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Flashcards in Breast Deck (54)
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Second leading cause of cancer deaths in women next to lung cancer

Breast cancer.

1

Indications

Used as an adjunct to mammography, a target rather than screening.

2

Ultrasound vs Mammography

Mammo sees tiny micro Ca+

Mammo has hard time imaging dense breast

Ultrasound differentiates cystic vs solid

US characterizes a palp mass

US can assess with trauma,inflammation,augmentation

US guided cyst aspiration

3

Breast anatomy

Paired mammary glands containing fatty glandular and fibrous connective tissue

Parenchyma has 15-20 lobes, further divided into 20-40 lobules

Each lobe has a lactiferous duct 15-20 that converge at the nipple and enlg with lactation

4

Terminal duct lobular unit TDLU

< 2 mm, where most Breast pathology arises

5

Benign

Lesion won't cross fibrous plane
Well defined
Well circumscribed
Smooth
Mild lobulations
Thin
Echogenic pseudocapsule
Round
Ovoid
Horizontal
Wider than tall
Uniform
Hypoechoic
Anechoic
Homogeneous
Non attenuating
Enhancement with cyst
Compressible
Mobile
Fluid-filled lacks flow
Solid masses are hypovascular or lack a signal

6

Malignant

Can invade fibrous plane
Finger-like projections in radial
True shadow persists with pressure
Ill defined
May indicate invasion
Spiculated
Angular
Many small lobulations
Thick
Echogenic halo
Taller than wide
Irregular
Vertical
Markedly hypoechoic
Heterogeneous
Attenuating
Shadowing
Non compressible
Fixed
Increased peripheral flow (feeding vessel)
Increased internal flow (flow in tumor mosaic)
Clustered microcalcifications

7

Layers

Skin

Subcutaneous fat

Fascial plane

Mammary zone/ Breast parenchyma, glandular tissue

Retromammary fat

Muscle

Ribs

8

Blood supply

Arteries: internal mammary, lateral thoracic, thoracocromial, intercostal

Veins: superficial and deep networks. Axillary intercostal vein, vertebral veins

9

Glandular tissue is supported by

Cooper's ligaments

10

Tail of Spence

Mammary tissue which may extend into axilla

11

Montgomery's Gland

Sebaceous glands in areola

12

Skin thickness

2-3 mm

13

Fat is affected by

Age, parity, and obesity

14

Fatty tissue is ___ Echogenic than parenchyma

Less

15

Gynecomastia

Ductal elements enlarge in males.

16

Ducts

< or = 3 mm
Course towards nipple

17

Lymph nodes

Seen near axilla
< 10-15 mm
Kidney bean, echogenic hilum

18

Rotter's nodes

Interpectoral group

19

Breast function

Fluid transport

Milk secretion via acini cells due to prolactin. Prolactin is suppressed by progesterone which is high during pregnancy and low after placenta is delivered. Baby sucking on nipple makes oxytocin which also raises prolactin.

20

Patient position

Supine/oblique with ipsilateral arm above head.

21

Fremitus

Power Doppler. Presence of flow confirms solid lesions.

22

Hypoplasia

Underdeveloped breast

23

Hypertrophy

Overdeveloped breast
May cause back pain and skin problems due to bra strap

24

Polythelia

Accessory nipple
MC congenital anomaly
In milk line

(Embryos have breast buds that normally regress)
Black people
Can be confused with mole.
Assoc with renal cyst/duplication/unilateral agenesis

25

Polymastia

Accessory breast
May occur with athelia (no nipple)
Enlg with puberty, pregnancy, and lactation. Can have breast pathology

26

Cyst

MC breast lesion
Usually benign
35-50 yr old female
Pain, palp, mobile, compressible, no color flow within


Mammo: spherical or oval, low density, smooth margin, halo sign, eggshell with ca++

27

Fibroadenoma

Common solid benign
15-40 yr old, black women
May get bigger when pregnant. Hormone influenced

Palp, mobile, nontender, may have macrolobulations

Well circumscribed, hypo, smooth margins

28

Breast cancer

Affects 1 in 8 females
MC is invasive ductal carcinoma

Risk: female, fam hx, inc age

29

Fibroadenoma

Common solid benign
15-40 yr old
May get bigger when pregnant. Hormone influenced