breast
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| mammography | is the main screening tool in he detection of breast cancer
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| usually, _______ MHz probe is used for breast songraphy | 10-14
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| A lower frequency transducer may be needed for sonography of? | large or dense breasts
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| 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
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| 4 specific applications of breast sonography: | image lesion found on mammagram, image palpable lump, image axilla for lymphadenopathy, & guidance for interventional procedures
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| 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
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| 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.
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| The breast is a _____. | modified sweat gland
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| Nipple | The _____ is the raised central area where milk is secreted.
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| The _____ is a pigmented area near the center of the breast. | areola
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| The ______ is an oblique line extending from the armpit to the symphisis pubis. | Mammary Milk Line
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| Tail of Spence | The ______ is breast tissue that extends toward the armpit.
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| retromammary layer | The _____of the breast is located just anterior to the chest muscle.
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| The ______ of the breast is the thickest layer of breast tissue. | mammary layer
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| subcutaneous layer | The _______ of the breast is located just beneath the skin.
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| The _____ of the breast is where the glandular tissue is located. | mammary layer
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| The ______ of the breast is made up of fat separated by septae of connective tissue. | subcutaneous layer
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| The ____ of the breast is made up of lobes of glandular tissue, ducts, and supporting connective tissues. | mammary layer
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| The ______ of the breast is a layer of fat and connective tissue posterior to the functional part of the breast | retromammary layer
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| fat | ___ is the least echogenic tissue in the breast.
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| Cooper's Ligaments | ________ create a fibrous skeleton within the breast.
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| terminal ductal lobular unit | TDLU, site of origin of nearly all pathologic processes that occur w/in the breast.
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| 4 pathologic processes that originate in the TDLU: | fibroadenomas, atypical ductal hyperplasia, lobular neoplasia, & ductal carcinoma in situ
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| why do older women's breast start to sag? | glandular tissue slowly replaced w/fat
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| 3 things that affect the appearance & structure of breast: | depends on genetics, hormonal status, body habitus, & age
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| On sonography, dense breast tissue is ______ echogenic | more
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| On mammography, dense breast tissue is ______ white | more
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| most lymph fluid from the breast drains via the _______ nodes. | axillary
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| supraclavicular | nodes are located near the clavicle and drain the upper quadrant of the breast.
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| interpectoral | nodes are also called rotter's nodes
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| internal mammary | nodes are channels that lead from one breast to the other and serve as an alternate drainage route
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| parasternal | nodes are located along sides of the sternum via which inner quadrant may drain.
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| inferior phrenic | nodes are located inferior to the diaphram and may serve as a drainage route for the lower inner quadrant of the breast.
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| gynecomastia | enlargerment of the male breast result of hypertrophy of ductal tissue in male breast that may occur during puberty, or later in life
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| 4 causes of gynecomastia: | hormonal changes, some diseases, some medications, liver disease, pituitary artisticular tumors, kline fielters syndrome
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| do men get breast cancer? | yes
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| 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
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| breast cancer screening techniques are done even if there are no symptoms of disease. | true
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| when is deagnosic breast imaging done? | when a woman has symptoms or changes on SBE or CBE also if screening mammagram is abnormal
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| what is mammotome? | method of performing large core needle biopsy under songraphic guidance
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| what is sentinel node biopsy? | nuclear medicine procedure used to locate 1st lymph node that receives drainage f/ area of breast containing the mass
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| 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
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| how is the breast compressed & imaged for the cranio-caudad view? | superior to inferior
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| what does this view tell us about the location of a breast mass? | medial or lateral
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| 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
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| how is the breast compressed and imaged for the media-lateral oblique mammo view? | compressed obliquely side to side
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| what does medial-lateral view tell us bout the location of breast mass | sup or infer
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| on MLO views, masses in the lateral part of the breast will look lower than they are. | false
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| diagnostic mammogaphic view of 90 degrees lateral: | compressed straight f/ medial to lateral
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| diagnostic mammographic view of spot compression | used to put targeted compression over an area of questionable mass
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| mammographic view of open magnification | special lens used on the mamma machine to take a magnified image of the breast
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| mammographic view of spot magnification | magnified images are taken of a targeted area of the breast using the spot compression paddle
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| mammographic view of cleavage valley view | modified CC view, exaggerated to the medial aspects of both breast on one film
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| mammographic view of exaggerated cranio-caudad view | modified CC view exaggerated to the lateral portion on the breast
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| If a structure is located closer to the midline of the body, it is said to be ___. | medial
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| If a structure is behind, or deeper than another structure, it is said to be_____. | posterior
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| If a structure is closr to the surface than another structure, it is said to be _____. | anterior
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| On mammography, ______ look like thin linear structures criss crossing through the breast and radiating back from the nipple. | ducts
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| On mammography, _______ look like fluffy, vague densities in the mid breast. | lobules
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| On mammography, __________ will be white and often hides other structures in the breast. | dense connective tissue
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| On mammography, ________ is gray or radiolucent. | adipose tissue (fat)
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| On mammography, _________ appear as kidney shaped densities with a darker gray (radiolucent) hilum. | intramammory lymph node
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| An area seen on mammography as lines radiating from a central point with no mass seen is called _________. | architectural distortion
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| 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
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| 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
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| _____ is the only exam that can consistently identify calcifications. | mammography
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| 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
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| 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)
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| All breast cancers show up on either mammography or songraphy. | false
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| How does compression w/ the transducer help improve transmission of the sound beam? | decreasing scattering
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| Soft masses ____ changer shape w/ compression by the transducer. | will
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| Masses that change shape w/ compression are usually ____ | benign
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| Cysts filled w/ _____ fluid will change shape more readily w/ compression. | serous
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| ____ masses will drag adjacent tissue w/ them when compressed. | fixed
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| Masses that slip thru the tissue w/ compression are more likely _____. | benign
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| With appropriate transducer compression and TGC settings, not all layers of breast tissue will be seen. | false
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| 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
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| 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
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| Fremitus | maneuver using power Doppler to distinguish borders of a mass
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| How will a true mass respond to the Fremitus maneuver? | will not be filled w/ color while surrounding tissue wil
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| Is color or power Doppler able to distinuesh malignant from benign masses? | no
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| 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
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| Masses that are wider than they are tall are most likely _____. | benign
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| 3 benign causes of shodowing: | Coopers liganments- scatter beam scars-dense tissues absorbs beam. fibrous breast tissue refracts beam.
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| Shadowing behind a _______ mass is less suspicious. | echogenic
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| characteristics of a simple breast cyst | round/oval shape, well-defined borders, anechoic, post. enhancement, maybe lobulated
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| What makes a cyst comples? | simple cyst complex
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| _____ cysts are more suspicious. | complex
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| 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
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| Septations within a breast cyst are caused by ______________ within the cyst. | dilated terminal ductiles
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| A cyst containing milk is called a ______. The echogenicity of the cyst depends on the CONCENTRATION of the milk. | galactocelle
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| What is a Montgomery's Gland? | special sebacous gland located at the margins of the areola
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| small cyst seen next to the skin that may have internal echoes is most likely a ___________. | seabacous gland
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| 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
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| What is lipoma? | fatty tumor usually located near skin. maybe hypoechoic or echogenic
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| What is a breast hamartoma? | made up of fat gladular tissue and epethelial tissue
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| _____ is a result of damage to fat cells in the breast due to surgery, trauma, or radiation therapy. | necrosis
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| 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
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| Hematomas ____ requere treatment for them to resolve. | rarely
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| Hematomas appear ______ and resolve slowly. | quickly
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| What is the classic songraphic sign of a hematoma? | bruise/collection of blood w/in the breast tissue due to surgical procedure or trauma
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| A _____ is a collection of plasma/tissue flued that occurs after surgery or trauma. | seroma
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| What is the most common cause of bloody nipple discharge? | introductal papilloma
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| A benign, solid, hypoechoic mass within the lactiferous duct is most likely a ______. | introductal papilloma
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| The most common solid breast tumor is the _______. | Fibroadema
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| On mammography, a round, oval, or lobulated mass with will-circumscribed margins is most likely a ___________ or a ________. | fibroadema & cyst
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| Fibroadenomas are easily distinguishable from cysts on mammography. | false
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| Fibroadenomas have a capsule | false
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| 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.
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| List three things that may cause skin thickening: | mastitis, abscess, cancer, fat necrosis
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| Why is a stand-off pad used when assessing skin thickening? | to evaluate skin thickness
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| Superior Vena Cava obstruction can cause skin thickening of the breast due to upper body edema. | true
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| What is Mondor's Disease? | rare syndrome involving thromb ophlebitis of superficial veins of breast
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| Mastitis | inflammation of the breast
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| How does lactational mastitis occur? | infant transmits staph bactieria into milk duct infection milk get blocked in duct leading to infection
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| plasma cell mastitis | periductal inflammation caused by ductal ectasia or dilation
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| plasma cell mastitis | is an inflammatory process that destroys the elasticity of the ducts in the breast
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| clinical signs of inflammatory breast cancer? | redness pain tenderness skin edema may also see nipple retraction inverse avillary lymph node met
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| How long do patients with inflammatory breast cancer usually live? | patient rarely live 2 yr
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| What is peau d'orange? | orange peel like dimpled appearance or skin associated w/ skin thickening
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| 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
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| plasma cell mastitis, fat necrosis, and inflammatory carcinoma are all examples of __________ mastitis. | non infectious
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| taller than wide | suspicious
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| irregular shape | suspicious
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| smooth margins | benign
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| posterior shadowing | suspicious
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| trangular shaped anterior wall | suspicious
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| good thru transmission | benign
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| ill-defined margins | suspicious
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| changes shape w/ compression | benign
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| tethering | suspicious
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| radial extensions | suspicious
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| hypoechoic w/ posterior shadowing | suspicious
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| margins invading adjacent tissue | suspicious
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| mobile | benign
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| if __ suspicious features are found in a mass, there is a 98.4% chance that it is cancer. | 5
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| If __ suspicious features are found in a mass, biopsy/further workup is indicated. | 1
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| DCIS arises from the _____of the milk duct. | epithelium
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| 90% of cancers arise in the _____. | duct
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| DCIS is confined to the? | duct
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| DCIS is associated w/ __________ on mammography. | suspicious calcification
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| DCIS | is the most common NON INVASIVE cancer.
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| Non-comedo | is the type of DCIS that is slow growing and not aggressive.
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| comedo | is the type of DCIS that is mor aggrissive and accounts for 60% of all DCIS.
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| invasive ductal carcinoma | most common breast cancer in the world
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| desmoplasia | scarring process that makes invasive lobular cancer rock hard.
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| pagets disease | a form of ductal carcinoma that invades the skin of the nipple
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| 50% | of pt's w/ Paget's disease will have a negative mammogram.
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| Intra Cystic Papillary Carcinoma | rare type of cancer that occurs within a cyst
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| It is important to identify calcifications because: | they can be early sign of cancer
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| If calcifications are large, coarse, and have smooth margins, they are most likely___. | benign
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| Skin | calcifications are seen around the areola or in the axilla and have dark centers
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| _______ cacifications are deposits in ectatic ducts and are often seen near the nipple. | Lg rod shaped
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| ___________ is seen as fuzzy deposits within cysts. | milk of calcium
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| ________ are seen as linear tubes and represent atherosclerosis. | vascular calcifications
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| If calcifications are tiny, flaky, heterogeneous, and in broken lines, they are likely ______. | malignant
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| ____ of calcifications are commonly seen and are associated with fibroadenomas. | clustered
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| _____ calcifications are associated with pathology in the ducts. | linear
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| ______ calcifications are scattered randomly through the breast. | diffuse
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| _____ calcifications look like a dotted line or staples and are suspicious. | segmental
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| 4 examples of mommographic findings that will require further workup: | new calcifications, spiculated lesions, asymetric breast tissue, clustered micro calcifications
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| 2 examples of a highly suspicious mass: | speculated lesions, fine, linear branching calcifications
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| 3 examples of suspicious mammographic findings:: | mass w/ ill defined margins, mass w/ micro lobulations, architectural distortion, distorted parenchymal edge
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| 3 examples of probably benign mammographic findings: | solitary mass w/ circumscribed margins, solitary asymmetric duct, round, regular, clustered calcifications
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| What does the fluid aspirated from an intracystic papillary carcinoma usually look like? | usually produce dark bloody fluid on aspiration
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| _______ is a type of invasive ductal cancer in which some of the cancer cells produce mucin around the invasive cancer cells. | Mucous Carcinoma
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| Which of the following refer to the same type of breast cancer? | Mucinous Carcinoma, Gelatinous Carcinoma, Colloid Carcinoma
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| What age group is most often affected by mucinous carcinoma? | 20's in 30's
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| 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.
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| Compare multicentric and multifocal cancer: | (blank)
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| _______ starts from the epithelium of the breast lobule and remains contained in the lobule. | Lobular Carcinoma in situ cancers
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| Is LCIS easily seen on mammo or songraphy? | No, no mass seen on mammo
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| _________ invades tissue in linear columns. 70% of this type of cancer is multicentric. | Invasive lobular carcinoma
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| What is the most commonly missed breast cancer? | Invasive lobular carcinoma
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| Can mammo or sonography tell the difference between invasive ductal and invasive lobular carcinoma? | No
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| ___% of phylloides tumors are malignant. | 5-10
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| _____ is what makes the diagnosis of malignant phylloides tumor versus benign. | Biopsy
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| Malignant phylloides tumor mets to the lungs instead of the lymph nodes. Why? | Bcause it spreads thru the blood instead of lymph
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| What is the life expectancy for pt's w/ malignant phylloides tumor? | 5 yr
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| Lymphoma of the breast is ________. | either primary or secondary
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| What is the most frequent source of metastic cancer to the breast? | melanoma
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| What is Scirrhous Carcinoma? | mets to the skin after mastectomy. Occur in mastectomy scar
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| 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.
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| 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
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| Describe 3 types of breast implant placement; | Single lumen - filled w/ silicone or saline Double lumen outer filled w/ silicone inner w/saline
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| Which type is illegal in the USA? | Subcutaneous silicone injections
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| What is a radial fold? | folding of INTACT envelope into gel forming a tear drop shape at area of the envelope
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| Describe the normal sonographic appearance of breast implants: | ability to evaluate both breast at same time. anechoic smoothe borders
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| 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
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| 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?
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| What is the snowstorm sign? | increase echogenicity of silicone implant back & forth into implant lumen
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| What is the step ladder sign? | may also see rupture envelope folding back & forth into implant lumen
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| What happens to the sonographic appearance of the breast following reduction mammaplasty? | scar tissue causes shadowing breast tissue has swirled appearance
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| 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?
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| 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.
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| Secondary Varicocele | caused by increased pressure on spermatic vein by hydronephrosis, cirrhosis(portal htn), or abdominal tumor.
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| Varicocele | no abnormal sonographic appearance
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| Scrotal Hernia | bowel herniates thru inguinal canal into scrotum. Usually diagnosed clinically- enlaarged scrotum, abd pain, may be blood in stool.
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| B | Bowel
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| F | Fluid
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| T | Testis
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| Solid Masses of the Scrotum | Benign: less than 5% of all solid scrotal masses are benign! 95% cancerous Non germ cell tumors
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| 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
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| estrogen & testosterone | sexual immaturity
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| PTH | tetany
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| ADH | excessive urination w/out high blood glucose levels; cause dehydration and tremendous thirst
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| thyroxine | goiter
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| thyroxine | cretinism; a type of dwarfism in which the individual retains childlike proportions and is mentally retarded
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| insulin | excessive thirst, high blood glucose levels, acidosis
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| growth hormone | abnormally small stature, normal proportions
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| estrogen & progesterone | miscarriage
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| thyroxine | lethargy, hair loss, low basal metabolic rate, obesity (myxedema in the adult)
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| granulocytes | granules in their cytoplasm can be stained- possess lobed nuclei, include neutrophils, eosinophils, & basophils
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| eosinophils | large brick-red cytoplasm granules, fights allergies
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| buffy coat | contains leukocytes & platelets (less than 1% of blood) , thin whitish layer between the erythrocytes & plasma.
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| Non living matrix of blood? | plasma
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| erythrocytes | RBC's, main function is to carry oxygen account for about 45% of that volume of a blood sample (hemotrocrit)
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| How many grams of hemoglobin to 1 mL? | 12-18gm
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| RBC disorders | Thrombocytopenia: platelet deficiency, even normal movements can cause bleeding from small blood vessels that require platelets for clotting
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| (blank) | Hemophillia: hereditary bleeding disorder, normal clotting factors missing.
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| Does leukemia fall in this category? | No
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| Erythrocytes | non nucleus, biconcave disks, essentially bags of hemoglobin, & contain few organelles. Only mature ones move back &forth between tissues. No diapedis
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