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DMST 295 Abdomen 2 > Breast Ultrasound > Flashcards

Breast Ultrasound Flashcards

1
Q

What are the risk factors for breast ultrasound?

A
  1. Lifestyle
  2. Hereditary factors
  3. Reproductive/ hormonal factors
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2
Q

What are some examples of lifestyle behaviours for breast ultrasound?

A
  1. Obesity
  2. Physical inactivity
  3. Alcohol intake
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3
Q

What are some reproductive/ hormonal factors for breast ultrasound?

A
  1. Older age at first brith
  2. Late menopause
  3. Menstruation at an early age
  4. BCP
  5. HRT
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4
Q

What are some indication for breast ultrasound? 10

A
  1. Complements mammography
  2. Identify and characterize an abnormality
  3. Dense breast tissue
  4. Equivocal mammogram or physical findings
  5. <30 years of age: initial
  6. Pregnant/ lactating breast
  7. Male breast
  8. Interventional guidance
  9. Breast implants
  10. Treatment planning for radiation therapy
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5
Q

What are some advantages for ultrasound for breast ultrasound?

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

What is the anatomy of the mammary gland?

A
  1. Modified sweat gland
  2. Fat, glandular and fibrous tissue
  3. Three layers
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7
Q

What are the three layers of the mammary gland?

A
  1. Subcutaneous
  2. Mammary
  3. Retromammary
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8
Q

Label the image

A
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9
Q

Label the image

A
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10
Q

Where is the subcutaneous (premammary) area located?

A

Between skin and mammary fascia

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11
Q

What is the subcutaneous area?

A

Fat surrounded by connective tissue

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12
Q

Does the subcutaneous area have breast lesions?

A

No

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13
Q

What is the mammary fascia?

A

Connective tissue enveloping mammary zone

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14
Q

What is the mammary fascia continuous with?

A

Coopers ligaments

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15
Q

What supports and shape Breast?

A

Cooper’s ligaments

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16
Q

Which of the three layers is the functional layer?

A

Mammary layer

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17
Q

Which of the three layers is a fibroglandular tissue?

A

Mammary layer

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18
Q

Where is the mammary layer located?

A

UOQ and areolar region

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19
Q

How many lobes are in the mammary layer?

A

15-20 lobes

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20
Q

How is the 15-20 lobes in the mammary layer look like?

A

Variable

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21
Q

How is the 15-20 lobes of the mammary layer arranged?

A

Radially

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22
Q

What are the 15-20 lobules consistent of?

A
  1. Ducts
  2. Stroma
  3. Acinus
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23
Q

How many lobules are located in the mammary layer?

A

20-40 lobules per lobe

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24
Q

Where are the acini located?

A

In the lobules

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25
Q

What are the acini?

A

Milk producing glands

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26
Q

What does the ducts (lactiferous) in the mammary layer drain

A

Drain acini, lobules, lobes

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27
Q

What does the ducts (lactiferous) of the mammary layer converge towards?

A

Nipples > Lactiferous sinus

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28
Q

What is the TDLU?

A

Functional unit of the mammary layer

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29
Q

What does the TDLU consist of ?

A

Lobule and extralobular terminal duct

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30
Q

How big is the TDLU?

A

1-2 mm

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31
Q

What is the site of most major breast pathology?

A

TDLU

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32
Q

Label the image

A
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33
Q

What is the tail of Spence?

A

Mammary tissue extending into the axilla region

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34
Q

Label the image

A
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35
Q

What is the retromammary layer?

A

Deepest layer, thin

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36
Q

What does the retromammary layer consist of?

A
  1. Fat
  2. Blood vessel
  3. Lymphatics
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37
Q

What is the nipple?

A

Fibromuscular papilla projecting form the center of the breast

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38
Q

What is a inverted nipple?

A

Normal variant

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39
Q

How many openings are in nipples?

A

Multiple openings

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40
Q

What is the areolas?

A

Pigmented area around the nipple with sebaceous glands (bumpy appearance)

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41
Q

What is the pectoral is major located in relation to th retromammary layers?

A

Posterior to retromammary

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42
Q

What is the pectoralis minor covered by?

A

Pec major

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43
Q

What is the vascular supply for the breast?

A
  1. Lateral thoracic
  2. Internal mammary
  3. Intercostal arteries
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44
Q

What does the Venous drainage of the breast consist of?

A

Deep and superficial network

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45
Q

What is the lymph flow of the breast?

A

Flows to axilla

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46
Q

Where does the lymph supply in the breast originate?

A

In the connective tissue of lactiferous ducts

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47
Q

What has frequent invasion with Br.Ca?

A

Lymph nodes

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48
Q

What does the primary function of breasts?

A

Produce and secrete milk

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49
Q

Age and stage of breast function influence what?

A

The amount of parenchyma and stroma

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50
Q

What hormones are found in the breast?

A
  1. Estrogen
  2. Progesterone
  3. Prolactin
  4. Oxytocin
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51
Q

What does progesterone do in the breasts?

A

Stimulates development of lobular cells

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52
Q

What does prolactin do in the breast?

A

Stimulates milk production

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53
Q

What does oxytocin do in the breast?

A

Causes milk ejection from lactating breast

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54
Q

What does estrogen do in the breast?

A

Promotes growth of ductal tissue

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55
Q

What is the physiology of prepubescent breasts?

A
  1. Rudimentary ducts
  2. Tissue developing under nipple, little fat
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56
Q

What is the physiology of the young adult?

A
  1. Fibroglandular tissue (Dense)
  2. Minimal fat
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57
Q

What is the physiology of the adult?

A

Fibroglandular = fat

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58
Q

What is the physiology of the pregnant/ lactating breast?

A

Mostly glandular/ prominent ducts

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59
Q

What is the physiology of the older breast?

A

Increase fat

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60
Q

What is the physiology of the menopause breast?

A

Parenchyma beneath nipple and UOQ

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61
Q

What is the physiology of the postmenopause breast?

A

Fatty tissue

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62
Q

What can ultrasound identify in the breast? 10

A
  1. Skin
  2. Nipple
  3. Subcutaneous fat
  4. Parenchyma
  5. Lactiferous ducts
  6. Cooper’s ligaments
  7. Retromammary layer
  8. Muscles
  9. Ribs
  10. Nodes
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63
Q

What is the sonographic appearance of the skin?

A
  1. 2 thin echogenic lines
  2. 2-3 mm
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64
Q

What is the sonographic appearance of the nipple?

A
  1. Homogenous medium level
  2. Posterior shadowing
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65
Q

What is the sonographic appearance of the subcutaneous fat?

A
  1. Amount varies
  2. Does not extend posterior to nipple
  3. Hypoechoic, thin echogenic strands, edge artifact
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66
Q

What is the sonographic appearance of the parenchyma?

A
  1. Homogenous, echogenic compared to fat
  2. Interspersed hypoechoic zones (Fat)
  3. Ducts - hypoechoic/ anechoic tubular structure
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67
Q

What is the sonographic appearance of the cooper ligaments?

A

Curved echogenic striations encasing hypoechoic fat lobules

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68
Q

What is the sonographic appearance of the retromammary layer?

A

Hypoechoic due to fat, anterior to muscle

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69
Q

What is the sonographic appearance of the pectoralis muscle?

A

Medium to low level echoes, striated

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70
Q

What is the sonographic appearance of the ribs?

A
  1. Lateral ribs - acoustic shadowing
  2. Medial cartilage - hypoechoic
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71
Q

Where are the nodes located? How big are they? What is the sonographic appearance of the nodes?

A
  1. In axilla and parenchyma
  2. <1cm
  3. Oval, hypoechoic, echogenic hilum
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72
Q

What transducer should we use for breast ultrasound?

A

Highest frequency tranducer

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73
Q

How should position the patient?

A
  1. Supine or slightly obliqued
  2. Prop patient with cushion of foam wedge
  3. Ipsilateral arm placed above head
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74
Q

How much pressure should we use for breast exams?

A
  1. Moderate pressure
  2. Adjust to penetrate to breast wall
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75
Q

How many planes should we scan the breast?

A

2 planes

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76
Q

How should we measure lesions in the breast?

A
  1. In two orthogonal planes
  2. Sagittal and transverse
  3. Radial/ anti radial
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77
Q

What does this image demonstrate?

A
  1. Quadrant and clock-face annotation
  2. Transducer scan planes
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78
Q

What doe we scan the axilla for?

A

Nodes

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79
Q

When scanning the nipple, what do we do?

A
  1. Place probe adjacent to the nipple
  2. Angle retroareolar
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80
Q

How should we label the breast exams?

A
  1. Right or left
  2. Quadrants
  3. O’clock
  4. Plane (sag/ trans, rad/ ARad)
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81
Q

Label the quadrants

A
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82
Q

What BIRADS stand for?

A

Breast imaging reporting and data system

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83
Q

What is BIRADS

A
  1. A standardized form of reporting and documenting breast lesions
  2. Risk categorization
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84
Q

What does BIRADS classifies?

A

Lesions according to suspicion of breast cancer

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85
Q

What are the different levels of BIRADS?

A
86
Q

What are some abnormalities in the breast exams?

A
  1. Benign
  2. Malignant
  3. Augmented Breast
  4. Gynecomastia
87
Q

Which demographic of individuals are affect but breast cyst?

A

35-50

88
Q

How are cysts common formed?

A

Obstructed ducts

89
Q

How does cysts feel like?

A

Palpable and round

90
Q

How many cysts are commonly seen?

A

Single/ multiple

91
Q

What is the size of cysts?

A

Variable size that can change with compression

92
Q

What does this image demonstrate?

A

Simple cyst in a mammogram and a ultrasound

93
Q

What does complex cysts look like sonographically?

A
  1. Low level echoe s
  2. Septations
  3. Posterior enhancement
94
Q

What are acorn cyst?

A

Cysts that display a non-dependent echogenic layer

95
Q

What is the most common benign solid tumor in the breast?

A

FIbroadeomas

96
Q

When does fibroadenomas form?

A

In adolescence

97
Q

Hat is fibroadenomas stimulated from? What can make them grow

A

Estrogen and may increase in size with pregnancy and HRT

98
Q

What is the size and shape of fibroadenomas?

A
  1. Variable size
  2. Variable shape
99
Q

What are fibroadenomas placed? And how do they feel?

A
  1. Unilateral/ bilateral
  2. Palpable, painless and mobile
100
Q

What does this image demonstrate?

A

Fibroadenomas. Notice the

101
Q

What is cystosarcoma phylloides referred to?

A

Giant fibroadenoma

102
Q

How common is cystosarcoma phylloides?

A

Rare

103
Q

Is Cystosarcoma phylloides benign or malignant?

A

Typically benign but malignant transformation possible

104
Q

Which demographic of individuals are affected by cystosarcoma phylloides?

A

Individuals that are 40-50 years

105
Q

What is cystosarcoma phylloides similar to?

A

Fibroadenomas except it is larger and more Lobulated

106
Q

Which pathology rapidly increases in size?

A

Cystosarcoma phylloides

107
Q

What is this an example of?

A

Cystosarcoma Phylloides

108
Q

What are lipomas?

A

Asymptomatic benign fatty tumor

109
Q

Which demographic of individuals are affected by lipoma?

A

Middle aged/ postmenopausal patient

110
Q

Lipomas can be what type of mass?

A

Hypoechoic mass

111
Q

What are defined as margins?

A

Lipomas

112
Q

What is this an image of?

A

Lipoma

113
Q

What is fat necrosis?

A

Hemorrhage or liquefaction of fatty area

114
Q

What does fat necrosis lead to?

A

Leads to necrosis

115
Q

What causes fat necrosis?

A
  1. Trauma
  2. Surgery
  3. Inflammation
116
Q

Fat necrosis forms what?

A

Dense scar or cysts (lipid cysts)

117
Q

The fat necrosis area may do what eventually?

A

Calcify

118
Q

How might a fat necrosis feel?

A
  1. Firm nodule
  2. Skin retraction
  3. Nipple inversion
119
Q

How might a fat necrosis look like?

A
  1. Irregular hpoechoic
  2. Complex mass
  3. May shadow
120
Q

What does this image demonstrate?

A

Fat necrosis

121
Q

What is a papilloma?

A
  1. Benign solid masses in lining of ducts, can also develop in a cyst
122
Q

What is the most common cause of blood nipple discharge?

A

Papilloma

123
Q

Where is a papilloma located?

A

Near nipple

124
Q

What kind of lesion is a papilloma?

A

Solid lesion in a duct or cyst

125
Q

Papillomas are possible_______ near mass

A

Ductal ectasia

126
Q

What are vascular stalks?

A

Papillomas

127
Q

What does the arrows point to?

A

Papilloma

128
Q

How common are fibrocycstic change?

A

Common

129
Q

How do fibrocystic cyclic changes present like in breast tissue?

A

Exaggerated cyclic changes in breast tissue

130
Q

What does the cells in fibrocystic changes do?

A

Cells proliferate and retain water

131
Q

Which quadrant are fibrocystic changes located?

A

Typically UOQ

132
Q

What does fibrocystic changes look like sonographically?

A
  1. Multiple cysts
  2. Echogenic tissue
  3. Small nodules
133
Q

What are some sign and symptoms of fibrocystic changes?

A
  1. Lymph, swollen, painful breasts, modularity
  2. Nipple discharge
  3. Mammographies changes
134
Q

What are galactocele? Where are they located in relation to the areola?

A
  1. Obstructed lactiferous duct
  2. Retroareolar
135
Q

What does Galactocele often lead to?

A

Mastitis

136
Q

H what does galactocele look like on U/S?

A
  1. Well-defined cystic mass
  2. Less posterior enhancement
  3. Internal debris
137
Q

What does this image demonstrate?

A

Galactocele

138
Q

What is duct ectasia?

A

Asymptomatic tubular hypoechoic structure converging toward nipple (>8mm)

139
Q

Who does duct ectasia usually affect?

A

Lactating patients and >50 years of age

140
Q

What can duct ectasia lead to?

A

Mastitis

141
Q

What is mastitis?

A

Breast inflammation (focal or diffuse)

142
Q

When is mastitis common?

A

During lactation

143
Q

Why is mastitis bad?

A

Obstruction leads to bacterial infection

144
Q

What can develop due to mastitis?

A

Abscess?

145
Q

What are some signs and symptoms of Mastitis?

A
  1. Hot, red, tender breast, fever
  2. Palpable mass
  3. Nipple discharge
146
Q

What does acute inflammation/ infections look like in breast tissue?

A
  1. Irregular fluid collection with debris
  2. Loss of tissue definition (edematous)
  3. Complex collection/ shaggy wall
  4. Septations
  5. Posterior enhancement
147
Q

What does this image demonstrate?

A

Acute inflammation/ infection

148
Q

What does nipple discharge include in terms of ethologies?

A

Both low and high risk ethologies

149
Q

What are some low risk nipple discharge ethologies?

A
  1. Bilateral, multiple duct orifices
  2. Milk or greenish
  3. Fibrocystic change or duct ectasia
150
Q

What are high risk nipple discharge?

A
  1. Unilateral, spontaneous, clear, bloody, serous
  2. Galactogram procedure
151
Q

What do we assess for breast malignancies?

A

Assess breasts lesions for malignant characteristics

152
Q

What are some malignant lesions categorizations?

A
  1. Location
  2. Invasiveness
153
Q

Where are locations of malignant lesions?

A
  1. Ductal
  2. Lobular
154
Q

What are malignancies invasiveness?

A
  1. Non-invasive (in-situ)
  2. Invasive (infiltrative)
155
Q

What are the assessment criteria for breast exams? 8

A
  1. Shape, size, number
  2. Orientation
  3. Location (UOQ common)
  4. Margins
  5. Echogenicity/ Echotexture
  6. Internal echo content (cystic/ solid)
  7. Shadowing or enhancement
  8. Effect on surrounding tissue
156
Q

What are some malignant characteristics? 9

A
  1. Hypoechoic
  2. Taller than wide
  3. Angled margins/ speculations
  4. Heterogenous
  5. Posterior shadowing
  6. Thick echogenic rim or halo
  7. Ductal extension
  8. Micorlobulations
  9. Calcifications
157
Q

What are some secondary findings examples? 6

A
  1. Skin changes
  2. Inverted nipple
  3. Axillary or intramammary lymph nodes
  4. Dilated ducts
  5. Highly echogenic surrounding tissue
  6. Thickened Cooper’s ligaments
158
Q

What are some types of non invasive carcinomas?

A
  1. DCIS
  2. Lobular carcinoma in Situ
159
Q

What does DCIS stand for?

A

Ductal carcinoma in Situ

160
Q

What are examples of infiltrating (invasive) Carcinomas?

A
  1. Infiltrating ductal
  2. Infiltrating lobular
  3. Intracystic papillary carcinoma in Situ
161
Q

Where does ductal carcinoma in Situ arise from?

A

Ducts

162
Q

What is the most common noninvasive tumor?

A

DCIS

163
Q

When does DCIS typically arise?

A

Postmenopausal

164
Q

What does DCIS usually present with?

A
  1. Microcalcifications in 80%
  2. Nipple discharge
165
Q

Which non-invasive carcinoma is not a cancer?

A

Lobular carcinoma in Situ

166
Q

When does lobular carcinoma in Situ have a increased incidence?

A

In reproductive years

167
Q

How common is intracystic papilllary carcinoma in Situ?

A

Rare

168
Q

Which demographic is usually afflicted with Intracystic papillary carcinoma in Situ?

A

Middle age females

169
Q

What does intracystic papillary carcinomas in Situ look like sonographically?

A

Well defined, mobile mass

170
Q

What is the most common type of invasive carcinoma?

A

Invasive ductal carcinoma

171
Q

What does invasive ductal carcinomas look like sonographically?

A
  1. Hard
  2. Stationary
  3. Painless
  4. Palpable mass
172
Q

Where is Invasive ductal carcinomas located commonly?

A

UOQ

173
Q

What does Invasive ductal carcinomas present with?

A
  1. Microcalcifications
  2. Spiculations
174
Q

How often is the incidence rate of invasive lobular carcinomas?

A

8-13%

175
Q

What is the most frequently missed cancer?

A

Invasive lobular carcinoma

176
Q

Invasive lobular carcinoma development is commonly where?

A

Secondary primary in opposite breast

177
Q

What does the nipples look like with invasive lobular carcinoma?

A

Nipple retraction

178
Q

Is it hard to detect invasive lobular carcinoma?

A

Difficult to detect with mammogram and clinically

179
Q

What invasive tumor is rare, fast growing, affects middle aged women, and looks like a fibroadenoma?

A

Medullary

180
Q

What is a mutinous tumor? Who does it affect?

A
  1. Rare
  2. Slow growing invasive tumor
  3. Affects older women
181
Q

What are papillary tumours? Who’s does it affect?

A
  1. Invasive tumours
  2. Postmenopausal women
182
Q

What is a common sign for papillary tumours?

A

Blood nipple discharge

183
Q

Where is papillary tumours located?

A

Central breast area

184
Q

What is the prognosis like for papillary muscles?

A

Good

185
Q

What are augmented/ implanted breasts made of?

A

Saline or silicone

186
Q

Where are implants placed?

A

Placed anterior or posterior to pectoralis muscle

187
Q

How easy is it to evaluate augmented breasts with mammography?

A

Difficult

188
Q

If mammography has a hard time doing breast exams on implants what should we do?

A

Use ultrasound

189
Q

What are come concerns with Implants?

A
  1. Contracture
  2. Obscures normal breast tissue on mammo
  3. Leakage or rupture
190
Q

What does implants look like sonographically?

A
  1. Relative echo free oval posterior to breast tissue
  2. Anterior reverberation Normal
191
Q

Label the image

A
192
Q

What are things we see in the normal implant?

A
  1. Radial folds
  2. Fill valves
193
Q

Radial folds are dependent on what?

A

Anterior folds and patient position

194
Q

When/ would we see fill valves?

A
  1. With saline implants
  2. Posterior to nipple typically
195
Q

How do fill valves feel?

A

Palpable

196
Q

What are two types of leakages with silicone implants?

A
  1. Intra-capsular
  2. Extra capsular
197
Q

What does intravascular leaks look like?

A
  1. Tear in shell
  2. Gel between the capsule and shell
  3. Step ladder sign
198
Q

What is this an example of?

A

Intracapsular rupture

199
Q

What is this an example of?

A

Extracapsular rupture

200
Q

What does extra-capsular leaks look like?

A
  1. Tear through the shell and capsule
  2. Snowstorm appearance
201
Q

Where do silicone bleeds happen?

A

In silicone implants

202
Q

What are silicone bleeds?

A
  1. Microscopic leak contained in fibrous capsule
  2. Migrates to lymph nodes
203
Q

What does silicone bleeds results in?

A

Lymphadenopathy

204
Q

What is this an example of?

A

Silicone bleeds

205
Q

What does contractures look like?

A

Capsule should be larger than the implant and flexible

206
Q

With contracture, the fibrous capsule does what?

A

Contracts and constricts, disfiguring the breast

207
Q

What is gynecomastia?

A
  1. Male breast enlargement
  2. Abnormal proliferation of glandular tissue and increased subcutaneous fat
208
Q

What is gynecomastia linked to?

A
  1. Estrogen and androgen use
  2. Drugs for hypertension and depression
  3. Estrogenic neoplasms
209
Q

How solid is the link to breast cancer for gynecomastia?

A

Unclear

210
Q

What does gynecomastia look like?

A
  1. Enlarged breast
  2. Palpable firm mass under nipple
  3. Pain/ tenderness
211
Q

What is the ultrasonic appearance of gynecomastia?

A
  1. Triangular area of hypoechoic glandular tissue under areolar region
  2. Ducts converging toward nipple
  3. Increased fat
212
Q

What is this an example of?

A

Gynecomastia

DMST 295 Abdomen 2 (8 decks)

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