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ABDOMEN 4 > 4.1 Breast > Flashcards

4.1 Breast Flashcards

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1
Q

Increase Breast Cancer Risks (3)

A
  1. Lifestyle behaviours (obese,inactive,alcohol)
  2. Hereditary factors
  3. Reproductive/hormonal factors (early menstruation, LMA with 1st pregnancy, late menopause, BCP, HRT)
    * exposed to estrogen longer
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2
Q

Indications for Breast ultrasound (7)

A

Dense breast tissue (more fibroglandular than fatty)
Mammogram uncertain
can be initial test under 30 years of age (due to radiation)
Biopsy
Breast implants
Male breast
Help plan radiation treatment

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3
Q

What is the gold standard for examining the breast?

A

Mammography

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4
Q

Advantages of using sonography for examining breasts?

A
  1. noninvasive
  2. Painless
  3. Non-ionizing
  4. Low cost
  5. Image chest wall
  6. Doppler
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5
Q

The mammary gland is a?

A

modified sweat gland

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6
Q

The mammary gland is composed of 3 different types of tissue:

A
  1. Fat tissue
  2. glandular tissue
  3. fibrous tissue
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7
Q

Th mammary gland is divided into 3 different layers or zones.

A
  1. Subcutaneous zone (Premammary)
  2. Mammary zone
  3. Retromammary zone
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8
Q

Where is the Subcutaneous zone (Premammary) located?

A

between skin and mammary fascia

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9
Q

What does the Subcutaneous zone (Premammary) consist of?

A

fat surrounded by connective tissue (CT)

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10
Q

Because the Subcutaneous zone (Premammary) consists of fat and CT this means No __ __ ___ develop here

A

True breast lesions

*but could spread here from mammary zone

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11
Q

What is the mammary fascia?

A

CT enveloping the mammary zone

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12
Q

What is the mammary fascia continuous with?

A

Cooper’s ligaments

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13
Q

What are Coopers ligaments?

A

They support and shape the breast

think coopers droopers

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14
Q

Mammary zone is the ____ layer

A

Functional

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15
Q

Mammary zone is composed of?

A

Fibroglandular tissue (breast parenchyma)

predominately located Upper outer quadrant(UOQ) and areolar region

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16
Q

Mammary zones contains ____ & ____

A

Lobes and lobules

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17
Q

Mammary zone have approx ___ lobes arranged ____. They contain which 3 things?

A

15-20 lobes; radilally
variable in size and contain
Ducts, stroma and acinus

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18
Q

Mammary zone contains_-__ _____per lobe and contains

A

20-40 LOBULES

Acini (milk producing glands)

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19
Q

Mammary zone Ducts are called?

A

Lactiferous ducts

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20
Q

What do the Lactiferous ducts do?

A

Drain acini, lobules, lobes

and converge towards the nipple to the lactiferous sinus

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21
Q

What is the functional unit of the breast

A

TDLU

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22
Q

What does the TDLU consist of?

A

Lobule and extra-lobular terminal duct (more common in duct)

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23
Q

Each TDLU is about __ to ___ in size.

A

1-2mm

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24
Q

THE SITE OF MOST MAJOR BREAST PATHOLOGY IS?

A

TDLU

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25
WHAT IS THE TAIL OF SPENCE?
Mammary tissue extending into the axilla region
26
Retromammary zone is the ___ layer and is ___.
deepest; thin
27
Retromammary zone consists of
Fat | BV's and lymphatics
28
The Nipple is a ____ ___ projecting from the center of the breast with multiple openings
Fibromuscular papilla
29
A normal variant of the nipple is?
inversion of the nipple | can also be seen with certain types of breast cancer, ask if recent change
30
The pigmented area around nipple is called the?
AREOLA
31
The bumpy appearance around the nipple is the?
sebaceous glands (oil producing)
32
What are the 2 muscles related to the breast?
1. Pectoralis Major | 2. Pectoralis Minor
33
Pectoralis Major lies?
posterior to retromammary zone
34
Pectoralis Minor is covered by the?
Pectoralis Major muscle
35
What are the 3 arteries of the breast?
1. Lateral thoracic arteries 2. Internal mammary arteries (havested) 3. Intercostal arteries
36
The venous drainage consists of both a ___ and ___ network?
deep and superficial network
37
Lymph flows from the breast to the ?
axilla
38
Lymph originates in the ____ and the ____
CT and lactiferous ducts
39
FREQUENT INVASION OF THE LYMP SYSTEM Occurs with?
breast cancer. Note: When find suspicious mass in breast always scan axilla looking for abnormal lymph nodes
40
Physiology of the breast. What do they do?
Produce and secrete milk | Age and Stage of breast function influence amount of parenchyma and stroma
41
What are the 4 HORMONES ASSOCIATED WITH THE BREAST?
1. Estrogen 2. Progesterone 3. Prolactin 4. Oxytocin
42
What does Estrogen do?
Promotes growth of ductal tissue
43
What does Progesterone do?
Stimulates development of lobular cells
44
What does Prolactin do?
Stimulates milk production
45
What does Oxytocin do?
Causes milk ejection from lactating breast
46
PREPUBESCENT breast consists of?
Rudimentary ducts and tissue developing under nipple, little fat
47
YOUNG ADULT breast consists of?
``` Fibroglandular tissue (dense, hard to see with mammography, why US, 1st choice) very minimal fat ```
48
ADULT breast consists of?
Fibroglandular = fatty tissue
49
PREGNANT /LACTATING breast consists of?
mostly glandular/prominent ducts
50
OLDER breast consists of?
increase fat in breast, easier mammography
51
MENOPAUSE breast consists of?
Parenchyma beneath nipple and UOQ, mostly fat
52
POSTMENOPAUSE breast consists of?
Fatty tissue. | lobules and ducts atrophy
53
What do we identify with breast US? (10)
``` skin nipple Subcutaneous fat parenchyma Lactiferous Ducts Cooper's ligament Retromammary layer Muscles Ribs Nodes ```
54
Sonographic appearance of Skin
2 thin echogenic lines 2-3mm (with radiation, can see skin thickening)
55
Sonographic appearance of Nipple
``` Homogenous, medium level echoes posterior shadowing ( hard to see pathology behind nipple) ```
56
Sonographic appearance of Subcutaneous fat
Amount varies, does not extend posterior to nipple | Hypoechoic lobules, thin, echogenic strands, edge artifact.
57
Sonographic appearance of breast parenchyma
Homogenous, echogenic compared to fat. | Interspersed hypoechoic zones (fat islant )
58
Sonographic appearance of Lactiferous DUCTS + SIZE
Hypoechoic/anechoic tubular | enlarges towards nipple (up to 8mm)
59
Sonographic appearance of Coopers ligament
Curved echogenic striations encasing hypoechoic fat lobules
60
Sonographic appearance of Retromammary layer
Hypoechoic due to fat content and anterior to pectoralis muscle
61
Sonographic appearance of Pectoralis muscle
Medium to low level echoes, striated
62
Sonographic appearance of Lateral Ribs
Acoustic shadow
63
Sonographic appearance of Medial cartilage
Hypoechoic
64
Sonographic appearance of Lymph Nodes + size
In axilla and parenchyma Oval, hypo, echogenic hilum should be < 1cm AP
65
What makes a lymph node suspicious
>1cm , more round and no hilum
66
Before starting exam
Hx-family,gravida,meds, surgeries, discharge Review previous Physical assessment - check for skin changes and scars palpate mass
67
What probe should you use for breast ultrasound?
12-18Mhz (highest possible)
68
What do we want to penetrate to always?
Chest wall/pectoralis muscle
69
What are the 2 methods/approaches we use to scan ?
Clock face or quadrant approach | orthogonal plames = 90 degree from each other
70
quadrant approach
RUOQ( right upper outer) RUIQ (right lower inner) RLOQ (right lower outer) RLIQ (right lower inner). same 4 left
71
Clock face approach (more common)
9: 00-lateral in right, medial in left 3: 00- medial in right breast, lateral in left
72
Describe Radial and antiradial planes
Radial- rays of sun Anti radial - 90 degrees to this lobules are orientated in radial manner
73
Always scan axilla for nodes, why?
most likely place for breast cancer to metastasize
74
When scanning scan posterior to nipple, place adjacent to nipple and angle?
retroareolar
75
BIRADS stands for
Breast Imaging Reporting and Data System
76
What is BIRADS
Reporting form documents breast lesions method of risk categorization Classify according to suspicion of breast cancer
77
BIRADS rating
``` 1= sonographically normal 2=benign finding 3=probably benign - 6 month f/o 4a=low suspicion 4b=intermediate 4c=moderate suspicion 5=highly suggestive of malignancy. - 4/5=biopsy 6=known cancer ```

ABDOMEN 4 (10 decks)

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