Breast Flashcards
What to think of when asymettric breasts are mentioned in Q?
Asymmetic breast can be completely normal
Abnormalitis that cause shrunken breast and therefore asymmetry include Invasive lobular breast cancer
-if size difference is NEW or breast parenchyma is asymettrically dense = think cancer
Breast calcifications
If there are** linear or segmental calcifications** that pass along a duct = this is suspicious for malignancy
What is main blood supply to breast?
Where is lymphatic drainage?
60% is from internal mammary artery
The other is from lateral thoracic and intercostal vessels
Lymph drainage is 97% to the axilla (last 3% is to internal mammary)
How many types of nodes are present in breast?
Where are they located?
Where are Rotter nodes located?
There are 3 types
Level 1: Lateral to pec minor
Level 2: Deep to pec minor
Level 3: Medial and above pec minor
Rotter Nodes: located between pec major and pec minor
What is Sternalis muscle?
Accessory muscle of the chest
Not everyone has it
It can be mistaken for a breast mass on CC views
Should not biopsy
How to tell if it is a mass or not?
It will only be visible on CC views not MLO
Where is the most common area for ectopic breast tissue?
Axillary is most common
Next is inframammary fold
High yield trivia
What is a galactocele and how does it appear?
A benign fat containing and milk containing lesion
Usually seen after cessation of lactation
Basically a retention cyst seen after occlusion of lactiferous duct
Usually subareolar
-fat fluid level is buzzword
What are lactating adenomas?
Usually appear as multiple masses that look like Fibroademonas in women who are breastfeeding
Can regress after you stop lactation
Followup in 4 - 6 months post partum
In what cases might you use a LMO view instead of MLO?
Patients with kyphosis or pectus excavatum
Or to avoid central line or pacemaker
ML vs LM
Which parts of breast are shown better in each view?
ML shows lateral breast in better detail
LM shows medial breast in better detail
Does mammography always use a grid?
Yes but not on Magnification views
How to localise a single lesion on the MLO view
Muffins Rise
Lead Sinks
If lesion is medial on CC view it will be at top on true lateral
If lesion is lateral on CC view if will be on bottom of true lateral
How to localise a lesion only seen on the CC view?
Do rolled views
If breast is rolled medially from the top = superior lesion will appear more MEDIAL
inferior lesion will appear more LATERAL
Calcifications in breast
3 types:
- Benign
- Artefact
- Suspicious
Benign calcs breat
Give examples
- Dermal calcs - appear in skin folds or anywhere women sweat. can confirm with tangenital projection*. They stay in the same place on CC and MLO views
- Vascular calcs
- Popcorn calcs - seen in **degenerating fibroadenoma
- Secretory Calcs - appear as rods or ‘dashes’. 10 - 20 years post menopausal and will point towards nipple.
- Eggshell calcs = think Fat necrosis. can be due to any kind of trauma. Lucent centre is buzzword. Appear as peripheral calcs. Seen in Oil cysts
- Dystrophic calcs = irregular in shape post radiation/trauma/surgery
- Rounded calcs - usually in both breasts scattered - if bilateral, and symmetric think of these.
Benign Calcs continued
Teacup or milk calcs
*Appear as teacup in shape on an ML view
Due to fluid fluid levels as a result of fibrocystic change*
Suspicious calcs in Breast
Fine pleomorphic and fine linear branching are most suspicious for malignancy with FIne linear branching being the worst
Makes DCIS more suspicious
What is Mondor Disease?
Benign
Essential a thrombosed vein in breast
Treat with NSAIDS and warm compress
No anticoags
Name 5 fat containing lesions of the breast?
- Hamartoma - ‘breast within a breast’ hard to see on US
- Galactocele - fluid fluid levels in lactating women
- Oil cyst - can have peripheral egg shell calcs (can be post surgery/trauma/random)
- Lipoma - enlargement is criteria for biopsy
- Intramammary lymph node - often located along pectoral muscle
Fibroadenoma
What are features?
What age group?
Most common palpable mass in young women (15-25 years, rarely over 50)
Oval, well circumscribed hypoechoic mass with central HYPERechoic band
T2 bright with type 1 progressive enhancement
If seen in an older patient - can have popcorn calcs
What is Phyllodes?
Solid mass containing cystic components and posterior acoustic enhancement
Fast growing breast mass
Think of this when you see a mass that looks like a fibroadenoma in an older patient
-risk of malignant degeneration and can metastasize to lungs
-haematogenous mets (not via lymphatics therefore don’t need to sample sentinel nodes)
Invasive ductal carcinoma
What are appearances?
Most common aggressive breast cancer
Arises in ducts but invades surrounding tissues and metastasizes
-spiculated irregular mass
-pleomorphic calcifications
-posterior acoustic shadowing on US
Invasive Ductal NOS (not otherwise specified) is most common breast cancer. NOS is where there is no distinguishing histological features.
Invasive Ductal carcinoma subtypes
What is multifocal vs mutlicentric Breast Ca?
Mutifocal = multiple primaries in same quadrant
Mutlicentric = multiple primaries in different quadrants
What is typical appearance of invasive lobular carcinoma?
2nd most common cancer
Ill defined area of shadowing on US
-can be bilateral and multicentric
-can cause breast shrinkage or loss of compressibility
-older population
Inflammatory Breast Cancer
What are features?
Skin thickening, red breast, swollen
REMEMBER - mastitis is ONLY seen in breastfeeding women so always think of cancer in a non-breastfeeding woman with red swollen breast
Also, inflammatory changes in inflamm breast cancer can improve with antibiotics so dont be fooled and dismiss
If incomplete response to antibiotics within 1-2 weeks - suspect IBC
MRI is best modality for detecting primary lesion
5 lesions that should be excised
Primary breast lymphome is most commonly of which subtype?
Non-hodgkins
What does architectural distorion appear like when compared to summation?
Architectural distorion will appear as radiating lines to a single point (summation will be lines that continue past eachother)
What rea the features of gynaecomastia in a man?
4 things
Name atypical and concerning features?
- Flame shaped - fans inwards from behind nipple
- Behind nipple
- Bilateral but asymmetric
- Can be painful
What are atypical features?
-Not behind nipple
-Calcification
Male breast cancer
What is usual type?
Lump behind nipple is most common presentation
Average age is 70 years
Assc with alcoholism, klinefelters, cirrhosis
Invasive Ductal Carcinoma - NOS is most common type
Classic location is near the nipple
-abnormal lymph nodes
-calcifications (tend to be coarse)
-looks like breast cancer
What are the different types of implant rupture?
Intracapsular and Extracapsular rupture
Once inserted - the body forms a fibrous capsule around the ‘foreign’ **SILICONE **breast implant
Intracapsular Rupture: when there is a rupture of the shell of the silicone implant and it doesnt’ extend outwith the fibrous capsule. Breast and implant usually keep shape.
-creates linguine sign on MRI
Extracapsular rupture: when rupture extends outwith the fibrous capsule. Implant loses shape. Snowstorm appearance on US
Can NOT have intracapsular rupture with saline implant - just extracapsular
What is a mimic for breast implant rupture?
How to differentiate?
Radial folds
These are normal infoldings of the silicone shell.
They will always connect with outer silicone shell
Syndromes assocaited with Breast Cancer
Breast Trivia
