Ch 21 Breast

breasts are modified ______ glands

sweat

an extension of the breast into the axilla is known as a ____________

tail of spence

1 in __ women will develop breast cancer

8

if a patient has an extra nipple, it will be found on the ____________ line

mammary milk

layers of the breast (3):

subcutaneous, mammary, retromammary

most superficial layer of the breast

subcutaneous

breast layer made up of fatty tissue

subcutaneous

fatty tissue in the breast appears _________ on US

hypoechoic

these form a "fibrous skeleton" to maintain breast shape

Cooper ligaments

functional layer of the breast

mammary

the mammary layer contains _______ lobes

15-20

breast layer that contains the lactiferous ducts and the terminal ductal lobular unit

mammary layer

the milk producing area of the breast is the

acini

a terminal ductal lobular unit is a group of _______

acini

the deepest breast layer is the __________ layer

retromammary

the pectoralis major and minor muscles are _________ to the retromammary layer

posterior

the nipple will have posterior __________ on US

shadowing

Cooper ligaments are ________ on US and dispersed in a linear pattern

echogenic

breast layer that lies between the subcutaneous fatty layer and the retromammary layer

mammary-glandular layer

young patients have a _____________ pattern on US

dense echogenic

young patients have ________ elements

fibrous

in the pregnant or lactating patient, the patient will have denser portions of the breast with less __________ interfaces

echogenic

as the breast matures, _________ tissue begins to replace the glandular tissue

fatty

vascular supply to the breasts are done through (2):

internal mammary arteries

lateral thoracic arteries

venous drainage of the breast is done through ________ veins

superficial

lymphatic drainage generally flows to the __________ lymph nodes

axillary

a large majority of lymph is removed by the __________ chain

axillary

if ductal elements hypertrophy in the male breast, it leads to

gynecomastia

male breast cancer is rare, at ________ cases per year

1,300

syndrome that results from a male having two or more X chromosomes, putting them at risk for breast cancer

Klinefelter syndrome

primary features of Klinefelter syndrome are ________ and small ________

infertility

testicles

the primary function of the breast is _________ transport

fluid

________ system is crucial for transports of fluids within the breast

ductal

breast development beings at age _______ , before menarche

16

the ductal system proliferates due to ___________

estrogen

during pregnancy, _________ is produced by the pituitary gland which stimulates cells to produce and excrete milk

prolactin

mammography is typically not done until __________ after breastfeeding

6 months

types of breast cancer screenings (3):

self examination, clinical examination, mammography

self examination of the breast begins _________ at age _______

monthly

20

clinical breast exams are performed every _____ years for patients 20-39

3

clinical breast exams are performed ________ for patients 40 years and older

annually

screening mammography begins annually at age ________

40

most common sign of breast cancer

palpable lump

common or less common signs?

irregular, highly dense mass

clustered pleomorphic microcalcifications

focal distortion

primary common signs

common or less common signs?

focal asymmetric density

developing density

primary less common signs

common _________ signs include:

nipple/skin retraction

skin thickening

increased vascularity

secondary

during a breast examination for a palpable mass, you should note the ________ of the mass and the ___________ or quadrant

location

clock face

___________ is the primary imaging tool for patients under 30

ultrasound

mammography is contraindicated in patients under _____ years old

20

with pregnant or lactating patients, ________ is the primary imaging tool

ultrasound

most masses during pregnancy/lactating patients are benign ___________

fibroadenoma

a cyst that fills with milk is known as

galactocele

with patients who have breast implants, ________ is the imaging choice

ultrasound

true/false:

ultrasound should not be used as a substitute for mammography

true

why mammography is needed with US:

microcalcifications and focal distortion are better seen with mammography and are both principle signs of ______________

breast cancer

annotation methods include (4 but not limited to):

clock face

quadrants

distance from nipple

1,2,3 .... a, b, c

radial/anti-radial is a ___________ measurement method

3 dimensional

ultrasound _______ include:

pseudomass

infiltrative pattern

large, fatty breast

pitfalls

best patient positioning for breast ultrasounds:

supine with arm behind head

quadrants of the breast include (4):

right/left upper outer

upper inner

lower outer

lower inner

clock annotations for the breast:

1-12, with 12 o'clock beginning vertically to top of nipple

a simple breast cyst is automatically _________

benign

margins of a _______ mass include:

smooth, rounded

benign

margins of a _______ mass include:

indistinct, fuzzy, spiculations

malignant

a technique that can be used to confirm margins of a mass:

fremitus

technique where you have the patient hum while color is on to confirm mass margins :

fremitus

benign masses will be ________ while malignant masses are firmly fixed

mobile

true/false:

malignant tumors are non-compressible

true

malignant masses will be hypervascular and contain a _______ vessel

feeder

___% of lesions removed from the breast are benign

70

_________ pathology includes:

cysts

fibrocystic changes

fibroadenoma

lipoma

fat necrosis

acute&chronic mastitis

abscess

cystosarcoma phyllodes

intraductal papilloma

benign

a normal condition characterized by a palpable lump on the outer portion of the breast and changes with menstrual cycle

fibrocystic condition

most common diagnosis at a breast biopsy

fibrocystic condition

most common benign breast tumor

Fibroadenoma

fibroadenomas grow with ___________

estrogen

benign condition due to infection, trauma, or obstruction

mastitis

clinical symptoms of ________:

enlarged, red, tender breast

mastitis

mastitis occurs during ___________

breast feeding

galactoceles occur after ___________

breast feeding

chronic mastitis is in _________ women

older

malignant carcinoma names describe where it __________ and if it has __________

started

spread

most common malignant breast cancer

Invasive ductal carcinoma

invasive ductal carcinoma is the most common malignant breast cancer at ____%

80

ductal carcinoma has a ___% cure rate if found before it spreads

100

ductal carcinoma in situ started in the ________ and ________ spread (has/hasn't)

ducts, hasn't

lobular carcinoma in situ started in the ______ and _______ (has/hasn't)

lobes, hasn't

malignant masses will show posterior _____________

shadowing

malignant masses have a ___________ appearance

taller than wide

benign masses have a ___________ appearance

wider than tall

a smaller tumor connected to a larger tumor is known as a __________ tumor

satellite

guidelines used to classify a breast lesion:

BI-RADS

BI-RADS scores:

1 =

2 =

5 =

negative

benign

malignant

mammography is rarely indicated in patients under 20 because:

breast cancer is _____ in patients under 20

rare

mammography is rarely indicated in patients under 20 because:

younger breast tissue is more _______

dense

mammography is rarely indicated in patients under 20 because:

younger breast tissue is more sensitive to __________

radiation

annotation most facilities use for breast US images:

quasi grid pattern

zone 1 of the breast is just outside the _________

nipple

zone 2 of the breast is about 2/3 of the surface from the ________

nipple

zone 3 of the breast is to the breast _________

periphery

invasions of a mass into surrounding tissues that appear as finger like extensions and small lines on US

spiculations