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
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
3
Q
what are the 6 advantages of ultrasound
A
- noninvasive
- painless
- non ionozing
- low cost
- image chest wall
- doppler
4
Q
what is a mammary gland and what is it composed fo
A
- modified sweat gland
- composed of fatty, glandular, and fibrous tissue
5
Q
what ae the 3 layers/zones of the mammary gland
A
- subcutaneous
- mammary
- retromammary
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
7
Q
do any breast legions originate in the subcutaneous zone?
A
- no
8
Q
what is the mammary fascia
A
- connective tissue enveloping mammary zone
9
Q
what is the mammary fascia continuous with
A
- coopers ligaments
10
Q
what is the purpose of coopers ligament
A
- support and shape breast
- located in subcutaneous zone
11
Q
what is the mammary zone
A
- functional layer made up of fibroglandular tissue
12
Q
what is the location of the mammary zone
A
- mostly Upper Outer Quadrant
- areola
13
Q
what 2 things does the size of the mammary zone depend on
A
- functional state
- inherited tissue pattern
14
Q
what are the 3 structures that make up to mammary zone
A
- lobes
- lobules
- lactiferous ducts and sinuses
- TDLU
15
Q
what are the lobes
A
- 15-20 in each breast
- arranged radially and vary in size
- contain ducts, stroma, and acinus
16
Q
what are the lobules
A
- 20-40 per lobe
- contain individual milk producing glands - ACINI
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
18
Q
what is the TDLU
A
- functional unit
- terminal ductal lobular unit
- consists of lobule and extra lobular terminal duct
19
Q
where si the site of most major breast pathology
A
- TDLU
20
Q
what is the tail of spence
A
mammary tissue extending into the axilla region
21
Q
what is the retromammary zone
A
- deepest layer
- quite thin
- contains fat, blood vessels, lymphatics
22
Q
what is the nipple
A
- fibromuscular papilla
- projecting from the centre of the breast
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
24
Q
what is the areola
A
- pigmented area surrounding the nippler
- contains many sebaceous that giver area its bumpy appearance
25
what are the muscles in the breast
- pectorals major posterior to retromammary layer
| - pectoralis minor covered by pectorals major
26
what is the vascular supply to the breast
- lateral thoracic artery
- internal mammary artery
- intercostal arteries
- venous drainage via superficial and deep networks
27
what is the lymphatic drainage of the breast
- drainage flows to axillary nodes
| - originate in connective tissue ducts under skin
28
what often occurs with breast cancer
- frequency invasion of the lymph system
29
what is the purpose of the breast
- produce and secrete milk
30
what factors influence the amount fo parenchyma and stroma
- age and stage of breast function
31
what hormone promotes the growth of the ductal tissue
- estrogen
32
what hormone stimulates development of lobular cells
- progesterone
33
what hormones stimulate milk production and causes milk ejection from lactating breast
- prolactin
| - oxytocin
34
contents of the breast in prepubescent children
- rudimentary ducts
- tissue developing under nipple
- very little fat
35
contents of the breast in young adults
- mostly fibroglandular tissue (dense)
| - minimal fat
36
contents of the breast in adults
- equal fibroglandular and fat tissue
37
contents of the breast in pregnant/lactating
- mostly glandular tissue
| - prominent ducts
38
contents of the breast in older/multiparous
- increase subcutaneous/retromammary fat
39
contents of the breast in menopausal women
- parenchymal mainly under nipple and upper outer quadrant
40
contents of the breast in post menopausal women
- fatty replacement
| - lobules and ducts atrophy
41
what is the sonographic appearance of the skin
- 2 thin echogenic lines
| - 2-3mm in thickness
42
what is the sonographic appearance of the nipple
- homogeneous
- medium level echoes
- posterior acoustic shadowing
43
what is the sonographic appearance of the subcutaneous fat lobules
- amount varies
- does not extend posterior to the nipple
- hypoechoci lobules containing thin echogenic strands
- edge artifact
44
what is the sonographic appearance of the parenchyma
- homogenous
- echogenic compared to fat
- interspersed hypoechoci areas of fat
- hypoechoic ducts tracking toward nipple
45
what is the sonographic appearance of the lactiferous ducts
- hypoechoci tubes tracking toward the nipple
- increasing in size
- radial pattern
46
what is the sonographic appearance of the coopers ligament
- curved echogenic striations
| - encase fat lobules
47
what is the sonographic appearance of the retromammary layer
- hypoechoic due to fat
| - anterior to the pectoralis muscle
48
what is the sonographic appearance of the muscles
- medium to low level echoes
| - striated
49
what is the sonographic appearance of the ribs
- lateral ribs= attenuating structures with shadowing
| - medial cartilage = hypoechoic
50
what is the sonographic appearance of the lymph nodes
- < 1cm normal
- oval hypoechcoi
- echogenic hilum
51
what are 5 family history questions that you should as a patient coming in for breast exam
- family history
- parity gravida
- medication
- surgeries
- nipple discharge
52
in what direction is the patient rolled when scanning and what arm is raised above the patients head
- rolled toward opposite side that is being scanned
| - ipsilateral arm raised and placed behind head
53
what are the 2 different approaches to scanning the breast in two planes
- clock face approach
| - quadrant approach
54
what are the two different ways to measure a lesion
- sag/trans
| - radial/antiradial
55
what are the steps to labelling a breast image
- right or left
- quadrant
- o'clock
- plane = sag, trans, radial, antiradial
56
what is BIRADS
- breast imaging reporting and data system
| - classifies lesions according to suspicion of breast cancer
57
what are the different BIRADS categories
-1, 2, 3, 4a, 4b, 4c, 5, 6,
58
what is. BIRAD 1
- sonographically normal
59
what is BIRAD 2
- benign finding
60
what is BIRAD 3
- probably benign
61
what is BIRAD 4a
- low suspicion
62
what is BIRAD 4b
- intermediate suspicion
63
what is BIRAD 4c
- moderate suspicion
64
what is BIRAD 5
- highly suggestive of malignancy >95%
65
what is BIRAD 6
- known cancer
66
what are the 11 benign abnormalities of the breast
- cysts
- fibroadenoma
- cystosarcoma phylloides
- lipoma
- fat necrosis
- papilloma
- fibrocystic changes
- galactocele
- ductal ectasia
- mastitis
- nipple discharge
67
what is the common age of women with cysts
- 35-50
68
what is a cyst in the breast
- obstruction in the terminal portion of duct
69
what are 4 common physical characteristics of breast cysts
- palpable and rounded
- move freely but not as mobile as fibroadenoma
- single or multiple
- variable size
70
what are the 4 sonographic criteria of a simple cyst
- posterior enhancement
- thin walled
- edge shadowing
- anechoic
71
what can change the shape of a breast cyst
- transducer pressure
72
what are the characteristics of a complex breast cyst
- low level internal echoes
- septations
- posterior enhancement
73
what is another name for a complex cyst in the breast
- foam cyst
74
what is an acorn cyst
- cyst that displays a non dependent echogenic layer
75
what is the most common benign tumor in women of child bearing years
- fibroadenomas
76
what hormone stimulates fibroadenomas
- estrogen
| - increase in size with pregnancy and HRT
77
what are 3 physical characteristics of a fibroadenoma
- various shapes and sizes
- unilateral/bilateral
- palpable, painless, mobile
78
what is the sonographic appearance of a fibroadenoma
- elliptical or gently lobulated
- thin echogenic capsule
- hypoechoci homogeneous
- WIDER THAN TALL
- solid
- no posterior acoustic enhancement
- no change in shape with compression
79
are cystosarcoma phylloides common or rare
- rare
80
what are cystosarcoma phylloides
- giant fibroadenomas
| - usually benign but can become malignant
81
what are 2 physical characteristics of cystosarcoma phylloides
- unilateral
| - rapidly increase in size
82
sonographic appearance of cystosarcoma phylloides
- similar to fibroadenoma but larger and more lobulated
| - may demonstrate cystic spaces
83
what is a lipoma and what age group does it affect
- benign tumour of fat
| - middle aged women
84
are lipomas symptomatic or asymptomatic
- asymptomatic
85
sonographic appearance of lipomas
- usually hypoechoic depends on surrounding tissue
- defined margins
- compressible with transducer pressure
86
what is fat necrosis and what causes it
- hemorrhage or liquefaction of fatty area which leads to necrosis
- trauma, surgery, inflammation
87
what does fat necrosis clinically present as
- firm nodule
- skin retraction
- nipple inversion
- features which mimic breast cancer
88
sonographic appearance of fat necrosis
- irregular
- hypoechoic
- complex mass that shadow
89
what is a papilloma
- bengin solid masses in the lining of the duct
90
what is the most common cause of bloody nipple discharge
- papiloma
91
where are papillomas typically located
- near the nipple
92
sonographic appearance fo papillomas
- solid lesion in a duct or cyst
- possible ductal ectasia
- vascular stalk may be visible with colour doppler
93
are fibrocystic changes common or uncommon
- common
94
what are fibrocystic changes
- exaggerated cystic changes in breast tissue
| - cells in ducts proliferate and retain water
95
what area of the breast is more effected by fibrocystic changes
- UOQ
96
what are the signs and symptoms of fibrocystic changes
- lumpy swollen painful breasts
- nodularity
- nipple discharge
- mammographic changes that mimmic cancer
97
sonographic appearance of fibrocystic changes
- multiple cysts
- echogenic fibrous tissue
- small nodules
98
what is a galctocele and where are they typically located
- obstruction of lactiferous duct in pregnant or lactating women
- retro areolar region
99
what Can a galactocele lead to
- mastitis
100
sonographic appearance of galactocele
- well defined cystic mass
- less posterior enhancement than a cyst
- internal debris
101
what is ductal ectasia who does it affect and what can it lead to
- tubular hypoechoic structures conversion toward the nipple
- lactating patients and patients >50
- can lead to mastitis
102
what is mastitis, is it focal or diffuse
- breast inflammation
| - focal or diffuse
103
what causes mastitis
- obstruction of duct by milk
| - bacteria enters via nipple
104
what are other causes of mastitis
- trauma
- radiation therapy
- diabetes
- immunocompromised
105
what are the signs and symptoms of mastitis
- hot red tender breast/fever
- palpable mass
- nipple discharge
106
ultrasound appearance of mastitis
- irregular fluid collections with debris
- loss of tissue definition
- complex fluid collection with shaggy wall
- septations
- poster enhancement
107
what are the low risk characteristics of nipple discharge
- bilateral, involves multiple ductal orifices
- milky greenish discharge
- like related to fibrocystic change or ductal ectasia
108
what are the high risk characteristics of nipple discharge
- unilateral
- spontaneous
- clear
- bloody
- serous
- galactogram procedure warranted
109
what are the two categorization techniques fo malignant lesions
- location = ductal,lobular
| - invasiveness = non invasive, invasive
110
what are the common sonographic appearance of malignancy
- 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
what are the secondary findings of a malignant lesions
- skin changes thickening flattening or retraction
- inverted nipple
- axillary or intramamary LN
- dilated ducts
- highly echogenic surrounding tissue
- thickened coopers ligaments
112
what percent of breast cancers are non invasive
15%
113
what are the 3 non invasive breast carcinomas
- ductal carcinoma in situ
- lobular carcinoma in situ
- intracystic papillary carcinoma in situ
114
what is the most common noninvasive carcinoma and where does it arise from
- ductal carcinoma in situ
| - arise in ducts
115
what age group is most affected by ductal carcinoma in situ
- post menopausal
116
what are two charcteristics of ductal carcinoma in situ
- nipple discharge
| - microcalcificatiosn
117
what is lobular carcinoma in situ
- increased incidence in reproductive years
- not TRUE cancer
- high risk for breast cancer
118
what is intracystic papillary carcinoma in situ
- rare
- middle aged females
- well defined mobile mass
119
what are the 5 invasive breast carcinoma
- infiltrating ductal carcinoma
- infiltrating lobular carcinoma
- medullary
- mucinous
- papillary
120
what is the most common cancer of the breast and where is it located
- invasive ductal carcinoma
| - UOQ
121
what are the physical characteristics of infiltrating ductal carcinoma
- hard
- stationary
- painless
- palpable
122
what are two sonographic appearances of infiltrating ductal carcinoma
- microcalcifications
| - spiculations
123
what is the most frequently missed cancer and what is it often associated with
- infiltrating lobular carcinoma
| - nipple retraction
124
characteristics of medullary carcinoma
- rare
- fastest growing
- middle aged
125
characteristics of mucinous carcinoma
- rare
- older
- slow growth
126
characteristics of papillary carcinoma
- post menopausal women
- bloody nipple discharge common
- located typically in central breast area
- good prognosis
127
what type of masses should always be considered suspicious
- solid masses
128
characteristics of augmented breast
- saline best choices or silicone
- cosmetic or reconstructive
- anterior or posterior to pectoralis
- difficult to asses with mammon's
129
what are the concerns with implants
- leakage or rupture
- contraction of capsule
- obscure normal breast tissue with mammo
130
sonographic appearance of implants
- oval
- echo free
- anterior reverberation artifact normal
- radial folds identified
131
where are fill valves usually seen
- saline implants
| - posterior to nipple
132
what are the two different silicone leaking issues
- intracapsular
| - extra capsular
133
what is an intracapsular leak
- tear in shell with silicone gel located between fibrous capsule and implant shell
- step ladder sign = numerous linear echogenic structures
134
what is extra capsular leak
- tear through implant shell and fibrous capsule
| - snow storm appearance
135
what are the signs and symptoms of silicon leaks
- change in breast shape or consistency
| - chronic burning
136
what is a silicon bleed
- occurs in all silicon implants
- microscopic leakage through an intact implant but contained in fibrous capsule
- silicon migrates to lymph nodes
137
what is contracture
- 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
what is gynecomastia
- male breast enlargement
| - abnormal proliferation of retroareolar glandular tissue and increase in fat
139
what is the most common breast abnormality in men
- gynecomastia
140
what is gynecomastia linked to
- estrogen and androgen use
- drugs for hypertension and depression
- estrogenic neoplasms
141
what are the signs and symptoms of gynecomastia
- enlarged breast
- palpable firm mass under nipple
- pain tenderness
142
sonographic appearance of gynecomastia
- triangular area of hypoechcoi glandular tissue under areolar region
- ducts identified converging toward nipple
- increased fat
