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mammography is the main screening tool in he detection of breast cancer
usually, _______ MHz probe is used for breast songraphy 10-14
A lower frequency transducer may be needed for sonography of? large or dense breasts
why use lower frequency transducer for dense or large breast? dense tissue attenuates the sound more quickly than fatty breast tissue. need lower frequency to penetrate
4 specific applications of breast sonography: image lesion found on mammagram, image palpable lump, image axilla for lymphadenopathy, & guidance for interventional procedures
3 interventional procedures with the breast that sonography is used for: cyst drainage, biopsy of solid mass, guidance for HDR Brachytherapy, needle localization of mass for open biopsy
Generally, sonography is performed after mammography. What is the exceptions to the rule: patient is under age of 30yrs of age and has a palpable breast lump. Patient is pregnant or lactation and has a breast problem.
The breast is a _____. modified sweat gland
Nipple The _____ is the raised central area where milk is secreted.
The _____ is a pigmented area near the center of the breast. areola
The ______ is an oblique line extending from the armpit to the symphisis pubis. Mammary Milk Line
Tail of Spence The ______ is breast tissue that extends toward the armpit.
retromammary layer The _____of the breast is located just anterior to the chest muscle.
The ______ of the breast is the thickest layer of breast tissue. mammary layer
subcutaneous layer The _______ of the breast is located just beneath the skin.
The _____ of the breast is where the glandular tissue is located. mammary layer
The ______ of the breast is made up of fat separated by septae of connective tissue. subcutaneous layer
The ____ of the breast is made up of lobes of glandular tissue, ducts, and supporting connective tissues. mammary layer
The ______ of the breast is a layer of fat and connective tissue posterior to the functional part of the breast retromammary layer
fat ___ is the least echogenic tissue in the breast.
Cooper's Ligaments ________ create a fibrous skeleton within the breast.
terminal ductal lobular unit TDLU, site of origin of nearly all pathologic processes that occur w/in the breast.
4 pathologic processes that originate in the TDLU: fibroadenomas, atypical ductal hyperplasia, lobular neoplasia, & ductal carcinoma in situ
why do older women's breast start to sag? glandular tissue slowly replaced w/fat
3 things that affect the appearance & structure of breast: depends on genetics, hormonal status, body habitus, & age
On sonography, dense breast tissue is ______ echogenic more
On mammography, dense breast tissue is ______ white more
most lymph fluid from the breast drains via the _______ nodes. axillary
supraclavicular nodes are located near the clavicle and drain the upper quadrant of the breast.
interpectoral nodes are also called rotter's nodes
internal mammary nodes are channels that lead from one breast to the other and serve as an alternate drainage route
parasternal nodes are located along sides of the sternum via which inner quadrant may drain.
inferior phrenic nodes are located inferior to the diaphram and may serve as a drainage route for the lower inner quadrant of the breast.
gynecomastia enlargerment of the male breast result of hypertrophy of ductal tissue in male breast that may occur during puberty, or later in life
4 causes of gynecomastia: hormonal changes, some diseases, some medications, liver disease, pituitary artisticular tumors, kline fielters syndrome
do men get breast cancer? yes
what is the main purpose of breast evaluation? the detection + diagnosis of breast cancer in its early stages when there is the best chance for cure
breast cancer screening techniques are done even if there are no symptoms of disease. true
when is deagnosic breast imaging done? when a woman has symptoms or changes on SBE or CBE also if screening mammagram is abnormal
what is mammotome? method of performing large core needle biopsy under songraphic guidance
what is sentinel node biopsy? nuclear medicine procedure used to locate 1st lymph node that receives drainage f/ area of breast containing the mass
why is it important for the sonographer to understand mammography films and techniques? so can look at mamma files & locate the abnormality that triggered the order for a sonogram
how is the breast compressed & imaged for the cranio-caudad view? superior to inferior
what does this view tell us about the location of a breast mass? medial or lateral
how does compression benefit mammography and the patient? thins breast tissue & holds it away f/ the chest wall, also prevents internal structures f/ overlapping & holds the tissue still so the image isn't blurred, reduce radiation level
how is the breast compressed and imaged for the media-lateral oblique mammo view? compressed obliquely side to side
what does medial-lateral view tell us bout the location of breast mass sup or infer
on MLO views, masses in the lateral part of the breast will look lower than they are. false
diagnostic mammogaphic view of 90 degrees lateral: compressed straight f/ medial to lateral
diagnostic mammographic view of spot compression used to put targeted compression over an area of questionable mass
mammographic view of open magnification special lens used on the mamma machine to take a magnified image of the breast
mammographic view of spot magnification magnified images are taken of a targeted area of the breast using the spot compression paddle
mammographic view of cleavage valley view modified CC view, exaggerated to the medial aspects of both breast on one film
mammographic view of exaggerated cranio-caudad view modified CC view exaggerated to the lateral portion on the breast
If a structure is located closer to the midline of the body, it is said to be ___. medial
If a structure is behind, or deeper than another structure, it is said to be_____. posterior
If a structure is closr to the surface than another structure, it is said to be _____. anterior
On mammography, ______ look like thin linear structures criss crossing through the breast and radiating back from the nipple. ducts
On mammography, _______ look like fluffy, vague densities in the mid breast. lobules
On mammography, __________ will be white and often hides other structures in the breast. dense connective tissue
On mammography, ________ is gray or radiolucent. adipose tissue (fat)
On mammography, _________ appear as kidney shaped densities with a darker gray (radiolucent) hilum. intramammory lymph node
An area seen on mammography as lines radiating from a central point with no mass seen is called _________. architectural distortion
types of margins: circumscribed: sharp, well-defined borders Obscured: magins hidden by overlying tissue Micro-lobulated: undulating edge Indistinct: poorly defined edges Spiculated: fine lines radiating f/ the margins of a mass Angular: sharp well defined angles
A non-palpable area seen in only one breast with no calcifications is called _____. It may only be an island of breast tissue, but must be evaluated as if it is a MASS. focal asymmetric tissue
_____ is the only exam that can consistently identify calcifications. mammography
5 BI-RADS categories and the action required for each: Birad 1: negative- routine follow up (1yr) 2: benign- routine follow-up (1yr) 3: prob. benign- short term follow up (6mth) 4: suspicious- consider biopsy 5: highly suggestive of malignancy- appropriate action should be taken 0: add. info needed
What does it mean to "manage a patient clinically"? the pt must be seen on short term follow up thru at least one menstrual cycle ( usually follow up for 3-6 mths)
All breast cancers show up on either mammography or songraphy. false
How does compression w/ the transducer help improve transmission of the sound beam? decreasing scattering
Soft masses ____ changer shape w/ compression by the transducer. will
Masses that change shape w/ compression are usually ____ benign
Cysts filled w/ _____ fluid will change shape more readily w/ compression. serous
____ masses will drag adjacent tissue w/ them when compressed. fixed
Masses that slip thru the tissue w/ compression are more likely _____. benign
With appropriate transducer compression and TGC settings, not all layers of breast tissue will be seen. false
echo-palpation and why it's important selective scanning of a palpable mass. It ensures that images are obtained at the precise location of the palpable mass whether or not the lesion is sonographically visible
Why would a stand-off pad be used when imaging the breast? to create distance between the transducer and superficial lesions or the skin of the breast
Fremitus maneuver using power Doppler to distinguish borders of a mass
How will a true mass respond to the Fremitus maneuver? will not be filled w/ color while surrounding tissue wil
Is color or power Doppler able to distinuesh malignant from benign masses? no
5 sonographic characteristics that are associated w/ benign masses: smooth borders, shape should be round or oval, Lt-Rt dimension should be greater than A-P dimension, homogeneous internal texture, smooth distinct anterior margin, posterior enhancement, lateral edge shadow - bilateral, good thru transmission
Masses that are wider than they are tall are most likely _____. benign
3 benign causes of shodowing: Coopers liganments- scatter beam scars-dense tissues absorbs beam. fibrous breast tissue refracts beam.
Shadowing behind a _______ mass is less suspicious. echogenic
characteristics of a simple breast cyst round/oval shape, well-defined borders, anechoic, post. enhancement, maybe lobulated
What makes a cyst comples? simple cyst complex
_____ cysts are more suspicious. complex
A cyst that has echogenic sediment at the bottom of it that occurs in women who are have recently been lactating is called a ______. Millk of Calcium Cyst, Teacup Cyst, Complex Cyst
Septations within a breast cyst are caused by ______________ within the cyst. dilated terminal ductiles
A cyst containing milk is called a ______. The echogenicity of the cyst depends on the CONCENTRATION of the milk. galactocelle
What is a Montgomery's Gland? special sebacous gland located at the margins of the areola
small cyst seen next to the skin that may have internal echoes is most likely a ___________. seabacous gland
A well-circumscribe cyst in the subcutaneous tissue with irregular echogenic material within it in a person who has mastitis or has recently had his/her nipple pierced is probably a ______________. subcutaneous abscess
What is lipoma? fatty tumor usually located near skin. maybe hypoechoic or echogenic
What is a breast hamartoma? made up of fat gladular tissue and epethelial tissue
_____ is a result of damage to fat cells in the breast due to surgery, trauma, or radiation therapy. necrosis
appearance of scarring in breast: scar f/ surgery usually triangled shape hypoechoic in center & echogenic borders. Has posterior shadow, no color flow signal, avascular when compressed moves as a unit thick/ unusual looking scars are biopsied if at site of previous cancer
Hematomas ____ requere treatment for them to resolve. rarely
Hematomas appear ______ and resolve slowly. quickly
What is the classic songraphic sign of a hematoma? bruise/collection of blood w/in the breast tissue due to surgical procedure or trauma
A _____ is a collection of plasma/tissue flued that occurs after surgery or trauma. seroma
What is the most common cause of bloody nipple discharge? introductal papilloma
A benign, solid, hypoechoic mass within the lactiferous duct is most likely a ______. introductal papilloma
The most common solid breast tumor is the _______. Fibroadema
On mammography, a round, oval, or lobulated mass with will-circumscribed margins is most likely a ___________ or a ________. fibroadema & cyst
Fibroadenomas are easily distinguishable from cysts on mammography. false
Fibroadenomas have a capsule false
Benign Phylloides Tumor are epithelial tumors that occur in the connective tissue of the breast lobule. They have a characteristic leaf-like shape to the mass.
List three things that may cause skin thickening: mastitis, abscess, cancer, fat necrosis
Why is a stand-off pad used when assessing skin thickening? to evaluate skin thickness
Superior Vena Cava obstruction can cause skin thickening of the breast due to upper body edema. true
What is Mondor's Disease? rare syndrome involving thromb ophlebitis of superficial veins of breast
Mastitis inflammation of the breast
How does lactational mastitis occur? infant transmits staph bactieria into milk duct infection milk get blocked in duct leading to infection
plasma cell mastitis periductal inflammation caused by ductal ectasia or dilation
plasma cell mastitis is an inflammatory process that destroys the elasticity of the ducts in the breast
clinical signs of inflammatory breast cancer? redness pain tenderness skin edema may also see nipple retraction inverse avillary lymph node met
How long do patients with inflammatory breast cancer usually live? patient rarely live 2 yr
What is peau d'orange? orange peel like dimpled appearance or skin associated w/ skin thickening
What are songraphic features of mastitis? skin thickining due to inflammatory edema subcutaneous fat echoes more prominant. Glandular (mammory layer) tissue thickened & tissues planes are blurry hard to see where diff. layers begin & end. may see abscess
plasma cell mastitis, fat necrosis, and inflammatory carcinoma are all examples of __________ mastitis. non infectious
taller than wide suspicious
irregular shape suspicious
smooth margins benign
posterior shadowing suspicious
trangular shaped anterior wall suspicious
good thru transmission benign
ill-defined margins suspicious
changes shape w/ compression benign
tethering suspicious
radial extensions suspicious
hypoechoic w/ posterior shadowing suspicious
margins invading adjacent tissue suspicious
mobile benign
if __ suspicious features are found in a mass, there is a 98.4% chance that it is cancer. 5
If __ suspicious features are found in a mass, biopsy/further workup is indicated. 1
DCIS arises from the _____of the milk duct. epithelium
90% of cancers arise in the _____. duct
DCIS is confined to the? duct
DCIS is associated w/ __________ on mammography. suspicious calcification
DCIS is the most common NON INVASIVE cancer.
Non-comedo is the type of DCIS that is slow growing and not aggressive.
comedo is the type of DCIS that is mor aggrissive and accounts for 60% of all DCIS.
invasive ductal carcinoma most common breast cancer in the world
desmoplasia scarring process that makes invasive lobular cancer rock hard.
pagets disease a form of ductal carcinoma that invades the skin of the nipple
50% of pt's w/ Paget's disease will have a negative mammogram.
Intra Cystic Papillary Carcinoma rare type of cancer that occurs within a cyst
It is important to identify calcifications because: they can be early sign of cancer
If calcifications are large, coarse, and have smooth margins, they are most likely___. benign
Skin calcifications are seen around the areola or in the axilla and have dark centers
_______ cacifications are deposits in ectatic ducts and are often seen near the nipple. Lg rod shaped
___________ is seen as fuzzy deposits within cysts. milk of calcium
________ are seen as linear tubes and represent atherosclerosis. vascular calcifications
If calcifications are tiny, flaky, heterogeneous, and in broken lines, they are likely ______. malignant
____ of calcifications are commonly seen and are associated with fibroadenomas. clustered
_____ calcifications are associated with pathology in the ducts. linear
______ calcifications are scattered randomly through the breast. diffuse
_____ calcifications look like a dotted line or staples and are suspicious. segmental
4 examples of mommographic findings that will require further workup: new calcifications, spiculated lesions, asymetric breast tissue, clustered micro calcifications
2 examples of a highly suspicious mass: speculated lesions, fine, linear branching calcifications
3 examples of suspicious mammographic findings:: mass w/ ill defined margins, mass w/ micro lobulations, architectural distortion, distorted parenchymal edge
3 examples of probably benign mammographic findings: solitary mass w/ circumscribed margins, solitary asymmetric duct, round, regular, clustered calcifications
What does the fluid aspirated from an intracystic papillary carcinoma usually look like? usually produce dark bloody fluid on aspiration
_______ is a type of invasive ductal cancer in which some of the cancer cells produce mucin around the invasive cancer cells. Mucous Carcinoma
Which of the following refer to the same type of breast cancer? Mucinous Carcinoma, Gelatinous Carcinoma, Colloid Carcinoma
What age group is most often affected by mucinous carcinoma? 20's in 30's
Why is medullary carcinoma difficult to detect? Get lg b4 detection cause they are soft & mobile smooth/round/oval similiar to fibroadenoma. Sonograph appearance good margins often lobulated hypoechoic, frequent post. enhancement tend to push tissue aside rather than invading it.
Compare multicentric and multifocal cancer: (blank)
_______ starts from the epithelium of the breast lobule and remains contained in the lobule. Lobular Carcinoma in situ cancers
Is LCIS easily seen on mammo or songraphy? No, no mass seen on mammo
_________ invades tissue in linear columns. 70% of this type of cancer is multicentric. Invasive lobular carcinoma
What is the most commonly missed breast cancer? Invasive lobular carcinoma
Can mammo or sonography tell the difference between invasive ductal and invasive lobular carcinoma? No
___% of phylloides tumors are malignant. 5-10
_____ is what makes the diagnosis of malignant phylloides tumor versus benign. Biopsy
Malignant phylloides tumor mets to the lungs instead of the lymph nodes. Why? Bcause it spreads thru the blood instead of lymph
What is the life expectancy for pt's w/ malignant phylloides tumor? 5 yr
Lymphoma of the breast is ________. either primary or secondary
What is the most frequent source of metastic cancer to the breast? melanoma
What is Scirrhous Carcinoma? mets to the skin after mastectomy. Occur in mastectomy scar
Why were silicone breast implants banned by the FDA from 1992 to 2003? Cases reported finding silicone in pts bloot & even in their livers. This implant was linked to autoimmune disease such as Rheumatoid arthritis.
Describe the different types of breast implants: Single lumen-filled w/silicone or saline Double lumen-outer filled w/saline, inner w/silicone Reverse double lumen-outer filled w/silicone, inner w/saline Expander, foam, or stacked implants-used to expand skin after mastectomy in prep 4 reconstruction
Describe 3 types of breast implant placement; Single lumen - filled w/ silicone or saline Double lumen outer filled w/ silicone inner w/saline
Which type is illegal in the USA? Subcutaneous silicone injections
What is a radial fold? folding of INTACT envelope into gel forming a tear drop shape at area of the envelope
Describe the normal sonographic appearance of breast implants: ability to evaluate both breast at same time. anechoic smoothe borders
What is the advantage of MRI in evaluating breast implants? ability to evaluate both breast at same time, can see diff. appearance of silicone fat and water so easier to pinpoint leak w/in this modality
Describe the common complications of breast implants; Fibrous capsule-most common type, formation of fibrous scare round implant & scar may contract making implant hard & mishappen Gel Bleed- leakage of silicone gel thru wall of implant which causes fibrous reaction & capsule formation Inplant Rupture-imp?
What is the snowstorm sign? increase echogenicity of silicone implant back & forth into implant lumen
What is the step ladder sign? may also see rupture envelope folding back & forth into implant lumen
What happens to the sonographic appearance of the breast following reduction mammaplasty? scar tissue causes shadowing breast tissue has swirled appearance
Describe TRAM Flap Reconstruction: Transverse Rectus Abdominus Myocutaneous Flap reconstruction done after mastectomy piece of tissue removed f/ downward abdomen a tunneled upward thru abdomen over period of wks. to the breast area w/ blood vessel intact, very painful, but have normal lo?
Primary Varicocele due to absent or faulty venous valves allowing retrograde flow back into scrotum. Causes infertility due to low sperm counts & low motility because of increased pressure in the seminiferous tubules.
Secondary Varicocele caused by increased pressure on spermatic vein by hydronephrosis, cirrhosis(portal htn), or abdominal tumor.
Varicocele no abnormal sonographic appearance
Scrotal Hernia bowel herniates thru inguinal canal into scrotum. Usually diagnosed clinically- enlaarged scrotum, abd pain, may be blood in stool.
B Bowel
F Fluid
T Testis
Solid Masses of the Scrotum Benign: less than 5% of all solid scrotal masses are benign! 95% cancerous Non germ cell tumors
Leydig Cell Tumors most common benign solid tumor arise from the supporting cells of the testis Occur in men 20-50 yrs old. Account for 1-3% of all testicular tumors
estrogen & testosterone sexual immaturity
PTH tetany
ADH excessive urination w/out high blood glucose levels; cause dehydration and tremendous thirst
thyroxine goiter
thyroxine cretinism; a type of dwarfism in which the individual retains childlike proportions and is mentally retarded
insulin excessive thirst, high blood glucose levels, acidosis
growth hormone abnormally small stature, normal proportions
estrogen & progesterone miscarriage
thyroxine lethargy, hair loss, low basal metabolic rate, obesity (myxedema in the adult)
granulocytes granules in their cytoplasm can be stained- possess lobed nuclei, include neutrophils, eosinophils, & basophils
eosinophils large brick-red cytoplasm granules, fights allergies
buffy coat contains leukocytes & platelets (less than 1% of blood) , thin whitish layer between the erythrocytes & plasma.
Non living matrix of blood? plasma
erythrocytes RBC's, main function is to carry oxygen account for about 45% of that volume of a blood sample (hemotrocrit)
How many grams of hemoglobin to 1 mL? 12-18gm
RBC disorders Thrombocytopenia: platelet deficiency, even normal movements can cause bleeding from small blood vessels that require platelets for clotting
(blank) Hemophillia: hereditary bleeding disorder, normal clotting factors missing.
Does leukemia fall in this category? No
Erythrocytes non nucleus, biconcave disks, essentially bags of hemoglobin, & contain few organelles. Only mature ones move back &forth between tissues. No diapedis
Created by: Acia