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Abd / SS 3 > Module 6 : Breast > Flashcards

Module 6 : Breast Flashcards

1
Q

what are three overall risk factors for breast cancer

A 
- lifestyle behaviours 
   \+ obesity, physical inactivity, alcohol intake
- hereditary factors
- reproductive/hormonal factors
   \+ older age at first birth
   \+ late menopause
   \+ menstruation at an early age
   \+ BCP
   \+ HRT
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2
Q

what are the 10 indications for breast ultrasound

A
  • compliments mammo
  • identify and characterize an abnormality
  • dense breast tissue
  • equivocal mamma or physical findings
  • patients <30 years
  • prenant/lactating
  • male breast
  • inteventional guidance
  • breast implants
  • treatment planning
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3
Q

what are the 6 advantages of ultrasound

A
  • noninvasive
  • painless
  • non ionozing
  • low cost
  • image chest wall
  • doppler
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4
Q

what is a mammary gland and what is it composed fo

A
  • modified sweat gland

- composed of fatty, glandular, and fibrous tissue

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5
Q

what ae the 3 layers/zones of the mammary gland

A
  • subcutaneous
  • mammary
  • retromammary
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6
Q

where is the subcutaneous/premammary zone and what is it composed of

A
  • between skin and mammary fascia

- fat surrounding by connective tissue

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7
Q

do any breast legions originate in the subcutaneous zone?

A
  • no
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8
Q

what is the mammary fascia

A
  • connective tissue enveloping mammary zone
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9
Q

what is the mammary fascia continuous with

A
  • coopers ligaments
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10
Q

what is the purpose of coopers ligament

A
  • support and shape breast

- located in subcutaneous zone

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11
Q

what is the mammary zone

A
  • functional layer made up of fibroglandular tissue
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12
Q

what is the location of the mammary zone

A
  • mostly Upper Outer Quadrant

- areola

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13
Q

what 2 things does the size of the mammary zone depend on

A
  • functional state

- inherited tissue pattern

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14
Q

what are the 3 structures that make up to mammary zone

A
  • lobes
  • lobules
  • lactiferous ducts and sinuses
  • TDLU
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15
Q

what are the lobes

A
  • 15-20 in each breast
  • arranged radially and vary in size
  • contain ducts, stroma, and acinus
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16
Q

what are the lobules

A
  • 20-40 per lobe

- contain individual milk producing glands - ACINI

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17
Q

what are the lactiferous ducts and sinuses

A
  • drain ACINI, lobules, lobes

- lactiferous ducts converge toward the nipple and enlarge to form the lactiferous sinus

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18
Q

what is the TDLU

A
  • functional unit
  • terminal ductal lobular unit
  • consists of lobule and extra lobular terminal duct
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19
Q

where si the site of most major breast pathology

A
  • TDLU
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20
Q

what is the tail of spence

A

mammary tissue extending into the axilla region

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21
Q

what is the retromammary zone

A
  • deepest layer
  • quite thin
  • contains fat, blood vessels, lymphatics
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22
Q

what is the nipple

A
  • fibromuscular papilla

- projecting from the centre of the breast

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23
Q

is inversion normal or abnormal

A
  • inversion can be normal
  • can also be seen with breast carcinoma
  • if inversion is present ask if there has been a recent change
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24
Q

what is the areola

A
  • pigmented area surrounding the nippler

- contains many sebaceous that giver area its bumpy appearance

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25
Q

what are the muscles in the breast

A
  • pectorals major posterior to retromammary layer

- pectoralis minor covered by pectorals major

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26
Q

what is the vascular supply to the breast

A
  • lateral thoracic artery
  • internal mammary artery
  • intercostal arteries
  • venous drainage via superficial and deep networks
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27
Q

what is the lymphatic drainage of the breast

A
  • drainage flows to axillary nodes

- originate in connective tissue ducts under skin

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28
Q

what often occurs with breast cancer

A
  • frequency invasion of the lymph system
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29
Q

what is the purpose of the breast

A
  • produce and secrete milk
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30
Q

what factors influence the amount fo parenchyma and stroma

A
  • age and stage of breast function
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31
Q

what hormone promotes the growth of the ductal tissue

A
  • estrogen
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32
Q

what hormone stimulates development of lobular cells

A
  • progesterone
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33
Q

what hormones stimulate milk production and causes milk ejection from lactating breast

A
  • prolactin

- oxytocin

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34
Q

contents of the breast in prepubescent children

A
  • rudimentary ducts
  • tissue developing under nipple
  • very little fat
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35
Q

contents of the breast in young adults

A
  • mostly fibroglandular tissue (dense)

- minimal fat

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36
Q

contents of the breast in adults

A
  • equal fibroglandular and fat tissue
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37
Q

contents of the breast in pregnant/lactating

A
  • mostly glandular tissue

- prominent ducts

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38
Q

contents of the breast in older/multiparous

A
  • increase subcutaneous/retromammary fat
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39
Q

contents of the breast in menopausal women

A
  • parenchymal mainly under nipple and upper outer quadrant
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40
Q

contents of the breast in post menopausal women

A
  • fatty replacement

- lobules and ducts atrophy

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41
Q

what is the sonographic appearance of the skin

A
  • 2 thin echogenic lines

- 2-3mm in thickness

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42
Q

what is the sonographic appearance of the nipple

A
  • homogeneous
  • medium level echoes
  • posterior acoustic shadowing
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43
Q

what is the sonographic appearance of the subcutaneous fat lobules

A
  • amount varies
  • does not extend posterior to the nipple
  • hypoechoci lobules containing thin echogenic strands
  • edge artifact
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44
Q

what is the sonographic appearance of the parenchyma

A
  • homogenous
  • echogenic compared to fat
  • interspersed hypoechoci areas of fat
  • hypoechoic ducts tracking toward nipple
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45
Q

what is the sonographic appearance of the lactiferous ducts

A
  • hypoechoci tubes tracking toward the nipple
  • increasing in size
  • radial pattern
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46
Q

what is the sonographic appearance of the coopers ligament

A
  • curved echogenic striations

- encase fat lobules

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47
Q

what is the sonographic appearance of the retromammary layer

A
  • hypoechoic due to fat

- anterior to the pectoralis muscle

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48
Q

what is the sonographic appearance of the muscles

A
  • medium to low level echoes

- striated

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49
Q

what is the sonographic appearance of the ribs

A
  • lateral ribs= attenuating structures with shadowing

- medial cartilage = hypoechoic

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50
Q

what is the sonographic appearance of the lymph nodes

A
  • < 1cm normal
  • oval hypoechcoi
  • echogenic hilum
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51
Q

what are 5 family history questions that you should as a patient coming in for breast exam

A
  • family history
  • parity gravida
  • medication
  • surgeries
  • nipple discharge
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52
Q

in what direction is the patient rolled when scanning and what arm is raised above the patients head

A
  • rolled toward opposite side that is being scanned

- ipsilateral arm raised and placed behind head

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53
Q

what are the 2 different approaches to scanning the breast in two planes

A
  • clock face approach

- quadrant approach

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54
Q

what are the two different ways to measure a lesion

A
  • sag/trans

- radial/antiradial

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55
Q

what are the steps to labelling a breast image

A
  • right or left
  • quadrant
  • o’clock
  • plane = sag, trans, radial, antiradial
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56
Q

what is BIRADS

A
  • breast imaging reporting and data system

- classifies lesions according to suspicion of breast cancer

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57
Q

what are the different BIRADS categories

A

-1, 2, 3, 4a, 4b, 4c, 5, 6,

58
Q

what is. BIRAD 1

A
  • sonographically normal
59
Q

what is BIRAD 2

A
  • benign finding
60
Q

what is BIRAD 3

A
  • probably benign
61
Q

what is BIRAD 4a

A
  • low suspicion
62
Q

what is BIRAD 4b

A
  • intermediate suspicion
63
Q

what is BIRAD 4c

A
  • moderate suspicion
64
Q

what is BIRAD 5

A
  • highly suggestive of malignancy >95%
65
Q

what is BIRAD 6

A
  • known cancer
66
Q

what are the 11 benign abnormalities of the breast

A
  • cysts
  • fibroadenoma
  • cystosarcoma phylloides
  • lipoma
  • fat necrosis
  • papilloma
  • fibrocystic changes
  • galactocele
  • ductal ectasia
  • mastitis
  • nipple discharge
67
Q

what is the common age of women with cysts

A
  • 35-50
68
Q

what is a cyst in the breast

A
  • obstruction in the terminal portion of duct
69
Q

what are 4 common physical characteristics of breast cysts

A
  • palpable and rounded
  • move freely but not as mobile as fibroadenoma
  • single or multiple
  • variable size
70
Q

what are the 4 sonographic criteria of a simple cyst

A
  • posterior enhancement
  • thin walled
  • edge shadowing
  • anechoic
71
Q

what can change the shape of a breast cyst

A
  • transducer pressure
72
Q

what are the characteristics of a complex breast cyst

A
  • low level internal echoes
  • septations
  • posterior enhancement
73
Q

what is another name for a complex cyst in the breast

A
  • foam cyst
74
Q

what is an acorn cyst

A
  • cyst that displays a non dependent echogenic layer
75
Q

what is the most common benign tumor in women of child bearing years

A
  • fibroadenomas
76
Q

what hormone stimulates fibroadenomas

A
  • estrogen

- increase in size with pregnancy and HRT

77
Q

what are 3 physical characteristics of a fibroadenoma

A
  • various shapes and sizes
  • unilateral/bilateral
  • palpable, painless, mobile
78
Q

what is the sonographic appearance of a fibroadenoma

A
  • elliptical or gently lobulated
  • thin echogenic capsule
  • hypoechoci homogeneous
  • WIDER THAN TALL
  • solid
  • no posterior acoustic enhancement
  • no change in shape with compression
79
Q

are cystosarcoma phylloides common or rare

A
  • rare
80
Q

what are cystosarcoma phylloides

A
  • giant fibroadenomas

- usually benign but can become malignant

81
Q

what are 2 physical characteristics of cystosarcoma phylloides

A
  • unilateral

- rapidly increase in size

82
Q

sonographic appearance of cystosarcoma phylloides

A
  • similar to fibroadenoma but larger and more lobulated

- may demonstrate cystic spaces

83
Q

what is a lipoma and what age group does it affect

A
  • benign tumour of fat

- middle aged women

84
Q

are lipomas symptomatic or asymptomatic

A
  • asymptomatic
85
Q

sonographic appearance of lipomas

A
  • usually hypoechoic depends on surrounding tissue
  • defined margins
  • compressible with transducer pressure
86
Q

what is fat necrosis and what causes it

A
  • hemorrhage or liquefaction of fatty area which leads to necrosis
  • trauma, surgery, inflammation
87
Q

what does fat necrosis clinically present as

A
  • firm nodule
  • skin retraction
  • nipple inversion
  • features which mimic breast cancer
88
Q

sonographic appearance of fat necrosis

A
  • irregular
  • hypoechoic
  • complex mass that shadow
89
Q

what is a papilloma

A
  • bengin solid masses in the lining of the duct
90
Q

what is the most common cause of bloody nipple discharge

A
  • papiloma
91
Q

where are papillomas typically located

A
  • near the nipple
92
Q

sonographic appearance fo papillomas

A
  • solid lesion in a duct or cyst
  • possible ductal ectasia
  • vascular stalk may be visible with colour doppler
93
Q

are fibrocystic changes common or uncommon

A
  • common
94
Q

what are fibrocystic changes

A
  • exaggerated cystic changes in breast tissue

- cells in ducts proliferate and retain water

95
Q

what area of the breast is more effected by fibrocystic changes

A
  • UOQ
96
Q

what are the signs and symptoms of fibrocystic changes

A
  • lumpy swollen painful breasts
  • nodularity
  • nipple discharge
  • mammographic changes that mimmic cancer
97
Q

sonographic appearance of fibrocystic changes

A
  • multiple cysts
  • echogenic fibrous tissue
  • small nodules
98
Q

what is a galctocele and where are they typically located

A
  • obstruction of lactiferous duct in pregnant or lactating women
  • retro areolar region
99
Q

what Can a galactocele lead to

A
  • mastitis
100
Q

sonographic appearance of galactocele

A
  • well defined cystic mass
  • less posterior enhancement than a cyst
  • internal debris
101
Q

what is ductal ectasia who does it affect and what can it lead to

A
  • tubular hypoechoic structures conversion toward the nipple
  • lactating patients and patients >50
  • can lead to mastitis
102
Q

what is mastitis, is it focal or diffuse

A
  • breast inflammation

- focal or diffuse

103
Q

what causes mastitis

A
  • obstruction of duct by milk

- bacteria enters via nipple

104
Q

what are other causes of mastitis

A
  • trauma
  • radiation therapy
  • diabetes
  • immunocompromised
105
Q

what are the signs and symptoms of mastitis

A
  • hot red tender breast/fever
  • palpable mass
  • nipple discharge
106
Q

ultrasound appearance of mastitis

A
  • irregular fluid collections with debris
  • loss of tissue definition
  • complex fluid collection with shaggy wall
  • septations
  • poster enhancement
107
Q

what are the low risk characteristics of nipple discharge

A
  • bilateral, involves multiple ductal orifices
  • milky greenish discharge
  • like related to fibrocystic change or ductal ectasia
108
Q

what are the high risk characteristics of nipple discharge

A
  • unilateral
  • spontaneous
  • clear
  • bloody
  • serous
  • galactogram procedure warranted
109
Q

what are the two categorization techniques fo malignant lesions

A
  • location = ductal,lobular

- invasiveness = non invasive, invasive

110
Q

what are the common sonographic appearance of malignancy

A
  • hypoechoic compared to breast tissue
  • taller than wide
  • angle irregular margins or borders
  • heterogeneous
  • posterior shadowing
  • thick echogeninc rim
  • ductal extension or branch pattern
  • microlobulations
  • calcifications
111
Q

what are the secondary findings of a malignant lesions

A
  • skin changes thickening flattening or retraction
  • inverted nipple
  • axillary or intramamary LN
  • dilated ducts
  • highly echogenic surrounding tissue
  • thickened coopers ligaments
112
Q

what percent of breast cancers are non invasive

A

15%

113
Q

what are the 3 non invasive breast carcinomas

A
  • ductal carcinoma in situ
  • lobular carcinoma in situ
  • intracystic papillary carcinoma in situ
114
Q

what is the most common noninvasive carcinoma and where does it arise from

A
  • ductal carcinoma in situ

- arise in ducts

115
Q

what age group is most affected by ductal carcinoma in situ

A
  • post menopausal
116
Q

what are two charcteristics of ductal carcinoma in situ

A
  • nipple discharge

- microcalcificatiosn

117
Q

what is lobular carcinoma in situ

A
  • increased incidence in reproductive years
  • not TRUE cancer
  • high risk for breast cancer
118
Q

what is intracystic papillary carcinoma in situ

A
  • rare
  • middle aged females
  • well defined mobile mass
119
Q

what are the 5 invasive breast carcinoma

A
  • infiltrating ductal carcinoma
  • infiltrating lobular carcinoma
  • medullary
  • mucinous
  • papillary
120
Q

what is the most common cancer of the breast and where is it located

A
  • invasive ductal carcinoma

- UOQ

121
Q

what are the physical characteristics of infiltrating ductal carcinoma

A
  • hard
  • stationary
  • painless
  • palpable
122
Q

what are two sonographic appearances of infiltrating ductal carcinoma

A
  • microcalcifications

- spiculations

123
Q

what is the most frequently missed cancer and what is it often associated with

A
  • infiltrating lobular carcinoma

- nipple retraction

124
Q

characteristics of medullary carcinoma

A
  • rare
  • fastest growing
  • middle aged
125
Q

characteristics of mucinous carcinoma

A
  • rare
  • older
  • slow growth
126
Q

characteristics of papillary carcinoma

A
  • post menopausal women
  • bloody nipple discharge common
  • located typically in central breast area
  • good prognosis
127
Q

what type of masses should always be considered suspicious

A
  • solid masses
128
Q

characteristics of augmented breast

A
  • saline best choices or silicone
  • cosmetic or reconstructive
  • anterior or posterior to pectoralis
  • difficult to asses with mammon’s
129
Q

what are the concerns with implants

A
  • leakage or rupture
  • contraction of capsule
  • obscure normal breast tissue with mammo
130
Q

sonographic appearance of implants

A
  • oval
  • echo free
  • anterior reverberation artifact normal
  • radial folds identified
131
Q

where are fill valves usually seen

A
  • saline implants

- posterior to nipple

132
Q

what are the two different silicone leaking issues

A
  • intracapsular

- extra capsular

133
Q

what is an intracapsular leak

A
  • tear in shell with silicone gel located between fibrous capsule and implant shell
  • step ladder sign = numerous linear echogenic structures
134
Q

what is extra capsular leak

A
  • tear through implant shell and fibrous capsule

- snow storm appearance

135
Q

what are the signs and symptoms of silicon leaks

A
  • change in breast shape or consistency

- chronic burning

136
Q

what is a silicon bleed

A
  • occurs in all silicon implants
  • microscopic leakage through an intact implant but contained in fibrous capsule
  • silicon migrates to lymph nodes
137
Q

what is contracture

A
  • fibrous capsule form around implant t
  • normally remains larger than implant and flexible
  • fibrous capsule contracts and constricts disfiguring the breast
  • lower risk of contracture with posterior placed implants
138
Q

what is gynecomastia

A
  • male breast enlargement

- abnormal proliferation of retroareolar glandular tissue and increase in fat

139
Q

what is the most common breast abnormality in men

A
  • gynecomastia
140
Q

what is gynecomastia linked to

A
  • estrogen and androgen use
  • drugs for hypertension and depression
  • estrogenic neoplasms
141
Q

what are the signs and symptoms of gynecomastia

A
  • enlarged breast
  • palpable firm mass under nipple
  • pain tenderness
142
Q

sonographic appearance of gynecomastia

A
  • triangular area of hypoechcoi glandular tissue under areolar region
  • ducts identified converging toward nipple
  • increased fat

Abd / SS 3 (6 decks)

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