Breast Sonography Exam 1 - Part 2

Anatomy and Pt. Care

when are the lactiferous ducts formed

15-20 wks

3 layers of breast tissue

subcutaneous, mammary, retromammary

subcutaneous layer contains:

fatty tissue and cooper’s ligaments

where do the lactiferous ducts carry milk from

lactiferous ducts to nipple

TDLU means

terminal ductal lobular unit

what is the TDLU made up of

acini and terminal ducts

cooper’s ligaments extend from where and do what

extend from the retromammary fascia to the skin and provide support

how many lobes in the mammary layer radiate from the nipple

15-20 lobes

retromammary layer contains

fatty tissue and cooper’s ligaments.

layers superficial to deep:

Skin

subcutaneous layer

mammary layer

retromammary layer

pectoral muscles

rib

mammary layer is AKA

glandular layer

what is the functional portion of the breast

the mammary layer

what is located both between and within the lobes, and consist of dense connective tissue, loose connective tissue, and fat

stromal elements

where is the site of origin for nearly all pathological processes that occur within the breast?

the TDLU in the mammary layer

what is the most common benign tumor of the breast

fibroadenomas

how many acini are in the breast

hundreds

where does pectoralis major lie

posterior to retromammary layer

where does pectoralis minor lie

superolateral and posterior to pectoralis major

sonographically they appear as a hypoechoic interface between the retromammary layer of the breast and ribs

lesions

where does over half the vascular supply come from

the internal mammary artery

where is the area towards the tail of spence

the UOQ

where does the other half of the vascular supply come from for the breast?

upper outer lateral thoracic

where does 97% of lymphatic drainage from all parts of the breast flow to

the axillary lymph nodes

where else may lymphatic drainage be forced to flow?

the supraclavicular nodes, rotter’s nodes, internal mammary chain, or opposite breast

what does surgical therapy of invasive breast cancer involve

axillary lymph node dissection

where are rotter’s nodes

posterior to the pectoralis major but anterior to the pectoralis minor

what is the primary function of the breast

fluid transport

when does breast development begin

before menarche

how long does breast development last

several years following menses

breast tissue changes DRASTICALLY due to:

hormonal levels of menses and pregnancy

what is the ductal system critical for

transporting fluids

what is produced in the acini and carried to the nipple through the ducts

milk

under which influence does the ductal system proliferate

estrogen

when does the estrogen influence begin

before menarche

what are the three hormones responsible for milk production

estrogen, prolactin, progesterone

what happens during pregnancy

acinar development is accelerated to enable milk production

produced by the pituitary gland to stimulate the acini to produce and excrete milk

prolactin

high levels of ________ during pregnancy suppress milk from being released

progesterone

after delivery of the placenta, what happens with progesterone?

it causes a drop in progesterone initiating milk production

mammographic screening is usually not performed until at least how many months after lactation ends?

6 months

at what age are most mammograms done

40s

the baby latching on to the breast initiates the release of:

oxytocin

why can men not produce milk

they do not develop the milk-producing lobular and acinar tissues

what percent of breast cancer in the US occur in men

1%

how many cases per year occur of men with breast cancer

2,670 cases

men do not have:

estrogen

males can have gynecomastia. what is it?

enlargement of breast glandular tissue in males

what is gynecomastia caused by

an inbalance between estrogen (high) and testosterone (low) hormones

who does gynecomastia affect

newborns and teens during puberty

when should women start monthly self exams

after menses forever

what percent of breast cancers can be detected through self-exams and clinical breast exams

70%

why would a woman have to have an ultrasound instead of a mammogram

young, dense breasts are difficult to penetrate by mammogram

7% of BRCA are found through:

BSE

when the sonographer immobilizes the mass between 2 fingers and scans with the opposite hand

echo palpation

benign masses are generally ______ and malignant masses are generally ________

mobile, fixed

what can cause masses to enlarge quickly whether benign or malignant

hormones

time gain compensation (TGC)

brightness in a certain area

overall gain

makes the overall image brighter, amplifies returning echo strength

why should you raise the patient’s arm behind their head?

spreads breast tissue more evenly and makes it easier to access the axilla

most common positioning

oblique

measure any finding in 3D

length, width, height

what is a stand off pad used for

greater detail of superficial layer

ideal thickness of standoff pad

1cm

what can be used when a patient is allergic to gel

alcohol or lotion

what can be used in place of stand off pad

a lot of gel

sonographic appearance of the layers of the breast depends on:

age, hormonal status, inherited parenchymal pattern, and lactation

what does a young woman’s parenchymal pattern look like

fibrous tissue, dense and echogenic

what does a pregnant/lactating woman’s parenchymal pattern look like

increases in density and volume

what does an older woman’s parenchymal pattern look like

fatty, less echogenic

which category is almost entirely fatty

category A

which category is scattered density

category B

which category is mostly dense

category C

which category is extremely dense

category D

what 2 methods are breast anatomy described by

quadrant and clock

What is the superior boundary for the location of the mammary glands?

2nd-3rd rib

Cooper's ligaments in breast tissue primarily function to:

Provide support by connecting fascia to skin

Cooper's ligaments extend from which layer to the skin?

Retromammary fascia

How many lobes are typically found in the mammary layer of the breast?

15-20

The primary arterial supply to the breast comes from which pair of arteries?

Internal mammary and lateral thoracic arteries

After lactation ends, how does breast tissue respond and when can mammography resume?

Breast tissue involutes; mammography resumes after 6 months