3322 Unit 3 Breast Review

What is whole breast sonography?

scanning entire breast for screening purposes

What is targeted breast sonography?

only a specific area of breast is examined

What are specific uses of sonography for breast imaging?

image lesion found on mammo, mammo with indeterminate lesion w/ no palpable mass, image palpable lump, image axilla for lymphadenopathy, guidance for intervention procedures

What are the common metastatic sites from primary breast cancer?

lymph nodes, bone, lung, liver, opposite breast

What type of breast implant is filled with silicone or saline?

single lumen

What type of breast implant has inner filled with silicone and outer filled with saline?

double lumen

What type of breast implant has inner filled with saline and outer filled with silicone?

reverse double lumen

What is the most common type of implant placement where implant is placed posterior to parenchymal layer and anterior to pectoralis muscle?

subglandular

What type of implant placement has increased risk of fibrous capsule forming?

subglandular

What type of implant placement is placed posterior to pectoralis major muscle with more complicated surgery and longer recovery, but less risk of fibrous capsule forming?

subpectoral

What type of implant placement is illegal in USA and has a much greater risk of complications?

subcutaneous silicone injection

What is the most common type of reaction to implant and is characterized by formation of fibrous scar of connective tissue around implant?

fibrous capsule formation

What implant complication is defined as leakage of the silicone into surrounding tissue with a non-ruptured implant?

silicone gel bleed

What type of implant rupture presents less clinical concern and is usually diagnosed clinically due to rapid deflation of implant?

saline implant rupture

What type of implant rupture is characterized by rupture of implant shell with escape of silicone into intact fibrous capsule and accounts for 80% of implant ruptures?

intracapsular silicone implant rupture

What type of implant rupture is characterized by rupture of both implant shell and fibrous capsule with the escape of silicone into the surrounding breast tissues?

extracapsular silicone implant rupture

What types of tissue compose the breast?

fibrous tissue, glandular tissue, adipose tissue

What is average breast diameter measurement?

10-12 cm

What is average breast central thickness measurement?

5-7 cm

What are the 4 zones the breast is divided into?

1. skin, nipple, subareolar structures

2. subcutaneous region

3. parenchyma (mammary region)

4. retromammary region

What glands are located within the areola?

montgomery glands/tubercles

What is the breast tissue extending superior/laterally toward axilla that is also called the axillary tail?

tail of spence

What is the oblique line that extends from axilla to symphysis pubis long which supernumerary nipples may be located?

mammary milk line

What layer of breast tissue is located just under skin and is very thin and composed of fat?

subcutaneous layer (premammary zone)

What layer of breast tissue makes up majority of breast thickness and is a functional layer?

mammary layer

What layer of breast tissue is located just anterior to chest wall and is very thin?

retromammary layer

What major fascial plane is located between the subcutaneous layer and mammary layer?

superficial layer of superficial fascia/anterior mammary fascia/premammary fascia

What major fascial plane is located between mammary and retromammary layers?

deep layer of superficial fascia/posterior mammary fascia/retromammary fascia

What is the fibrous suspensory ligament that connect the fascial layers?

Cooper’s ligaments

What types of tissue is the mammary layer composed of?

glandular tissue, ductal tissue, and stromal elements (supporting structures)

What tissue produces milk?

glandular tissue

How many lobes of glandular tissue in each breast?

15-20

How many acini make up a lobule?

30

What are the walls of the lactiferous duct?

epithelium, myoepithelium, basement membrane

How many major ducts open to the nipple?

15-20

What are the small units made up of terminal ducts and their acini, one lobule?

terminal ductal lobar unit (TDLU)

What is the site of origin of nearly all pathologic processes that occur within the breast?

terminal ductal lobar unit (TDLU)

What muscles do the breast lie over?

pectoralis major and serratus anterior muscles

Where does blood flow to the chest originate from?

subclavian/axillary artery

What is the path of arterial supply to the lateral aspect of breast?

thoracic aorta → posterior intercostal arteries → lateral aspect of breast

What is the path of blood supply to the medial aspect of breast?

subclavian artery → internal thoracic artery → medial aspect of breast

What is the path of blood supply to the posterior aspect of the breast?

branch of axillary artery → lateral thoracic artery → posterior aspect of breast

What is the name of the circular pathway that veins form around the areola?

circulus venosus

What veins does the circulus venosus drain into?

axillary and internal mammary veins

What are the 3 major routes of breast lymphatics?

supraclavicular, medial breast, axillary

What area of the breast lymphatics accounts for 75% of lymphatic drainage?

axillary lymph node chain

What are the 6 groups of nodes that make up the axillary lymph node chain?

external mammary, scapular, axillary, central, subclavicular, interpectoral (Rotter’s nodes)

What are the additional lymph node groups that are responsible for drainage of 25% of lymph?

internal mammary, intercostal, contralateral flow to opposite breast, supraclavicular, diaphragmatic

Is ultrasound considered a screening tool?

no

What type of transducer is commonly used for breast ultrasound?

high frequency >7 MHz linear transducer

What is the most important and AIUM-recommended scan plane for evaluating a solid breast mass?

radial plane

How does breast tissue change with age?

amount of fatty tissue increases and fibroglandular tissue decreases

What type of masses tend to change shape with compression?

softer (benign) masses

What type of masses will not change shape with compression?

harder (malignant) masses

What is the sensitive scanning technique used for optimal visualization of palpable masses that ensures images are obtained at the precise location of the palpable mass, whether or not the lesion is sonographically visible?

echo-palpation technique

What is placed between transducer and skin to create distance to improve visualization of superficial masses?

stand-off pads

What should thickness of stand-off pad not exceed?

1 cm

What is the maneuver using color/power Doppler to distinguish borders of a mass?

fremitus maneuver

What technique is used for subareolar imaging where transducer is aligned along long axis of duct and slides distally to include nipple and non-scanning hand is placed on opposite side of breast, applying pressure?

two-handed peripheral compression technique

What technique is used for subareolar imaging with transducer placed at edge of nipple parallel to duct with non-scanning hand opposite of nipple and light pressure applied to force nipple on side?

rolled nipple technique

What are advantages of using transducer pressure?

improving transmission of sound beam by decreasing scattering and improved image quality

Is the breast homogeneous or inhomogeneous on ultrasound?

inhomogeneous

What is another term for fibroadenolipoma?

hamartoma

What is a rare fatty breast tumor that is non-encapsulated and composed of fat, fibrous, and glandular tissues?

fibroadenolipoma

How does fibroadenolipoma appear on ultrasound?

well-defined mass, oval or lobulated shape, variable echogenicity, shadowing, large

What is the actual name for “swiss cheese disease”?

juvenille papillomatosis

What is the rare condition affecting females less than 30 years and is characterized by cysts, duct ectasia, intraductal hyperplasia, and sclerosing adenosis?

juvenile papillomatosis

What pathology appears with mass in periphery of breast and some have familial history of breast cancer

juvenile papillomatosis

How does juvenile papillomatosis appear on ultrasound?

hypoechoic, ill-defined mass, heterogeneous, visible cysts, duct ectasia

What region (1,2,3) is the inner third of breast (closest to nipple)?

region 1

What region (1,2,3) is middle third of breast?

region 2

What region (1,2,3) is outer third of breast?

region 3

What region (A,B,C) is most anterior of breast ultrasound image?

region A

What region (A,B,C) is mid portion of breast ultrasound image?

region B

What region (A,B,C) is posterior section of breast ultrasound image?

region C

What is another term for sebaceous cyst?

epidermal inclusion cyst

What is a retention cyst that results from an obstructed sebaceous gland within the dermis and contains sebum?

sebaceous cyst

How does sebaceous cyst appear on ultrasound?

round, well-marginated, variable appearance, superficial location, acoustic enhancement, claw sign

What is claw sign appearance typically associated with?

sebaceous cyst

What is the sign called where hyperechoic dermal tissue wraps around margin of lesion?

claw sign

What is the relatively new breast imaging technique that is used as adjunct to mammography?

MRI

What is the most accurate imaging modality in detection of implant rupture?

MRI

What is common shape and orientation of benign breast masses?

round, oval, ellipsoid, wider-than-tall

What is the moonbeam effect and what type of mass is it a common feature of?

echoes posterior to mass are brighter than adjacent tissue; seen in benign masses

How does skin layer appear compared to fat on sonography?

hyperechoic

What are characteristics of margins of a benign breast mass?

smooth, well-defined, circumscribed, macrolobulations

What are characteristics of border thickness of a benign breast mass?

thin, echogenic pseudocapsule

What are characteristics of echogenicity of a benign breast mass?

variable echogenicity and homogeneous

What are artifacts associated with benign breast masses?

acoustic enhancement and edge shadowing

What are Doppler characteristics of benign breast masses?

no internal flow in cysts and no flow or hypovascularity in solid masses

What are characteristics of shape and orientation of malignant breast masses?

irregular shape, angles and straight lines, spiculated, taller-than-wide

What are characteristics of margins of a malignant breast mass?

microlobulations, ill-defined, angular

What are characteristics of border thickness in malignant breast masses?

thick, echogenic halo

What are characteristics of echogenicity of a malignant breast mass?

hypoechoic and heterogeneous

What artifacts may occur with malignant breast masses?

shadowing

What are Doppler characteristics seen in malignant breast masses?

angiogenesis, more peripheral and internal flow, hypervascularity

What is another term for interpectoral nodes?

Rotter’s nodes

What nodes are located deep in chest between pectoralis muscles?

Rotter’s nodes

What pathology appears with change in appearance, shape, and consistency of breast, hardening of breast, may feel lump, breast tenderness and burning sensation

implant rupture

When and where does breast development begin?

in utero along mammary milk line