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breast
| Question | Answer |
|---|---|
| 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 |
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