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Breast Flashcards

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1
Q

What is the most common type of cancer in women?

A

breast cancer

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2
Q

What is the gold standard for imaging breast?

A

mammography

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3
Q

When is ultrasound used for breast?

A
  • palpable mass
  • suspicious mammo
  • dense tissue
  • young patients
  • characterization of masses
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4
Q

What are some ultrasound guided procedures for breast?

A
  • cyst aspiration
  • core biopsy
  • pre-op localization
  • vacuum assisted biopsies
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5
Q

Where do accessory nipples (supernumerary) form?

A

along the milk line

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6
Q

What is the tail of Spence?

A

Breast tissue that tapers (extends) into the axilla

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7
Q

How does fatty breast tissue appear on ultrasound?

A

hypoechoic

fat in the rest of the body appears hyperechoic

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8
Q

What are the 3 layers between the skin and pectoralis major muscle?

A
  • subcutaneous
  • mammary (glandular)
  • retromammary
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9
Q

What are Cooper’s ligaments?

A

supporting structures of the breast

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10
Q

Where does nearly all breast pathology begin?

A

TDLU (terminal ductal lobular unit)

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11
Q

Where is milk produced?

A

lobules

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12
Q

How do Cooper’s ligaments appear sonographically?

A

echogenic lines

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13
Q

Pectoralis major muscle is _______ to the retromammary layer

A

posterior

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14
Q

How do ribs appear sonographically?

A

hyperechoic with shadowing

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15
Q

Ducts behind nipple can be mistaken for?

A

mass

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16
Q

How does parenchymal pattern appear on young, pregnant or lactating, mature, & postmenopausal?

A

Young: fibrous tissue, dense echogenic pattern
Pregnant or lactating: larger & denser glandular portions; less echogenic interfaces
Mature: fatty tissue begins to replace glandular
Postmenopausal: ducts atrophy; less fibrous tissue

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17
Q

97% of lymphatic drainage is due to?

A

axillary lymph nodes

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18
Q

What is gynecomastia?

A

Abnormal breast enlargement in males

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19
Q

Male patients at increased risk for breast cancer:

A
  • klinefelter syndrome
  • male-to-female transsexual
  • history of chest wall irradiation
  • history of orchitis or testicular tumor
  • liver disease
  • genetic predisposition
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20
Q

What is Klinefelter syndrome?

A

the most common sex chromosome syndrome; usually have an extra X
- P53 is a tumor suppressor gene

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21
Q

Approx _____ cases of breast cancer in males in the US per year

A

1300

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22
Q

What is the purpose of breast screening?

A

detection and diagnosis of cancer in early stages

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23
Q

At what age is a mammogram needed yearly?

A

age 40

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24
Q

What exception is there to getting a mammo before the age of 40?

A
  • personal history of breast CA
  • 1st degree relative
  • atypical hyperplasia or LCIS (lobular carcinoma in situ) on previous biopsy
  • breast cancer gene: BRCA-1; BRCA-2
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25
What is the most common clinical sign of breast cancer?
breast lump (palp mass)
26
Clinical signs and symptoms of possible breast cancer:
- new or growing dominant, discrete breast lump (most common clinical sign of BC) - usually painless - does not fluctuate with hormonal cycle - lumpy breast texture - unilateral single duct nipple discharge - spontaneous, persistent, serous or bloody nipple discharge - red, hot breast - nonhealing ulcer - surface nipple lesion - new nipple retraction - focal irritation
27
Common primary signs of breast cancer on mammography:
- irregular (spiculated); high density mass - clustered pleomorphic (having many shapes) microcalcifications - focal distortion
28
Common secondary signs of breast cancer on mammography:
- nipple or skin retraction - skin thickening/skin dimpling - lymphedema pattern - increased vascularity
29
What are the BIRADS used for?
used to rate the results of mammogram
30
BIRADS categories
0 = needs additional imaging 1 = negative 2 = Benign 3 = probably benign - (short interval follow up) 4 = suspicious (need tissue diagnosis) 5 = highly suggestive of malignancy 6 = known biopsy proven cancer
31
Most common solid benign mass in breast is?
fibroadenoma
32
Benign pathology of breast:
- cysts - fibrocystic condition - fibroadenoma - lipoma - fat necrosis - acute mastitis - chronic mastitis - abscess - cystosarcoma phyllodes - intraductal papilloma
33
5 major categories of breast cancer are?
- Lobular carcinoma in situ (LCIS) - Invasive lobular carcinoma (ILC) - Ductal carcinoma in situ (DCIS) - Invasive ductal carcinoma (IDC) (most common) - Inflammatory breast cancer (IBC)
34
Most common breast cancer is?
Invasive ductal carcinoma (IDC)
35
Most common non-invasive breast cancer is?
Ductal carcinoma in situ (DCIS)
36
Inflammatory breast cancer findings:
More clinical signs than ultrasound findings: - necrosis - red, hot to touch, swollen - peau d'orange skin
37
Reasons to why we scan men for breast ultrasound?
- gynecomastia - breast cancer
38
Sonographic shape of a solid Mass: benign vs malignant
Benign: rounded or oval, large lobulations Malignant: sharp, angular microlobulations, taller than wide
39
Sonographic internal echo pattern of a solid mass: benign vs malignant
Benign: isoechoic, hyperechoic Malignant: hypoechoic, weak internal echoes, clustered microcalcifications
40
Attenuation effects of solid mass: benign vs malignant
Benign: posterior enhancement Malignant: strongly attenuating
41
Mobility of solid mass: benign vs malignant
Benign: some mobility Malignant: firmly fixed
42
Compressibility of solid mass: benign vs malignant
Benign: fatty tumors usually compressible Malignant: rigid, non compressible
43
Vascularity of malignant mass in breast appears:
Hypervascular; feeding vessel
44
Sonographic margins of solid mass: benign vs malignant
Benign: smooth, rounded, posterior enhancement or nothing posteriorly, well-defined borders, homogeneous Malignant: indistinct, ill-defined, spiculated, heterogeneous, posterior shadowing, taller than wide
45
Disruption of breast architecture with solid mass: benign vs malignant
Benign: grows within tissue causing compression of the tissue adjacent to the mass Malignant: grows through tissue without compressing adjacent tissue; may cause retraction of nipple or dimpling of the skin
46
Mastitis acute vs chronic:
Acute: enlarged, red, tender Chronic: nipple discharge, nipple retraction, elderly women
47
Which benign breast pathology?
- Can be simple, complex, galactocele, sebaceous, or oil Cyst
48
Which benign breast pathology?
- Bilateral lumps and pain that comes and goes during cycle; can be in one breast or both Fibrocystic condition (FCC)
49
Which benign breast pathology?
- Unilateral or bilateral; may be multiple "rubbery"; stimulated by estrogen, may have calcs Fibroadenoma
50
Which benign breast pathology?
- Fatty tissue, middle-aged or menopausal, smooth walls, hypoechoic Lipoma
51
Which benign breast pathology?
- Associated with oil cysts, history of radiation; obesity; can mimic cancer Fat necrosis
52
Which benign breast pathology?
- Caused by infection, trauma, blocked milk duct; can be acute or chronic Mastitis
53
Which benign breast pathology?
- Has mottled appearance, irregular margins, low-level echoes; pain, swelling; aspiration for diagnosis; mammogram may not be possible Abscess
54
Which benign breast pathology?
- Rare (<2%); usually benign, may grow from fibroadenoma; most frequent sarcoma of the breast Cystosarcoma phyllodes
55
Which benign breast pathology?
- Grows in acini; spontaneous nipple discharge; occurs in women 35-55 years of age; must have biopsy to rule out malignancy, recommended removal Intraductal papilloma
56
What is a sarcoma?
Cancer of mesenchymal tissue (muscle & bone)
57
What is carcinoma?
cancer of epithelial cells
58
What is adenocarcinoma?
Cancer arising from glandular organs
59
What is a radial scar?
- Scar formation caused by ductal epithelium invading surrounding stromal tissues; < 1 cm, no hypervascularity - It may present as a spiculated mass on mammography and sonography.
60
T/F? Breast cancer is the 2nd leading cause of cancer deaths after lung
True
61
Malignant cancers of the breast usually begin as?
Atypical hyperplasia
62
Most malignant breast conditions are located?
UOQ (50%)
63
2 types of malignant breast conditions:
- sarcoma - carcinoma
64
Malignant breast condition categories are based on what 2 factors?
- Origination: ductal or lobular - propensity to spread: noninvasive or invasive
65
T/F? Location can determine prognosis of breast cancer
False ## Footnote Location does not determine prognosis. Size and spread do
66
What is fremitus?
An examination where the patient is asked to hum a pitch while color or power Doppler is used to examine the breast. Softer portions of the breast vibrate more in response to the humming, while cancers and other firm masses vibrate less and thus become visible as areas of decreased color, even if they are isoechoic on the ordinary B scan. ## Footnote Benign: color around mass Malignant: color within mass

ABDOMEN 2 (3 decks)

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