Breast

Question 0

What kind of transducer do you use for breast US?

Answer 0

High frequency 7.5 -15MHz

Question 1

What is the most common type of cancer among women in the USA?

Answer 1

breast cancer

Question 2

What is the gold standard for breast scanning?

Answer 2

mammogram

Question 3

Where is the TAIL OF SPENCE?

Answer 3

in the axilla

Question 4

what are the three layers of the breast?

Answer 4

subcutaneous layer

mammary layer (glandular)

retromammary layer

Question 5

what layers are usually quite thin and are composed of fat surrounded by connective tissue?

Answer 5

the subcutaneous and retromammary layers

Question 6

What is the terminal ductal lobular unit (TDLU)

Answer 6

This is where cancer live (in the tree looking part)

Question 7

How does fat appear in the breast?

Answer 7

it is the least echogenic tissue within the breast

Question 8

What are you looking for in the breast tissue?

Answer 8

the disruption of the architecture of the tissue

Question 9

What is the volume and echogenicity of the mammary layer dependent on?

Answer 9

the patient’s general inherited breast tissue pattern as well as the functional state of the breast (pubertal, lactating, postmenopausal)

Question 10

What is the sonographic appearance of the retromammary layer

Answer 10

similar to subcutaneous layer

boundary echoes resemble skin reflections

Pectoral muscles:

low level echo areas posterior to the retromammary layer

ribs:

hyperechoic rounded structures

dense posterior shadowing

Question 11

What are Cooper’s ligaments?

Answer 11

the connective tissue septae within the breast that forms a fibrous skeleton

Question 12

What branches from the terminal duct?

Answer 12

the acinar cells (individual milk producing glands)

Question 13

What pathologies are found in the TDLU?

Answer 13

fibrocystic condition

fibroadenomas (most common benign tumor of the breast)

intraductal carcinomas

invasive carcinomas

Question 14

Where is a solitary benign intraductal papilloma found?

Answer 14

in the main duct near the nipple

Question 15

Fat appears ________whereas Cooper’s ligaments appear______

Answer 15

hypoechoic

echogenic

Question 16

What are the different parenchymal patterns?

Answer 16

Young

pregnant or lactating

mature

postmenopausal

Question 17

What is the parenchymal pattern of the young??

Answer 17

fibrous tissue elements

dense echogenic pattern

Question 18

what is the parenchymal pattern of the pregnant or lactating?

Answer 18

larger and denser glandular portions

less echogenic interfaces

Question 19

What is the main arterial supply to the breast?

Answer 19

lateral thoracic artery

mammary artery

intercostal arteries

Question 20

lymphatic drainage from all parts of the breast generally flows to…

Answer 20

the axillary lymph nodes

Question 21

What is gynecomastia?

Answer 21

a mass in the male breast

Question 22

What hormones affect breast tissue?

Answer 22

placental lactogen

prolactin

chorionic gonadotropin

Question 23

What are the three general categories of breast imaging?

Answer 23

breast cancer screening (mammogram)

diagnostic (consultative, problem solving, workup)

diagnostic and interventional breast procedures

Question 24

What are the breast cancer screenings?

Answer 24

monthly self (starting age 20 BSE breast self exam) doctor (CBE clinical breast exam, every 3 yrs until 40 - yearly) mammogram (yearly screening beginning age 40)

Question 25

What are the primary signs of breast cancer on mammography?

Answer 25

irregular (spiculated), high-density mass clustered microcalcifications focal distortion less common: focal asymmetric density developing density

Question 26

What does FCC cause on mammogram?

Answer 26

diffuse benign microcalcifications adenosis multiple round masses

Question 27

Where do you find the standards for breast imaging?

Answer 27

BI-RADS (breast imaging reporting and data system) found in the American college of radiology

Question 28

Breast BIRAD Categories

Answer 28

1 - negative 2 - benign 3- probably benign 4a- mildly suspicious 4b - moderately suspicious 5 - malignant

Question 29

a dominant _________ _________ is often the reason for patient referral for breast ultrasound

Answer 29

breast lump

Question 30

What clinical information do you need to gather?

Answer 30

size of lump location onset and duration of the breast problem relation to the menstrual cycle

Question 31

What kind of focus do you want to use for breast imaging?

Answer 31

multifocus linear, high frequency

Question 32

What else do you inspect when doing a breast ultrasound?

Answer 32

the skin

Question 33

Which layer includes the functional portion of the breast as well as the surrounding stromal tissues?

Answer 33

the mammary layer

Question 34

how many lobes are there that contain the mild producing glands and duct system that carries the milk to the nipple?

Answer 34

15-20 lobes

Question 35

What do the terminal ducts and the acini form?

Answer 35

small lobular units called the terminal ductal-lobular units (TDLU)

Question 36

What is the parenchymal pattern of the mature?

Answer 36

fatty tissue begins to replace glandular tissue

Question 37

what is the parenchymal pattern of the postmenopausal?

Answer 37

ducts atrophy less fibrous tissue

Question 38

What clinical assessments give rise to a breast study?

Answer 38

family/personal history palpable lump/mammographic findings discharge/ pain

Question 39

How does breast cancer appear sonographically?

Answer 39

generally painless lobular or irregular in shape uneven in surface contour "gritty texture" poorly moveable

Question 40

What are the two views of a mammogram?

Answer 40

cranio-caudal (cc) mediolateral - oblique (MLO)

Question 41

What are the pseudomasses?

Answer 41

retroareolar ducts costal cartilage prominent areas of fibroglandular tissue

Question 42

what is a fibroadenoma?

Answer 42

usually similar in shape often quite firm and rubbery in consistency homogeneously solid on US well defined, circumscribed, smooth walls

Question 43

What is the main indication for breast ultrasound?

Answer 43

evaluation of smooth round or oval benign appearing mammographic masses

Question 44

What is the most common breast lesion?

Answer 44

cyst - must meet cyst criteria 2-4% prove to be malignant

Question 45

What are the signs and symptoms of fibrocystic condition?

Answer 45

include lumps and pain that the patient feels fluctuate with every monthly cycle

Question 46

what dietary limitations might a doctor put a woman with fibrocystic condition be put on?

Answer 46

no caffeine or chocolate

Question 47

What represents normal physiologic processes of breast tissue that fluctuate under the influence of the normal female hormonal cycles?

Answer 47

fibrocystic condition (FCC)

Question 48

What are the sonographic characteristics of a solid mass?

Answer 48

shape: benign: rounded or oval, large lobulations Malignant: sharp, angular, microlobulations Orientation: malignant: Taller than wide radial growth suspicious for intraductal lesions

Question 49

Proliferative means????

Answer 49

can have cellular changes

Question 50

what are the characteristics of mobility?

Answer 50

benign: some mobility malignant: firmly fixed

Question 51

Characteristics of compressibility?

Answer 51

benign: fatty tumors, usually compressible malignant: rigid, noncompressible

Question 52

characteristics of vascularity

Answer 52

benign: avascular malignant: hypervascular, feeder vessel

Question 53

What is fremitus power doppler hum?

Answer 53

helps determine fat from true solid nodule artifact shadowing vs true shadowing multifocus vs unifocal disease

Question 54

Which quadrant has the most occurrence of breast cancer?

Answer 54

Outer, upper, quadrant

Question 55

what gauge needle is used for breast aspiration?

Answer 55

fine needle usually 25 G

Question 56

What are nonproliferative lesions?

Answer 56

no increased risk of subsequent development of breast cancer

Question 57

What are proliferative lesions without atypical cells?

Answer 57

mildly elevated risk of subsequent breast cancer

Question 58

what are proliferative lesions with atypical cellular changes?

Answer 58

moderately increased risk of subsequent breast cancer

Question 59

What are the internal echo patterns of solid masses?

Answer 59

benign: isoechoic, hyperechoic malignant: hypoechoic, weak internal echoes, clustered microcalcifications

Question 60

what are the attenuation effects of a solid mass?

Answer 60

benign: posterior enhancement malignant: strongly attenuating

Question 61

is a fibroadenoma benign or malignant?

Answer 61

benign - although solid appearing see slide 78 for picture

Question 62

What are the 5 benign pathologies of the breast?

Answer 62

cysts fibrocystic condition fibroadenoma lipoma fat necrosis

Question 63

What is the primary tool in breast imaging in all women under age 30?

Answer 63

ultrasound

Question 64

What are the two main causes of an enlarged, reddened, tender breast?

Answer 64

mastitis inflammatory breast cancer

Question 65

what is mastitis?

Answer 65

inflammation of the breast most often due to duct obstruction

Question 66

What are the three main reasons mammography is not used in women under age 20-25?

Answer 66

cancer is rare for this age tissue is too dense tissue is more sensitive to radiation damage

Question 67

What imaging modality is the primary tool for pregnant patients?

Answer 67

ultrasound

Question 68

when doing an ultrasound guided process what is the key in visualization of the needle?

Answer 68

keep the needle oriented as nearly parallel to the transducer face as possible

Question 69

what is a common interventional technique used in the breast?

Answer 69

cyst aspiration

Question 70

What are the two main indications for a cyst aspiration?

Answer 70

symptomatic cyst hypoechoic lesion that does not meet simple cyst criteria

Question 71

What is FNAC?

Answer 71

fine needle aspiration cytology

Question 72

What is the single greatest problem in FNAC?

Answer 72

inadequate specimen

Question 73

Who should perform a FNAC but is rarely available?

Answer 73

experienced pathologist (cytopathologist)

Question 74

What is the preferred method for evaluation of clustered microcalcifcations?

Answer 74

stereotactic guidance