Breast Review

Question 1

When does female breast tissue begin to develop beyond male breast tissue?

Answer 1

puberty

Question 2

Which technique uses vocal vibrations to differentiate benign and dense breast tissue?

Answer 2

vocal fremitus

Question 3

With the ABC and 123 method, explain what the letter and number tell us about a breast mass.

Answer 3

ABC: depth, A closest to nipple, C closest to muscle

123: distance, 1 closest to nipple, 3 furthest from nipple

Question 4

Name 5 indications for a breast ultrasound.

Answer 4

dense breasts, mammo finding, palpable mass, clinical finding, axillary nodes, pain, follow up

Question 5

What part of the breast has the most breast tissue?

Answer 5

UOQ

Question 6

Which germ layer is the nipple formed from?

Answer 6

mesoderm

Question 7

In breast sonography, why are transverse and sagittal scanning planes not utilized?

Answer 7

To follow the direction of the lobes in the breast

Question 8

Name 3 parenchymal elements of the breast.

Answer 8

acini, lobules, lobes, ducts

Question 9

What is it called when there are 2 or more masses less than 5 cm away from each other?

Answer 9

multifocal

Question 10

What is the smallest functional unit of the breast?

Answer 10

acini

Question 11

Why does patient positioning vary between individuals and why is it important to position correctly?

Answer 11

dependent on breast size, nipple needs to be centered and breast needs to be flat for consistency in labeling

Question 12

Contrary to common standards, many malignancies can display which three characteristics?

Answer 12

homogenous, hyperechoic, enhancement

Question 13

Name 3 short term implant complications.

Answer 13

pain, tenderness, hematoma, abscess, seroma, loss of nipple sensation

Question 14

What is the most common implant complication and why is it a necessary process?

Answer 14

capsular fibrosis, the body blocks it off as a foreign object which helps with healing and preventing rupture/attacking implant

Question 15

What kind of artifact will be seen with an extracapsular silicone implant rupture?

Answer 15

snowstorm sign

Question 16

Which location is an implant located in when it is anterior to the muscle and posterior to the breast tissue?

Answer 16

subglandular

Question 17

Which two scanning techniques should be practiced to ensure proper evaluation of mass vascularity?

Answer 17

light pressure, power doppler

Question 18

What are the two types of malignant nipple discharge and what do they each indicate?

Answer 18

blood: invasive cancer cells in ducts
clear: proliferation of ductal epithelial cells

Question 19

Which sonographic artifact occurs with silicone implants?

Answer 19

propagation speed, sound travels through silicone slower than soft tissue, posterior structures appear deeper than they actually are

Question 20

Benign masses are allowed to have an echogenic halo as long as the tumor is not taller than wide.
T or F

Answer 20

false

Question 21

Name two ways in which you can differentiate a radial scar and a scar.

Answer 21

scar will extend through skin/subcutaneous layer, clinical history

Question 22

Which two benign breast findings should be surgically removed due to their increased likelihood of becoming cancerous?

Answer 22

PASH, radial scar

Question 23

Name three clinical findings of acute lactational mastitis?

Answer 23

tender, swelling, plugged duct, purulent discharge, skin thickening, erythema, enlarged LNs, leukocytosis, fever

Question 24

When should benign cysts begin to involute?

Answer 24

menopause

Question 25

What solid breast mass is an estrogen induced tumor made of epithelial and connective tissues?

Answer 25

fibroadenoma

Question 26

Why does a hamartoma appear heterogenous on sonography?

Answer 26

mixed components - fibrous, glandular, fatty

Question 27

What is the most important differentiation between a complicated and complex cyst?

Answer 27

complex: solid component complicated: debris/other nonsolid material

Question 28

What is the most common cause of acute mastitis? Name 3 sonographic features you will see with it.

Answer 28

lactation skin thickening, edema, no focal mass, duct dilatation, parenchymal edema

Question 29

_____________ originates in the epithelial cells of acini and does not extend past the basement membrane. It is also a marker for an increased risk of future development of IDC.

Answer 29

LCIS

Question 30

Name 3 CLINICAL findings of inflammatory carcinoma.

Answer 30

peau d'orange, erythema, skin thickening, nipple retraction, swollen, tender, hard breast, enlarged LNs

Question 31

Name 3 risk factors for breast cancer.

Answer 31

- age - family history - benign proliferative disease - early menarche, late menopause - late pregnancy - nulliparity - radiation exposure - estrogen use - post meno obesity

Question 32

What is the most common type of noninvasive breast cancer?

Answer 32

DCIS

Question 33

Which type of breast cancer can undergo necrosis and has benign characteristics?

Answer 33

medullary carcinoma

Question 34

Name the type of breast cancer that will display architectural distortion and will invade the surrounding connective tissue.

Answer 34

invasive ductal carcinoma

Question 35

Stage ___ is when there is a mass less then 2 cm with NO lymph node involvement.

Answer 35

1

Question 36

_________ is an uncommon form of DCIS that causes tumor cells to spread along a subareolar duct and it affects the nipple or areola.

Answer 36

Paget's disease of the nipple

Question 37

What is the most common hematogenous mets route to a distant site?

Answer 37

bone

Question 38

Which type of breast cancer is the malignant counterpart of a fibroadenoma?

Answer 38

Phyllode's tumor

Question 39

Which type of breast cancer has the worst prognosis and accounts for 80% of all breast malignancies?

Answer 39

IDC

Question 40

Which type of breast cancer will show a fibrovascular stalk via ultrasound and a cluster of circumscribed masses in one quadrant via mammography.

Answer 40

papillary carcinoma

Question 41

Stage _____ is when there is a tumor larger than 5 cm with NO axillary lymph node involvement.

Answer 41

2

Question 42

Name 3 benign masses that can mimic Invasive Ductal Carcinoma.

Answer 42

- fat necrosis - radial scar - sclerosing adenosis - scar - fibrosclerosis - fibrous mastopathy - granular cell tumor

Question 43

Which type of breast cancer can be pure or mixed and has cells floating in pools of extracellular mucin presenting itself as a mildly compressible palpable mass?

Answer 43

colloid mucinous carcinoma

Question 44

Why is the MLO projection the most valuable mammographic view?

Answer 44

more breast tissue evaluation

Question 45

How is tomosynthesis mammography different from 2D mammography?

Answer 45

Tomo takes multiple xrays in a row giving the appearance of 3D by scrolling through the images stacked on one another. More efficient and diagnostic.

Question 46

Which mammographic diagnostic view uses a smaller paddle to apply more compression to one area of the breast?

Answer 46

spot compression

Question 47

When reading a mammogram report you see that the Radiologist documented a BI-RAD: Category 4A. What does this mean?

Answer 47

low suspicion for malignancy

Question 48

Why is the Eklund view important?

Answer 48

Displace implant to evaluate for breast tissue masses

Question 49

Describe how a spot magnification is performed and why a Radiologist would request it.

Answer 49

Spot paddle is used with a mag platform. Breast is brought closer to Xray machine giving the picture a magnification. Used for calcifications seen on mammo.