Breasts Notes

Question 1

What are the lifestyle risk factors for breast cancer? 3

Answer 1

1. Obesity
2. Physical inactivity
3. Alcohol intake.

Question 2

What are the hereditary risk factors for breast cancer?

Answer 2

Hereditary factors.

Question 3

What are the reproductive/hormonal risk factors for breast cancer? 5

Answer 3

1. Older age at first birth
2. Late menopause
3. Menstruation at an early age
4. BCP’s
5. HRT.

Question 4

What are the indications for breast ultrasound? 10

Answer 4

1. Compliments mammography
2. Identifies and characterizes an abnormality
3. Dense breast tissue
4. Equivocal mammogram or physical findings
5. Patients < 30 years of age: initial screen
6. Pregnant/lactating breast
7. Male breast
8. Interventional guidance
9. Breast implants
10. Treatment planning for radiation therapy.

Question 5

What are the advantages of ultrasound? 6

Answer 5

1. Noninvasive
2. Painless
3. Non-ionizing
4. Low cost
5. Image chest wall
6. Doppler.

Question 6

What is the mammary gland? 2

Answer 6

1. A modified sweat gland composed of fatty, glandular, and fibrous tissue
2. Three layers or zones: subcutaneous, mammary, and retromammary.

Question 7

What is the subcutaneous (premammory) zone? Is there breast lesions that originate in this zone?

Answer 7

1. Located between the skin and mammary fascia, containing fat surrounded by connective tissue.
2. No true breast lesions originate in this zone.

Question 8

What is the mammary zone? Where is this area mostly found?

Answer 8

1. The functional layer made up of fibroglandular tissue
2. Mostly found in the upper outer quadrant (UOQ) and areola region.

Question 9

What are lobes in the mammary zone? How many lobes are there in the mammary zone? 2

Answer 9

1. 15 to 20 in each breast, arranged radially
2. Containing ducts, stroma, and acinus.

Question 10

What are lobules in the mammary zone?

Answer 10

20 to 40 per lobe, containing individual milk-producing glands called acini.

Question 11

What are lactiferous ducts and sinuses?

Answer 11

They drain acini, lobules, and lobes, converging toward the nipple and enlarging to form the lactiferous sinus.

Question 12

What is TDLU? What are they the site of?

Answer 12

1. Terminal ductal lobular unit, the functional unit consisting of a lobule and extralobular terminal duct
2. Site of most major breast pathology.

Question 13

What is the retromammary zone? 2

Answer 13

1. The deepest layer, quite thin
2. Containing fat, blood vessels, and lymphatics.

Question 14

What is the nipple?

Answer 14

A fibromuscular papilla projecting from the center of the breast, with multiple openings and an areola surrounding it.

Question 15

What is the vascular supply of the breast?

Answer 15

Lateral thoracic artery, internal mammary artery, and intercostal arteries.

Question 16

What is the lymphatic drainage of the breast?

Answer 16

Flows to axillary nodes, originating in connective tissue, ducts, and under the skin.

Question 17

What is the physiology of the breast? What is it influenced by?

Answer 17

1. Produces and secretes milk
2. Influenced by age and stage of breast function, with estrogen promoting ductal tissue growth and prolactin stimulating milk production.

Question 18

What is the sonographic appearance of skin?

Answer 18

Two thin echogenic lines, 2-3 mm in thickness.

Question 19

What is the sonographic appearance of the nipple?

Answer 19

Homogenous with medium level echoes and posterior acoustic shadowing.

Question 20

What is the sonographic appearance of parenchyma?

Answer 20

1. Homogenous
2. Echogenic compared to fat, with interspersed hypoechoic areas of fat.

Question 21

What is the scanning technique for breast ultrasound? 3

Answer 21

1. Use the highest frequency transducer possible
2. Position the patient supine or slightly oblique
3. Scan in two planes: clock face and quadrant approach.

Question 22

What is BIRADS?

Answer 22

Breast Imaging Reporting and Data System, a standardized form of reporting and documenting breast lesions, classifying them according to suspicion of breast cancer.

Question 23

What are common benign abnormalities in breast ultrasound? 7

Answer 23

1. Cysts
2. Fibroadenomas
3. Cystosarcoma phyllodes
4. Lipomas
5. Fat necrosis
6. Papillomas
7. Fibrocystic changes.

Question 24

What are the characteristics of cysts?

Answer 24

Common in women 35-50 years, palpable and rounded, single or multiple, with variable size.

Question 25

What are the characteristics of fibroadenomas? 5

Answer 25

1. Most common benign tumor in women of childbearing years 2. Palpable 3. Painless 4. Mobile 5. Various shapes and sizes.

Question 26

What is fat necrosis?

Answer 26

Hemorrhage or liquefaction of fatty area leading to necrosis, often due to trauma or surgery.

Question 27

What is a papilloma?

Answer 27

Benign solid masses in the lining of the ducts, most common cause of bloody nipple discharge.

Question 28

What are fibrocystic changes?

Answer 28

Exaggerated cyclic changes in breast tissue, typically affecting the UOQ of the breast.

Question 29

What is a galactocele? Typically located in which region? What can they lead to?

Answer 29

1. Obstruction of a lactiferous duct in a pregnant or lactating woman 2. Typically located in the retro-areolar region 3. Can lead to mastitis. ## Footnote Sonographically, it appears as a well-defined cystic mass with less posterior enhancement than a cyst and may contain internal debris.

Question 30

What characterizes ductal ectasia? typically in patients of what age? Is it symptomatic?

Answer 30

1. It presents as tubular hypoechoic structures converging towards the nipple 2. Typically in lactating patients and those over 50 years of age. 3. Usually asymptomatic but can lead to mastitis.

Question 31

What is mastitis? 5

Answer 31

1. Breast inflammation that typically occurs in lactating females due to obstruction of duct by milk, allowing bacteria to enter via the nipple. 2. Trauma 3. Radiation therapy 4. Diabetes 5. Immunocompromised states. ## Footnote Symptoms include hot, red, tender breast, fever, palpable mass, and nipple discharge. Sonographically, it shows irregular fluid collection with debris and loss of tissue definition.

Question 32

What are the characteristics of nipple discharge? 8

Answer 32

1. Nipple discharge can have multiple etiologies. 2. Low-risk discharge is bilateral 3. Involves multiple duct orifices 4. Is milky or greenish, likely related to fibrocystic change or duct ectasia. 5. High-risk discharge is unilateral 6. Spontaneous 7. Clear 8. Bloody, or serous, warranting further investigation.

Question 33

How are malignant breast lesions categorized?

Answer 33

Malignant lesions are categorized by location (ductal or lobular) and invasiveness (non-invasive or invasive).

Question 34

What are the assessment criteria for a breast mass? 10

Answer 34

1. Criteria include shape 2. Size 3. Number 4. Orientation 5. Location (commonly UOQ) 6. Margins 7. Echogenicity/echotexture 8. Internal echo content 9. Posterior shadowing or enhancement 10. Effect on surrounding tissue.

Question 35

What are common sonographic characteristics of malignancy? 9

Answer 35

1. Common characteristics include being markedly hypoechoic compared to breast tissue 2. Taller than wide 3. With angled irregular margins (spiculated) 4. Heterogeneous texture 5. Posterior shadowing 6. Thick echogenic rim 7. Ductal extension 8. Microlobulations 9. Calcifications.

Question 36

What are secondary findings associated with breast malignancy? 6

Answer 36

1. Secondary findings may include skin changes (thickening, flattening, or retraction) 2. Inverted nipple 3. Axillary or intramammary lymph nodes 4. Dilated ducts 5. Highly echogenic surrounding tissue 6. Thickened Cooper's ligaments.

Question 37

What is ductal carcinoma in situ? How common is it? Typically found in which demographic? What are two symptoms?

Answer 37

1. It arises in the ducts and is the most common non-invasive breast cancer 2. Typically found in postmenopausal women. 3. Symptoms may include nipple discharge and microcalcifications.

Question 38

What is lobular carcinoma in situ? When does it have an increased incidence?

Answer 38

It has an increased incidence in reproductive years and is not considered a 'true' cancer, but it indicates a high risk for breast cancer.

Question 39

Most common breast cancer? What is it characterized by? Where is it frequently located?

Answer 39

1. Infiltrating (invasive) ductal carcinoma. 2. 2. Characterized by a hard, stationary, painless palpable mass 3. Frequently located in the UOQ of the breast, often with microcalcifications and spiculations.

Question 40

What is gynecomastia? What is it linked to?

Answer 40

1. Male breast enlargement due to abnormal proliferation of retroareolar glandular tissue and increased fat 2. Linked to estrogen and androgen use, certain medications, and estrogenic neoplasms. ## Footnote Symptoms include enlarged breast, palpable firm mass under the nipple, and pain or tenderness.

Question 41

What are the concerns with augmented breasts (implants)? How do they appear sonographically? 4

Answer 41

Concerns include 1. Leakage or rupture 2. Contraction of the capsule 3. Obscuring normal breast tissue in mammography. 4. Sonographically, implants appear oval in shape and relatively echo-free.

Question 42

What is a silicone leak (rupture)? 3

Answer 42

1. Occurs when silicone leaks outside the implant shell 2. With intra-capsular rupture showing a 'step ladder' sign 3. Extra-capsular rupture showing a 'snowstorm' appearance. ## Footnote Symptoms may include change in breast shape or consistency and chronic burning.

Question 43

What is silicone bleed? 2

Answer 43

1. It occurs in all silicone implants due to microscopic leakage through an intact implant, contained in the fibrous capsule, 2. Leading to silicone migration to lymph nodes and resulting in lymphadenopathy.

Question 44

What is contracture in relation to breast implants? What is the risk of contracture in posteriorly placed implants?

Answer 44

1. Contracture occurs when the fibrous capsule forms around an implant but constricts, disfiguring the breast. 2. There is a lower risk of contracture in posteriorly placed implants.