipple retraction nearly always result from ___________.
cancer
Benign tumors are rubbery, _______________, and well delineated (as seen in a fibroadenoma), whereas malignant tumors are often stone hard and irregular with a gritty feel.
mobile
Clinical signs and symptoms of ________________ include the lumps and pain that the patient feels that fluctuate with every monthly cycle. In most cases both breasts are equally involved.
fibrocystic condition
The growth of a fibroadenoma is stimulated ____________.
estrogen
Sonographically, fat necrosis appears as an irregular, complex mass with low-level echoes, may mimic a(n) _______________ lesion, and may appear as fat, but is separate and different from the rest of the breast parenchyma.
malignant
_____________ may result from infection, trauma, mechanical obstruction in the breast ducts, or from other conditions. It often occurs during lactation, beginning in the lactiferous ducts and spreading via lymphatics or blood.
Acute mastitis
An intraductal papilloma is a small, ____________ tumor that grows within the acini of the breast.
benign
In ____________ tissue, most cancer growth occurs along the borders.
fibrotic
_________ and _____________ are frequently used as pathways for new tumor development.
Lymphatics; blood vessels
If the tumor is ___________, it continues to grow in one area, compressing and distorting the surrounding architecture.
encapsulated
Most cancer originates in the __________ ductal lobular units, whereas a smaller percentage originates in the glandular tissue.
terminal
_____________ refers to breast tumors that arise from epithelium, in the ductal and glandular tissue, and usually have tentacles.
Carcinoma
Breast carcinomas are generally categorized by two factors; where the cancer cells originate (___________ or _____________) and whether the cancer is prone to spreading (_______________ or ______________).
ductal or lobular
noninvasive or invasive
Carcinomas that do not normally spread outside of the duct or lobule are called noninvasive, nonfiltrating, or ____________ cancers, whereas cancers that spread into nearby tissue are said to be invasive or infiltrating.
in situ
Identify which image (A, B,or C) clearly identifies a simple cyst of the breast.
Image A shows a well defined anechoic lesion with smooth borders and good through transmission, all characteristics of a cyst.
Image A shows the breast lesion without compression, and image B shows the lesion with compression. Would you suspect this breast lesion is benign or malignant? Why?
These images show a smooth, benign mass with homogeneous echogenicity. The mass is wider than tall with low-level posterior acoustic enhancement.
Would you say this breast lesion is benign or malignant? Why?
Malignant mass because the mass is heterogenous with poorly defined and irregular borders. The lesion is also higher than wide with no change in compression.
This mass was described as a large tumor with necrosis in a 45-year-old female. What are the differential considerations?
Differential considerations are medullary carcinoma, fat necrosis, and fibroadenoma.
