ARDMS Breast Registry Review Exam 503 Questions with Verified Answers,100% CORRECT

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ARDMS Breast Registry Review Exam 503 Questions with Verified Answers Artifact - CORRECT ANSWER An echo feature present or absent in a sonographic image that does not correspond to the presence o... r absence of a real structure. Eg. enhancement or shadowing. Attenuation - CORRECT ANSWER The reduction of intensity (and amplitude) of a sound wave as it travels through a material. Attenuation is due to absorption, reflection, and scattering. Complex - CORRECT ANSWER A structure in the body that contains both cystic and solid components. Echogenic - CORRECT ANSWER A structure or medium that produces echoes. Edge Shadowing - CORRECT ANSWER Decreased echo amplitude distal to the edge of a structure. This artifact results from refraction of the sound beam. Enhancement - CORRECT ANSWER Increased echo amplitude returning from regions lying beyond an object that causes little or no attenuation of the sound beam (typically a cystic structure). This artifact results in a brighter than normal appearance. Heterogeneous - CORRECT ANSWER A structure that has an uneven texture (hypoechoic and hyperechoic echoes throughout). Synonym - non-uniform. Homogeneous - CORRECT ANSWER Smooth uniform texture Ipsilateral - CORRECT ANSWER On the same side. Contrlateral - CORRECT ANSWER On the opposite side. Isoechoic - CORRECT ANSWER Same echogenicity as another structure or the surrounding tissue. Noise - CORRECT ANSWER Spurious echoes throughout the image. Real-time - CORRECT ANSWER The scanning and display of sonographic images at a sufficiently rapid rate so that moving structures can be seen to move at their natural rate. ***Frame rates of 15 frames per second or greater are considered real time*** Reverberation - CORRECT ANSWER Artifact causing linear echoes parallel to a strong interface. Sound "bounces" Ring Down - CORRECT ANSWER Reverb in which numerous parallel echoes are seen for a considerable distance. E.g. a biopsy needle. Sensitivity - CORRECT ANSWER The ability to diagnose disease in a patient when disease is present. Texture - CORRECT ANSWER The pattern of echoes seen from a mass or area of interest in the body. Refractive Edge Shadowing - CORRECT ANSWER Bending of a sound beam and loss of sound energy causing a shadow. Mid level gray corresponds to _____ in the breast. - CORRECT ANSWER Fat Hyperechoic describes what three structures visualized in breast sonography. - CORRECT ANSWER Fibroglandular tissue, Cooper's Ligament, Skin What frequency transducer is optimal for breast imaging? - CORRECT ANSWER 7.0-15.0 MHz is optimal for superior axial and lateral resolution while maintaining penetration to the chest wall. It should also be BROADBAND. Fixed elevation focusing represents.... - CORRECT ANSWER Focusing along the short axis of the transducer. What design of transducer is used in breast imaging? - CORRECT ANSWER Linear array is optimal The advantage of a rectangular image over a sector image is the avoidance of what artifact? - CORRECT ANSWER Beam divergence Interventional procedures are more accurately guided with a _______ __________ probe. - CORRECT ANSWER Linear array When is a curved array transducer used in breast imaging? - CORRECT ANSWER Pathology too large to fit on linear image Most linear transducers in breast sonography are ______ arrays. - CORRECT ANSWER 1-D 1-D arrays offer a fixed focus in the ________ plan (short axis) - CORRECT ANSWER Elevation 1.5-D matrix array transducers have multiple elements along the _____ axis of the probe. - CORRECT ANSWER Short 1.5-D arrays offer some electronic focusing in the __________ plane. - CORRECT ANSWER Elevation 2-D array transducers are not currently _________. - CORRECT ANSWER available Imaging depth should penetrate the chest wall-- ___ to ___ cm should be adequate - CORRECT ANSWER 3, 6 An echo's brightness is controlled by ______ - CORRECT ANSWER gain Know overall gain, TGC, and output power - CORRECT ANSWER This is ultrasound elementary. If your image is too bright decrease the ______________. - CORRECT ANSWER Output power If your image is too dark increase the ____________. - CORRECT ANSWER Receiver gain __________ focal zones are recommended for breast imaging. - CORRECT ANSWER Multiple Multiple focal zones will decrease what? - CORRECT ANSWER Frame rate a 7-12 MHz probe must be used to obtain an elevation focus depth of ____ to _____ cm. - CORRECT ANSWER 1,2 10 MHz = _____ cm elevation plane focus - CORRECT ANSWER 1.5 ____________ (artifact) decreases contrast resolution and spatial resoution (both axial and lateral). Places unwanted echoes in cysts. - CORRECT ANSWER Volume averaging _______ __________ is more sensitive to low velocity flow and offers angle independence. - CORRECT ANSWER Power Doppler Three reasons Doppler is useful: - CORRECT ANSWER (1)Solid vs Cystic (2)Inflammed vs Non-Inflammed (3)Complicated Cyst vs Complex Cyst vs Intraductal Papilloma To optimize Doppler for breast imaging (4 things) - CORRECT ANSWER (1) Low velocity scale (2) Low filter setting (3) Optimal Doppler gain setting (4) Increased PRF for high velocities Uses compounding technique to combine ultrsound lines acquired from different scanning directions (angles). Improves tissue differentiation, margin visualization, and internal architecture creating a "smoother" more realistic image. - CORRECT ANSWER Spatial compounding What are the advantages (2) and disadvantages (2) of spatial compounding? - CORRECT ANSWER Advantages: -Clears cysts -Reduces speckle and other noise artifacts (clutter) Disadvantages -Reduces acoustic enhancement and shadowing artifact -Subject to blurring A diagnostic methof that evaluates the elastic properties of tissue. Breast tissues vibrate differently based on their firmness. - CORRECT ANSWER Elastography Breast elastography may have the potential to differentiate benign from malignant breast tumors (BIRADS 3 from BIRADS 4 lesions) and potential reduce the number of __________. - CORRECT ANSWER Biopsies List the 6 anatomic layers from anterior to posterior. - CORRECT ANSWER 1. Skin 2. Subcutaneous aka Premammary Layer 3. Mammary Layer 4. Retromammary Space 5. Muscle Layers (Pectoralis major m, and Pectoralis minor m.) 6. Chest Wall (Ribs and Intercostal muscles) What is the normal thickness of the skin layer?**** - CORRECT ANSWER 0.5 to 2mm **** The breast skin is slightly thicker in ______ females and thins with ______. - CORRECT ANSWER young, age Area that consists of dense connective tissue and erectile muscle, contains many sensory nerve endings, and has _________ collecting duct openings. - CORRECT ANSWER Nipple, 15-20 The areola consists of _______ muscle. - CORRECT ANSWER Smooth These sebaceous glands are found in the areola. - CORRECT ANSWER Montgomery glands. The premammary layer primarily consists of ________. - CORRECT ANSWER fat The premammary layer is not seen where? - CORRECT ANSWER Posterior to the nipple. The amount of fat in the premammary layer increases with ______, _______, and _______. - CORRECT ANSWER Age, pregnancy, obesity. _________ __________ appear as prominent structures within the subcutaneous (premammary) layer. - CORRECT ANSWER Cooper's ligaments. The breast tissue is completely contained between the layers of the _______ __________. - CORRECT ANSWER Superficial fascia At the breast, the _________ ___________ divides into the superficial and deep layers. - CORRECT ANSWER Superficial fascia The superficial fascia is contained within the ____________ layer, anterior to the _________ layer. - CORRECT ANSWER subcutaneous (premammary), mammary Mammary layer is aka--- - CORRECT ANSWER Parenchymal or Glandular Layer Portion of the glandular tissue that extends into the axilla - CORRECT ANSWER axillary Tail of Spence What two types of tissue is the mammary layer composed of? - CORRECT ANSWER Stroma and Epithelium The supportive tissue of the breast within the mammary layer - CORRECT ANSWER Stroma - consists of interlobular fat and connective tissue (Cooper's ligaments, loose and dense connective tissue) The functional tissue within the mammary layer. - CORRECT ANSWER Epithelium - Consists of acini, lobules, TDLU's, lobes, and lactiferous ducts. These provide the architectural framework of the breast and run between the superficial and deep layers of the superficial fascia. - CORRECT ANSWER Cooper's ligaments The smallest functional unit of the breast. - CORRECT ANSWER Acini Milk producing gland. - CORRECT ANSWER Acini There are _________ of acini in each breast. - CORRECT ANSWER Hundreds Each acini gives rise to a _______ or ________. - CORRECT ANSWER Ductule, Terminal Duct What makes up a TDLU? - CORRECT ANSWER Lobule Intralobular Terminal Ducts Extralobular Terminal Ducts A TDLU usually measures ______ or less. - CORRECT ANSWER 2.0 mm Nearly all breast pathology originates where? - CORRECT ANSWER TDLU Several ________ make up a breast lobe. - CORRECT ANSWER TDLUs (lobules with terminal ducts) How many lobes are there in each breast? - CORRECT ANSWER 15-20 One lactiferous duct emerges from each ______ and travels downward toward the nipple. - CORRECT ANSWER Lobe Transports milk from the acini to the nipple. - CORRECT ANSWER Lactiferous ducts ___________ Ducts travel between the lobes. - CORRECT ANSWER Interlobular Intralobular and Extralobular ducts carry milk from the acini to the lactiferous duct. - CORRECT ANSWER Yep Area where the lactiferous duct enlarges slightly beneath the areola. - CORRECT ANSWER Lactiferous Sinus The __________ duct empties milk from the nipple. - CORRECT ANSWER Collecting duct Lactiferous ducts are lined with a ________ layer of _______ cells. - CORRECT ANSWER Double, Epithelial The ___________ or adventitia is the other fibrous portion of the duct. - CORRECT ANSWER Basement membrane. See illustration p. 27 The deep layer of the superficial fascia is often referred to as the ________ fascia. - CORRECT ANSWER Deep fascia The ________ fascia is located within the retromammary space posterior to the mammary layer. - CORRECT ANSWER deep Maintaining integrity of the _______ fascia is important in deterring the spread of cancer to the chest wall. - CORRECT ANSWER deep The retromammary space is where? What does it contain? - CORRECT ANSWER Posterior to the mammary layer, anterior to the muscle layer. It contains fat. The retromammary space contains fat and what? - CORRECT ANSWER The deep layer of the superficial fascia What layer allows movement of the breast over the chest wall? - CORRECT ANSWER Retromammary space Pectoralis _______ is located anterior to pectoralis ___________. - CORRECT ANSWER Major is anterior to minor Deep to the chest wall layer is the _____. - CORRECT ANSWER Lung Know the quadrant and clock method - CORRECT ANSWER This stuff is so simple if you scan breast! Where are a larger percentage of cancers found? - CORRECT ANSWER The upper outer quadrant of both breasts Glandular tissue is usually thicker in the _____________ quadrant. - CORRECT ANSWER Upper outer The early mammary gland begins developing at what week of embryology? - CORRECT ANSWER Week 4 Breast enlargment in the male or female newborn may be seen due to ________ and_______ __________ __________. - CORRECT ANSWER Placental, maternal, hormone stimulation Supernumary or accessory nipples are occasionally found along the ______ ______. - CORRECT ANSWER milk lines Absence of one or both breasts - CORRECT ANSWER Amastia ****Accessory breast or more than two breasts. - CORRECT ANSWER Polymastia Absence of the nipple - CORRECT ANSWER Athelia Accessory nipple - CORRECT ANSWER Polythelia **This is the most common breast anomaly*** Absence of the breast tissue with development of the nipple. - CORRECT ANSWER Amazia Assymetric growth of the breasts - CORRECT ANSWER Unilateral early ripening Polythelia is more common in ________ than in _______. - CORRECT ANSWER men, women What are the two main arteries that supply blood to the breast? - CORRECT ANSWER Lateral Thoracic Artery and the Internal Mammary Artery (LTA, IMA) Arises from the axillary Courses inferior and lateral along pectoralis major m. - CORRECT ANSWER Lateral thoracic artery Which artery does the lateral thoracic artery come off of? Which part of the breast does it supply? - CORRECT ANSWER Axillary, Lateral Breast What is the other name for the internal mammary artery? - CORRECT ANSWER Internal thoracic artery Which artery does the internal mammary arise off of? - CORRECT ANSWER Subclavian artery Which part of the breast does the internal mammary artery supply? - CORRECT ANSWER Medial breast. It courses lateral to the sternum and inferiorly behind the upper ribs. Which artery is often used for CABG procedures? - CORRECT ANSWER Internal mammary artery What are the two secondary sources of blood supply to the breast tissues? - CORRECT ANSWER Thoracoacromial artery (superior) Intercostal artery (Inferior) The ______________ veins allow venous commuication between the right and left breasts. They may be a route of cancer metastasizing to the opposite breast. - CORRECT ANSWER Superficial The superficial veins are located just deep to the _________ __________. - CORRECT ANSWER Superficial fascia What are the major deep veins of the breast? (5) - CORRECT ANSWER Internal mammary vein Lateral thoracic vein Axillary vein Subclavian vein Intercostal veins What is a potential venous route for metastasis to the bone from breast cancer? - CORRECT ANSWER The intercostal veins communicate with the vertebral veins Both ________ & ___________ venous systems communicate with the breast parenchyma - CORRECT ANSWER Superficial, deep The lymphatic vessels of the breast closely follow the routes of the _________ and ________ ___________ systems. - CORRECT ANSWER Superficial and deep venous Breast cancer most frequently spreads by __________ route. - CORRECT ANSWER hematogenous (blood stream) Flow direction in the deep lymph system of the breast is (toward/away from) the areola. - CORRECT ANSWER Toward From the areola, the lymphatic system travels in the ________ lymphatic vessels (superficial system). - CORRECT ANSWER subdermal What percentage of lymphatic drainage is to the axilla? - CORRECT ANSWER 75% What are the six groups of the Axillary Lymph Node Chain?**** - CORRECT ANSWER 1. External Mammary Group - along lateral thoracic vessels 2. Scapular Group - run with the subcapsular vessels 3. Axillary Group - run with the axillary vessels 4. Central group - run with the axillary vessels 5. Subclavicular group - run with the subclavian vessels ****6. Interpectoral (Rotter's) nodes - found between pectoralis major and minor muscles The other 25% of lymphatic drainage from the breast includes 5 groups.... - CORRECT ANSWER 1. Internal Mammary Lymph Nodes 2. Inercostal lymph nodes 3. Flow to the opposite breast 4. Supraclavicular lymph nodes 5. Diaphragmatic lymph nodes - allow drainage to the abdomen As a lymph node becomes cancerous, it generally __________ and definition of the ________ is lost. - CORRECT ANSWER enlarges, hilum Nerves that supply the breast (7) - CORRECT ANSWER 1. Long thoracic nerve 2. Thoracodorsal nerve 3. Thoracic intercostal nerves 4. 3rd and 4th branch of the Cervical plexus 5. Circumflex nerve 6. Subcapsular nerves 7. Anterior Thoracic nerves Hormone that stimulates the changes of the stromal tissues of the breast. - CORRECT ANSWER Estrogen Hormone that stimulates growth of the glandular tissue of the breasts. (TDLUs) - CORRECT ANSWER Progesterone What is a common time in the menstrual cycle for breast discomfort? - CORRECT ANSWER Premenstrual Hormones of pregnancy which affect the breast tissues - CORRECT ANSWER Estrogen Progesterone Lactogen Prolactin hCG Late in pregnancy the _______ ________ increase in size. - CORRECT ANSWER Lactiferous ducts Shortly after birth what hormones diminish and what hormone dominates? - CORRECT ANSWER Estrogen and progesterone diminish Prolactin dominates The lobules of the breast ________ in the peri-menopausal female. - CORRECT ANSWER involute The most common causes of an increase in breast parenchyma or glandular tissue with age.... - CORRECT ANSWER Pregnancy/Lactation Hormone Replacement Therapy Significant weight loss Ratio of glandular to fatty tissue determined by.... - CORRECT ANSWER Total Body Fat : Total Body Weight (Ratio) What are the American Cancer Society's guidlines for frequency and age for self exam, clinical exam, and mammography? - CORRECT ANSWER Breast Self-Examinations (BSE) - Monthly by women of all ages. Clinical Breast Examination - Every 3 years for women 20-40, Every year for women over 40 Mammography - Baseline for women 35-40, After 40-one per year A prominent area of glandular tissue that is easily palpated. Often mistaken for a mass. - CORRECT ANSWER Fibrous ridge Most cancers are found either by ______ or __________. - CORRECT ANSWER BSE, CBE (clinical or self breast exam) Mammo will detect about ____________ % of breast cancers in women without symptoms. - CORRECT ANSWER 80-90 What are the two guiding standards that help ensure that mammography is safe and diagnostic? - CORRECT ANSWER Mammography Quality Standards Act if 1992 (MQSA) and ACR A regular screeening mammogram includes what views? - CORRECT ANSWER MLO and CC of each breast Which view is considered the most valuable? - CORRECT ANSWER MLO Angulation of the MLO varies between ___ and _____ degrees depending on the patient. - CORRECT ANSWER 30 & 60 MLO view estimates the location of a mass as ________ or ________ to the nipple with slight variation due to obliquity. - CORRECT ANSWER Super, inferior Mammo view where the x-ray beam is perpendicular to the floor. - CORRECT ANSWER CC On a CC view, the marker placement is toward the ___________. - CORRECT ANSWER Axilla This view describes the location as medial or lateral to the nipple. - CORRECT ANSWER CC _________ is a true lateral view with the x-ray beam parallel to the floor. - CORRECT ANSWER Lateral, (ML or LM) The ___________ view is a view of the medial portion of both breasts. - CORRECT ANSWER Cleavage Other mammo views (3) - CORRECT ANSWER 1. Axillary tail view (similar to MLO-focused on tail of Spence) 2. Rolled views 3. Implant views - implance displaced (ID) or Eklund views Review pg. 44 for location correlation on mammo. - CORRECT ANSWER And go work with the mammo girls! Mammographic density of fat - CORRECT ANSWER Low absorption - dark gray to medium gray (radiolucent) Mammographic density of water - CORRECT ANSWER Medium absorption - light gray (radiopaque) Mammographic density of calcium? - CORRECT ANSWER White - radiopaque (high absorption) - corresponds to calcifications Diagnosis of a tumor cannot be made on _______ alone. - CORRECT ANSWER density Five shape descriptors for mammography - CORRECT ANSWER Round, Oval, Lobulated, Irregular, Spiculated Shapes typically considered benign - CORRECT ANSWER Round, oval, lobulated Shapes typically considered malignant - CORRECT ANSWER Lobulated, irregular, spiculated Most breast cancers seen on mammography are _________ shaped. - CORRECT ANSWER Irregularly. Six mammo descriptors of margins. - CORRECT ANSWER Smooth, macrolobulated, microlobulated, ill-defined, angular, spiculated Margin that is also called circumscribed - CORRECT ANSWER Smooth Margin that has gentle large lobulations. - CORRECT ANSWER Macro-lobulated Margins that are obscured or indistinct and poorly define--usually means tumor invasion into surrounding tissues. - CORRECT ANSWER Ill-defined Margins that are irregular and/or jagged. Highly sensitive for malignancy. - CORRECT ANSWER Angular Margins that have straigh lines which radiate from the center of a tumor (characteristic most specific for malignancy) - CORRECT ANSWER Spiculated Typically benign margins are: - CORRECT ANSWER Smooth (circumscribed), and/or macrolobulated Typically malignant margins are: - CORRECT ANSWER Microlobulated, Ill-defined, Angular, Spiculated Fat density structures are ___________. - CORRECT ANSWER Radiolucent Fat density structures (3) - CORRECT ANSWER Fat, Fatty Cysts, Lipomas Mixed fat and water density structures (3) - CORRECT ANSWER Lymph nodes, galactocele (benign), fibroadenolipoma (benign) Water density structures are ___________. - CORRECT ANSWER Radiopaque Water density structures (9--3 must know!) - CORRECT ANSWER Top three: cysts, fibroadenoma, malignant tumors Others: 1. Glandular tissue 2. connective tissue (stroma) 3. lactiferous ducts 4. pectoralis major muscle 5. hematoma 6. phyllodes (benign or malignant) ________________ is the only imaging modality that can consistently identify calcifications in the breast. _________ is not extremely helpful. - CORRECT ANSWER Mammography, Sonography Calcifications are more commonly ass'd with ________ processes, however, approximately 1/2 of all _________ __________ contain calcifications. - CORRECT ANSWER Benign, breast cancers Four types of calcifications - CORRECT ANSWER 1. Vascular 2. Large, coarse 3. Rod-shaped 4. Rim or egg-shell Calcification that appears as calcified tubes ass'd with vessels. - CORRECT ANSWER Vascular Calcification usually larger than 1mm--commonly caused by a degenerating fibroadenoma. Aka _______ - CORRECT ANSWER Large Coarse, popcorn Calcification made up of calcium deposited in the ducts. - CORRECT ANSWER Rod-shaped Calcification which may be seen as a crescent or rim shape or round with a lucent center--either represents calcium deposit in a cyst, milk of calcium cysts, sebaceous cyst, hemorrhagic cyst, or fat necrosis. - CORRECT ANSWER Rim or eggshell Three calcifications that are "suspicious" - CORRECT ANSWER Punctate (microcalcifications) Flake-shaped Linear Branching Suspicious calcification that is very small (less than 0.5 mm), pinpoint , associated with fibrocystic change, fibroadenoma, sclerosing adenosis, or malignancy. - CORRECT ANSWER Puncatate (microcalcifications) Small, indistinct and fuzzy, tend to be malignant. - CORRECT ANSWER Flake-shaped calcifications Fine, interrupted, linear calcifications within the ducts (not solid rods), almost exclusively ass'd with malignancy. - CORRECT ANSWER Linear branching calcifications Four calcification patterns - CORRECT ANSWER Diffuse, clustered microcalcifications, segmental, and regional Calc. patten - scattered randomly, ass'd with benign lesions - CORRECT ANSWER Diffuse Calc. pattern - usually ass'd with fibroadenoma or malignant lesions - CORRECT ANSWER Clustered microcalcifications Calc. pattern - Suggests the calcifications follow a ductal system. Ass'd with malignancy. - CORRECT ANSWER Segmental Calc. pattern - calcifications cover a segment or quadrant of the breast. Ass'd with malignancy. - CORRECT ANSWER Regional Patient history for breast sonography should include what 9 things? - CORRECT ANSWER Age Breast dz hx Person hx cancer Family hx cancer/breast dz Medications - esp. hormones Breast surgeries and findings Breast pain and location Findings from self exam (BSE) Findings rom clinical exam (CBE) What things should the sonographer document with a palpable lump? (7) - CORRECT ANSWER 1. Location 2. Size 3. Shape 4. Consistency 5. Mobility 6. Distance from nipple 7. Date when discovered- has it changed over time Right breast eval position - CORRECT ANSWER Left Posterior Oblique Left breast eval position - CORRECT ANSWER Right posterior oblique Medial aspect breast eval position - CORRECT ANSWER supine What position may be used to simulate the CC mammo view? - CORRECT ANSWER Upright AIUM recommends which scan plane for breast imaging? - CORRECT ANSWER Radial If a solid lesion is found, the sonographer should scan in what planes? Why? - CORRECT ANSWER Radial and antiradial - to allow visulaization of tumor or ductal extensions branching outward or toward the nipple 123, ABC method indicates what - CORRECT ANSWER 123 - distance from nipple in levels, 1 being the closes to the nipple and 4 being the periphery ABC - Depth of lesion - A being superficial and C being near the chest wall. A standoff pad moves the ___________ _________ __________ more superficial. - CORRECT ANSWER elevation plane focus This ultrasound device allows for improved focusing and greater detail in the superficial layers of the breast. - CORRECT ANSWER stand-off pad Other than skin and superficial "things", what can a standoff pad be useful for? - CORRECT ANSWER Scanning surgical specimens What is the ideal stand-off pad thickness for breast imaging? - CORRECT ANSWER 1 cm Review the gray levels on page 60 - CORRECT ANSWER Do it now! Due to the overlap in echogenicities between benign and malignant tissues, BUS is not capable of distinguishing benign from malignant. Accurate diagnosis can only be determined by __________. - CORRECT ANSWER Biopsy In general __________ disease will not cross fibrous planes. - CORRECT ANSWER Benign _________ diseases may cross fibrous planes and have a tendency to grow toward the skin. - CORRECT ANSWER Malignant What information can be gained from using transducer compression to evaluate a cyst or mass? (5) - CORRECT ANSWER -Cysts will change shape -Soft, benign lesions tend to change shape (eg lipoma) -Hard, malignant lesions will not change shape -Internal echoes within a benign lesion may become more uniform -Debris within cysts or ducts may be better visualized Technique used to isolate a palpable mass - CORRECT ANSWER Echo-palpation or sono-palpation see graphic p.62 Techinque where the sonographer immobilizes a mass between two fingers while scanning with the opposite hand to ensure visualization of the correct structure. - CORRECT ANSWER Echo-palpation or sono-palpation Echo-palpatio may also be used to assess the _______ of a lesion by attempting to move the mass with two fingers while scanning simultaneously. - CORRECT ANSWER mobility aka Vibrational Doppler Imaging - CORRECT ANSWER Fremitus Vibration of the tissues (usually in the chest) during speech. - CORRECT ANSWER Fremitus Fremitus used in combination with Power Doppler will cause _______tissues to light up and ______tissue to demonstrate no signal. - CORRECT ANSWER normal, foreign In what five instances can fremitus be helpful? - CORRECT ANSWER 1. Normal fat lobules 2. Normal tissue vs. isoechoic tumor 3. Ill defined borders 4. Non-visualized posterior margin 5. Benign versus malignant characteristics Benign or malignant feature: Round - CORRECT ANSWER Benign Benign or malignant feature: Oval or Ellipsoid - CORRECT ANSWER Benign Benign or malignant feature: Horizontal Orientation - CORRECT ANSWER Benign - aka wider than tall Benign or malignant feature: Smooth, well defined or circumscribed - CORRECT ANSWER Benign Benign or malignant feature: Macrolobulation - CORRECT ANSWER Benign Benign or malignant feature: Thin, echogenic pseudocapsule - CORRECT ANSWER Benign. Caused by compression or rimming of adjacent tisues around the lesion (opposite of invasion) What benign structure is anechoic? - CORRECT ANSWER Simple cyst What benign structures are hyperechoic? - CORRECT ANSWER Fibroglandular Pseudomass or Lipoma What benign structures are mildly hypoechoic, isoechoic, or mildly hyperechoic? - CORRECT ANSWER Solid, benign tumors **some highly cellular malignant lesions may appear homogenous Acoustic enhancement - CORRECT ANSWER -Most are cysts -Solid benign tumors may enhance -Good visulization of the posterior tumor wall -Some highly cellular malignant tumors may enhance Benign solid masses demonstrate __________ flow or are ______________. - CORRECT ANSWER no , hypovascular Ducts generally measure less than ____,mm, and ______ in size as they run toward the nipple. - CORRECT ANSWER 3, increase Causes of duct dilatation or duct ectasia - CORRECT ANSWER 3rd trimester of pregnancy, lactation, perimenopause Some dict dilatation may be ass'd with ductal carcinoma or papillary carcinoma Large calcification causing shadowing artifact are typically a ____________ characteristic. - CORRECT ANSWER benign Calcifications may arise from what? - CORRECT ANSWER scarring, necrosis, hemorrhage, cysts, or fibroadenomas Small curvilenar calcs in the dependent portion of a cyst likely represent what? - CORRECT ANSWER Milk of calcium Clustered microcalcifications are common with what? - CORRECT ANSWER Breast cancer Benign or malignant feature: Irregular shape - CORRECT ANSWER Malignant Benign or malignant feature: Spiculated - CORRECT ANSWER Malignant Benign or malignant feature: Vertical orientation - CORRECT ANSWER Malignant - aka Taller than wide Benign or malignant feature: Microlobulation - CORRECT ANSWER Malignant - multiple small lobulations usually 2mm Benign or malignant feature: Ill-defined margins - CORRECT ANSWER Malignant. Usually indicates tumor invasion into surrounding tissue Benign or malignant feature: Angular margins - CORRECT ANSWER Highly sensitive for malignancy ***Extension of a tumor into a duct coursing toward the nipple. - CORRECT ANSWER ***Duct extension ***Extension of a tumor into a duct coursing away from the nipple - usually involves multiple ducts. - CORRECT ANSWER ***Branch pattern ***A thick echogenic halo is usually _____________. - CORRECT ANSWER Malignant ***Thick echogenic halo which usually indicates tumor invasion with fibrotic host response. - CORRECT ANSWER ***Desmoplasia Benign or malignant feature: Mildly to markedly hypoechoic. Also described as "almost anechoic" - CORRECT ANSWER Malignant--highly suspicious for malignancy Benign or malignant feature: Heterogeneous texture - CORRECT ANSWER Malignant. Except benign complex cysts and benign tumors with internal fibrosis, degeneration or calcifications. Benign or malignant feature: Causes shadowing - CORRECT ANSWER Malignant. Most solid malignant tumors demonstrate some degree of shadowing. This may arise from only part of the lesion. Exception: Cooper's ligaments may cause shadowing due to refraction. Exception: Some benign lesions such as calcifed fibroadenoma, radial scar, and fat necrosis may cause shadowing. The ability of a malignancy to develop new blood vessels. - CORRECT ANSWER Angiogensis You can/cannot distinguish benign vs. malignant based on Doppler signals within a lesion. - CORRECT ANSWER Cannot. Inflammation may demonstrate hypervascularity with an increased Doppler signal. These lack a basement membrane or adventitia--giving them only two layers to their walls. - CORRECT ANSWER Tumor vessels. Skin dimpling, skin thickening, nipple retraction, and retraction of Cooper's ligaemnts are all __________ indicators. - CORRECT ANSWER Malignant Crossing fibrous planes is an indicator of ___________ disease. - CORRECT ANSWER Malignant Ductal dilatation, internal echoes or debris within ducts, and tumor extension within the duct are all signs of a _________ lesion. - CORRECT ANSWER Malignant BUS may be able to see ___________ ____________ within a tumor, however mammography is superior in visualizing these. - CORRECT ANSWER Clustered microcalcifications Lymph node features that indicate malignancy - CORRECT ANSWER 1. Loss of fatty hilum 2. Enlargement >2cm 3. Microcalcifications 4. High resisitve Doppler waveform Simple cysts may regress after menopause, but may perisist in women taking _______. - CORRECT ANSWER HRT Result from obstructed lactiferous ducts due to fibrosis or proliferative changes in the duct epithelium. Or can result from hormonal dilatation. - CORRECT ANSWER Cysts Mammographic appearance of a cyst. (4) - CORRECT ANSWER 1. Round or oval 2. Smooth (circumscribed) margins 3. Radiopaque - Water Density 4. Halo Sign (lucent rim of fat) Sonographic appearance of a cyst - CORRECT ANSWER *Round or oval, anechoic, *well circumscribed, *acoustic enhancement, may have edge shadowing, occasionally lobulated, compressible, no internal doppler signal. These three criteria are required to classify a cyst as "simple" Three criteria required for a cyst to be classified as simple. - CORRECT ANSWER Round or oval Anechoic Acoustic enhancement Only _______% of breast cysts are simple. - CORRECT ANSWER 11 Artifacts within a cyst may be caused by... (9) - CORRECT ANSWER 1. TGC 2. Overall gain 3. Focal position 4. Small size 5. Superficial location (use standoff) 6. Deep location 7. Side or grating lobe artifact 8. slice (section) thickness artifact 9. Volume averaging artifact Types of non-simple cysts ((5) - CORRECT ANSWER 1. Complicated cysts 2. Complex cysts 3. Clustered microcysts 4. Septated cysts 5. Calcified cysts Cyst containing homogeneous low level internal echoes with fluid-fluid or fluid-debris levels which react to gracity. Malignancy is 0-1.4%. - CORRECT ANSWER Complicated cyst Refer to chart on page 75 to list the types of complicated cysts and their contents. - CORRECT ANSWER Do it. No Doppler flow will be detected within the debris of a __________ cyst. - CORRECT ANSWER Complicated _________ can reveal the true nature of the complicated cyst. - CORRECT ANSWER Cytology (upon aspiration) Cysts which contain a solid component. - CORRECT ANSWER Complex Cyst -- **managed differently than complicated cysts due to higher malignancy rate. What is the malignancy rate for a complex cyst? - CORRECT ANSWER 23% Cyst with partial or total wall calcification. - CORRECT ANSWER Calcified cyst Cyst that contains one or several internal septations. - CORRECT ANSWER Septated cyst Commonly seen as fibrocystic changes on mammography and sonography. May be difficult to distinguish from a hypoechoic mass. - CORRECT ANSWER Clustered microcysts A milk filled cyst caused by the obstruction of a lactiferous duct. Usually ass'd with childbirth, affecting both breast feeding and non breast feeding mothers. - CORRECT ANSWER Galactocele A galactocele is typically located where? - CORRECT ANSWER The subareolar region A galactocele may be what echogenicity? - CORRECT ANSWER Hypoechoic to isoechoic -- but will be homogeneous, wil enhance, and will have no Doppler signal. What else may be present with a galactocele? - CORRECT ANSWER Dilated ducts, mastitis, abscess Results from an obstructed sebaceous gland associated with the skin of the breast. - CORRECT ANSWER Sebaceous cyst Sebaeceous cysts are commonly associated with what? - CORRECT ANSWER Montogomery glands of the areola or found at the inframammary fold ***The most common disorder of the breast which accounts for nearly half of all surgical procedures. - CORRECT ANSWER ***Fibrocystic changes Fibrocystic changes affect what percentage of females from age 20-40? - CORRECT ANSWER 60-90% Fibrocystic changes are caused by a battle of _______ and ________ of the stromal tissues of the breast--resulting in cyst formation, fibrosis, and possible epithelial hyperplasia. - CORRECT ANSWER proliferation, resorption What four things may be seen on ultrasound in the fibrocystic breast? - CORRECT ANSWER 1. Cysts of various sizes (simple and complex) 2. Cluster of cysts 3. Increased fibrosis of the parenchymal layer (hyperechoic fibroglandular tissue) 4. Dilated ducts Bilateral involvement, multiple nodules, and pain prior to menses suggests a _______ ________ ________. - CORRECT ANSWER Benign fibrocystic process ***The most common benign solid tumor of the breast. - CORRECT ANSWER Fibroadenoma Estrogen related benign tumor typically affecting women between 20 and 40 yrs which arises from epithelial and stromal tissue of the breast. - CORRECT ANSWER Fibroadenoma A fibrodenoma arises from what tissue of the breast? - CORRECT ANSWER Epithelial and stromal There is an increased incidence of fibroadenomas in which population? - CORRECT ANSWER African american females Where does a fibroadenoma arise from? - CORRECT ANSWER The TDLU Fibroadenomas are generally less than ______ cm in size. - CORRECT ANSWER 3 _________ may influence rapid growth of fibroadenomas. - CORRECT ANSWER Pregnancy Are fibroadenomas moveable or fixed? - CORRECT ANSWER Moveable What is the consistency of a fibroadenoma? - CORRECT ANSWER Firm or rubbery What changes might a fibroadenoma undergo? - CORRECT ANSWER Necrosis or calcification Mammo appearance of this benign mass is: -Round oval or lobulated -Circumscribed -Radiopaque - Water density -May have halo -May have calcifications -Unable to differentiate from cyst - CORRECT ANSWER Fibroadenoma The pseudo-capsule of a fibroadenoma is caused by what? - CORRECT ANSWER Compression of adjacent structures ***Seen in adolescent girls, a highly cellular type of benign fibroadenoma. Grows rapidly and may measure up to 5 cm. *** - CORRECT ANSWER Juvenile (Giant) Fibroadenoma Sono appearance of a fibroadenoma - CORRECT ANSWER Homogeneous Round, oval, or lobulated Well defined borders Mildy hypoechoic or isoechoic Thin, echogenic pseudocapsule Wider than tall May compress (due to soft nature) Edge shadowing No significant enhancement or shadowing Peripheral and internal flow may be present A benign tumor growing from the ductal epithelium projecting into the lumen of the duct. - CORRECT ANSWER Intraductal papilloma Age at which intraductal papilloma is most common - CORRECT ANSWER 30-55 The most common cause of bloody nipple discharge. - CORRECT ANSWER Intraductal papilloma Intraductal papillomas are typically located in what region? - CORRECT ANSWER The subareolar region Intraductal papillomas are usually less than ___ cm in size. - CORRECT ANSWER 2 Intraductal papillomas are non-________. - CORRECT ANSWER Palpable Intraductal papillomas can cause _____ _________. - CORRECT ANSWER Duct obstruction Most frequent symptom of intraductal papilloma - CORRECT ANSWER Serous or bloody nipple discharge Benign tumor which may have a raspberry appearance*** - CORRECT ANSWER ***Intraductal papilloma What other type of imaging may be helpful in the diagnosis of Intraductal papilloma? - CORRECT ANSWER Ductography Injection of contrast into the lactiferous duct followed by mammography - CORRECT ANSWER Ductogram (galactogram) What would you see on a ductogram that confirms and intraductal papillom or papillary carcinoma? - CORRECT ANSWER Filling defect What scan plan is optimal for visualizing and Intraductal papilloma? - CORRECT ANSWER Radial Duct dilatation is often associated with what benign tumor? - CORRECT ANSWER Intraductal papilloma Sonographic appearance of an intraductal papilloma - CORRECT ANSWER 1. small, solid, within the duct 2. hypoechoic or isoechoic 3. round, oval, or tubular 4. associated ductal dilatation 5. Dippler within solid component confirms that it is either a papilloma or a papillary carcinoma (no signal confims complicated cyst) The focal dilatation of a duct caused by an obstructing papilloma. - CORRECT ANSWER Intracystic papilloma This is generally thought of as a type of intraductal papilloma. - CORRECT ANSWER Intracystic papilloma Clinical symptoms of an intracystic papilloma are the same as symptoms of a ____________ _____________. - CORRECT ANSWER Intraductal papilloma ***Aka swiss cheese disease - CORRECT ANSWER ***Juvenile papillomatosis Condition that usually presents as a mass located in the peripher of the breast resembling a fibroadenoma. - CORRECT ANSWER Juvenile papillomatosis A rare benign condition affecting females less than 30 years of age, characterized by cysts, duct ectasia, intraductal hyperplasia, and sclerosing adenosis. - CORRECT ANSWER Juvenile papillomatosis What percentage of patients with Juvenile papillomatosis have a positive family hx of breast ca? - CORRECT ANSWER 25 Sonographic appearance of juvenile papillomatosis - CORRECT ANSWER Hypoechoic, ill defined mass Heterogenous appearance May have visible cysts and/or duct ectasia ***An encapsulated tumor of mature adipose tissue.*** - CORRECT ANSWER ***Lipoma Where do lipomas typically arise from? - CORRECT ANSWER The subcutaneous fat layer--anywhere in the body The only breast lesion with a true capsule. - CORRECT ANSWER Lipoma May be mistaken for a fat lobule. - CORRECT ANSWER Lipoma Mammo appearance of a lipoma - CORRECT ANSWER Radiolucent Circumscribed Thin Capsule Sono appearance of a lipoma - CORRECT ANSWER 1. Oval and well defined 2. Isochoic(although hyperechoic and hypoechoic lesions are seen) 3. Homogeneous 4. Compressible 5. Usually superficial 6. May be mistaken for a fat lobule Aka hamartoma*** - CORRECT ANSWER Fibroadenolipoma*** A rare type of fatty tumor occuring in the breast composed of fat, fibrous and glandular tissues. Thought to develop due to an overgrowth of normal breast tissues. - CORRECT ANSWER Fibroadenolipoma Fibroadenolipomas usually occur in women over what age? - CORRECT ANSWER 35 Sonographic appearance of a fibroadenolipoma - CORRECT ANSWER Well-defined pseudocapsule Oval or lobulated Varying echogenicity Possible shadowing May be quite large Typically arises as a rapidly enlarging palpable mass during pregnancy. - CORRECT ANSWER Lactating adenoma Benign lesion of pregnancy usually surgically removed due to large size and aggressive growth. - CORRECT ANSWER Lactating adenoma Sonographic appearance of a lactating adenoma - CORRECT ANSWER Large, well defined mass Lobulated margins Multiple sepations within the mass Breast inflammation - CORRECT ANSWER Mastitis Most common form of inflammation - CORRECT ANSWER Lactational (peurperal) mastitis Peurperal mastitis is usually caused by what? - CORRECT ANSWER A cracked nipple allows bacteria to invade the ducts causing inflammation of the ducts--possible plugging and milk stasis Non-lactational forms include: Infected cysts Subareolar abscess Post surgical Plasma cell (periductal) Tuberculosis Inflammatory Carcinoma - CORRECT ANSWER Mastitis Severe mastitis may be hard to distinguish from what? - CORRECT ANSWER Inflammatory carcinoma Condition that presents with: Firm, tender swollen breast Localized skin thickening and redness Purulent nipple discharge Tender axillary lymph nodes Leukocytosis and fever - CORRECT ANSWER Acute mastitis Sonographic appearance: Increased echogenicity of subcutaneous fat and prenchymal layers Possible shadowing due to cellulitis Blurred tissue planes Skin thickening Possible dilated ducts Increased Doppler signal (vascularity) - CORRECT ANSWER Mastitis Complication of lactational or non-lactational mastitis - CORRECT ANSWER Abscess An abscess is typically found in the ________ region--but may develop anywhere in the breast tissue. - CORRECT ANSWER Subareolar Sonographic appearance -Complex, predominantly cystic mass -Thick irregular borders -Acoustic enhancement -Localized skin thickening -Increased Doppler signal at the periphery (vascularity) - CORRECT ANSWER Abscess Aka periductal mastitis - CORRECT ANSWER Plasma cell mastitis Mastitis that usually begins with dilated lactiferous ducts - CORRECT ANSWER Plasma cell mastitis Plasma cells and other white blood cells begin to cause irritation of the duct lining and a secondary infection develops due to debris and ulceration of the ducts. - CORRECT ANSWER Plasma cell mastitis Common characteristics of this form of mastitis: -Nipple discharge -Palpable hard mass -Subareolar location -Nipple retraction -Possible linear calcifications -Symptoms of breast inflammation - CORRECT ANSWER Plasma cell mastitis Sonography appearance of plasma cell mastitis - CORRECT ANSWER Dilated ducts with internal debris or wall thickening Localized skin thickening The thickness of the skin of the breast is usually - CORRECT ANSWER 0.5-2mm Interruption of the dermis layer is suspicious for ____________. - CORRECT ANSWER Carcinoma Causes of skin thickening (7) - CORRECT ANSWER 1. Trauma 2. Benign inflammation 3. Fat necrosis 4. Post-surgical scarrign 5. Malignancy 6. Radiation 7. Restriction of venous return Bilateral milk discharge from a non-lactating and non-pregnant female. - CORRECT ANSWER Galactorrhea Galactorrhea is usually ____________ enduced or __________ enduced. - CORRECT ANSWER endocrine, medication endocrine can be caused by a pituitary adenoma medication can be oral contraceptives, antihypertensive drugs, or other Discharge that has the appearance of pus as a result of breast inflammation. - CORRECT ANSWER Purulent ***Breast tumors causing nipple discharge (1 benign, 3 malignant) - CORRECT ANSWER *** Benign - Intraductal papilloma Malignant - Intraductal papillary carcinoma DCIS Invasive ductal carcinoma ***Types of discharge that MAY indicate breast cancer are: (4) - CORRECT ANSWER ***Serous (clear, yellow) Serosanguinous (Pink, both serous and bloody) Sanguineous (Red, bloody) Watery (clear, pale yellow) Conditions that may occur following trauma - CORRECT ANSWER Fat necrosis, hematoma, seroma, lymphocele, post-op scarrin A thickening or scarring in the fatty tissue that is caused by an injurty to the breast. - CORRECT ANSWER Fat necrosis Fat necrosis may occur without trauma in _____________________________________. - CORRECT ANSWER Obese women with fatty, pendulous breasts Fat necrosis presents in two ways. - CORRECT ANSWER Oil cyst Firm, fixed, spiculated mass A blood filled tumor of the breast following direct trauma (accidental or iatrogenic). Usually demonstrates bruising on the skin. - CORRECT ANSWER Hematoma Sonographic appearance of a hematoma - CORRECT ANSWER Varies--depends on the amount of coagulation A localized collection of serous fluid within the breast. - CORRECT ANSWER Seroma What usually happens with a seroma? - CORRECT ANSWER Spontaneous resolution--although occasionally persists or becomes complicated by infection. A seroma can vary in appearance. What might it look like? - CORRECT ANSWER Simple cyst Free fluid with angular margins Low level internal echoes Thick walled with septations A cystic tumor filled with lymph fluid- features similar to a simple or complex cyst. - CORRECT ANSWER Lymphocele What does a lymphocele look like on ultrasound? - CORRECT ANSWER Simple or complex cyst Following surgery--this may present as a palpable mass. - CORRECT ANSWER Post-operative scarring Type of lesions that may present as a palpable mass following surgery, may appear similar to a cancer--so careful clinical correlation is required. - CORRECT ANSWER Post-operative scarring Post-operative scarring sonographic appearance - CORRECT ANSWER Think shadow from the skin surface Spiculated, fixed, hypoechoic mass with shadowing Doppler demonstrates no increase in flow A benign enlargement of a breast lobule due to epithelial and stromal hyperplasia. - CORRECT ANSWER Sclerosing adenosis Acini of the TDLU increase in number and produce a distorted, spiking, infiltrative appearance. This enlarged lobule occasionally presents as a palpable mass and may have calcifications. - CORRECT ANSWER Sclerosing adenosis The primary significance of sclerosing adenosis is what? - CORRECT ANSWER Its ability to mimic cancer Mammo appearance of sclerosing adenosis - CORRECT ANSWER Architectural distortion Spiculated appearance Microcalcification Sono appearance of sclerosing adenosis - CORRECT ANSWER Irregular, spiculated, or lobulated mass Hypoechoic Possible shadowing No increased Doppler signal The invasion of the ductal epithelium into the surrounding stromal tissues. - CORRECT ANSWER Radial scar ________ _________ results in a scar formation that may present as a suspicious mass. - CORRECT ANSWER Radial scar Radial scar is a __________ process not associated with ________. - CORRECT ANSWER Benign, Trauma Radial scars are usually less than ____ cm and are ______-_________________. - CORRECT ANSWER 1, non palpable In 20% of cases, a radial scar is associated with ________ _________. - CORRECT ANSWER Tubular carcinoma What is the suggested treatment of radial scar? - CORRECT ANSWER Local excision Radial scar appearance (mammo/sono) - CORRECT ANSWER Mammo: Spiculate, may have calcs Sono: Irregular, spiclated, posible shadowing, no increased Doppler ***A rare thrombophlebitis of a superficial vein of the breast. - CORRECT ANSWER Mondor's disease Mondor's disease is usually associated with what vessel? - CORRECT ANSWER Lateral thoracic vein - causes pain in the lateral half of the breast Lateral breast pain can be associated with what rare condition? - CORRECT ANSWER Mondor's Disease Mondor's disease is usually caused by what? - CORRECT ANSWER Trauma May present clinically as a palpable, tender, cord-like superficial mass. Patient may also have a fever. - CORRECT ANSWER Mondor's disease What is the treatment for Mondor's and how quickly does it resolve? - CORRECT ANSWER Hot compress therapy, 2-8 weeks Sono appearance of Mondor's - CORRECT ANSWER Duh--what a blood clot would look like in a superficial vessel! Breast enlargement during puberty in females usually occurs between what ages? - CORRECT ANSWER 9-16 Onset of breast enlargement before age ____ is known as precocious puberty. - CORRECT ANSWER 8 Most common cause of precocious puberty - CORRECT ANSWER Ovarian enlargement and hyperstimulation Several causes exist for precocious puberty including - CORRECT ANSWER Ovarian Enlargement Ovarian Cyst Adrenal Gland Tumor Adrenal Cortex Hyperplasia Adrenogenital syndrome Primary Hypothyroidism Early production of gonadotropiin The non-neoplastic enlargement of the male breast - CORRECT ANSWER Gynecomastia Gynecosmastia is usually associated with an increase in ________and/or a decrease in __________. - CORRECT ANSWER estrogen, testosterone TDLU's are not evident in the ________ ________. - CORRECT ANSWER Male breast Results in increased fat and stromal elements, duct enlargement, and possible glandular development. - CORRECT ANSWER Gynecomastia **Gynecomastia may present as (5) - CORRECT ANSWER Breast enlargement Palpable subareolar nodule** Breast tenderness/soreness Skin thickening Possible nipple discharge There are several causes of gynecomastia. Be familiar with these!! ** - CORRECT ANSWER Hormonal changes in the male Estrogen treatment of prostate cancer Testicular failure Neoplasms: testicular, adrenal, and lung Chronic disease: **liver, **renal, **and pulmonary Medicatons: digitalis, antidepressant, antihypertensive, estrogen Marijuana Klinefelter's syndrom (xxy) Idiopathic Sonography may reveal in gynecomastia - CORRECT ANSWER Presence of glandular tissue Possible dilated ducts Increased fat MC signs of breast cancer is what? - CORRECT ANSWER A new lump or mass What percent of breast cancers originate in the duct? - CORRECT ANSWER 90% **Most cancers arise from the ___________, and a larger percentage of cancers are located in the ___________ quadrant. - CORRECT ANSWER TDLU, Upper outter How many women will develop breast cancer? - CORRECT ANSWER 1 in 8 Breast cancer is the _____ _______ cancer among wome. - CORRECT ANSWER Most common Second leading cause of cancer death in women--exceeded only by lung cancer. - CORRECT ANSWER Breast cancer Women rarely get breast cancer before age ______. - CORRECT ANSWER 30 Male breast cancer makes up less than ___% of the toal. - CORRECT ANSWER 1 What ethnic group is at the highest risk? The lowest? - CORRECT ANSWER White women, Japanese women who live in the far east What is the number one risk factor for developing breast cancer? - CORRECT ANSWER Female gender - 100x more common in women than in men #2 risk factor for breast cancer - CORRECT ANSWER Age Having a First-Degree Relative with breast cancer approximately ______ a woman's risk. - CORRECT ANSWER Doubles Having two first degree relatives multiplies a woman's risk by ____. - CORRECT ANSWER 5 A woman with a mother who diagnosed _______ has a greater risk than a woman whose mother devloped the disease __________. - CORRECT ANSWER younger, later What percentage of patients with breast cancer have no family history? - CORRECT ANSWER 75% A rare inherited condition in which nearly all female members of a single family develop breast cancer makes up what percentage of all breast cancer patients? - CORRECT ANSWER 5-10% 10% of breast cancers result from mutations of what genes? - CORRECT ANSWER BRCA1 and BRCA2 What percentage of women with inherited BRCA mutations will develop breast cancer by age 70? - CORRECT ANSWER 50-60% What other cancer do BRCA mutations increase risk of? - CORRECT ANSWER 50-60% Personal history of breast cancer increases risk of developing a new cancer (in either breast) by how much? - CORRECT ANSWER 3-4 times Menarche that occurs before age ____ or menopause after age _____ does what to breast cancer risk? - CORRECT ANSWER 12, 50, increases Who is at higher risk for developing breast cancer--women who have or have not had children? - CORRECT ANSWER Women who have not had children--or who had their first child after age 30 What may be the best defense against breast cancer? - CORRECT ANSWER A healthy diet and excercise Prolonged use of OCP's and/or use of HRT does what to breast cancer risk? - CORRECT ANSWER Increases. Any additional estrogen exposure. Women with a personal history of any type of cancer--especially ovarian or endometrial cancer have a ______ _____ risk - CORRECT ANSWER slightly higher Biopsy result of atypical hyperplasia increases risk by how much? - CORRECT ANSWER 4-5x Risk factors (11) - CORRECT ANSWER 1-Gender 2-Age 3-Family hx breast ca 4-Personal hx breast ca 5-Age of menarche/menopause 6-Child bearing 7-Hormonal influence 8-Personal hx of ca 9-Bx finding of atypical hyperplasia 10-Radiation therapy 11-Obesity What are the two types of non-invasive breast cancer? - CORRECT ANSWER DCIS, LCIS Malignant changes of the ductal epithelium without expansion past the basement membrane. - CORRECT ANSWER DCIS DCIS arises from the _________. - CORRECT ANSWER TDLU DCIS is usually confined to.... - CORRECT ANSWER one lobe or segment. DCIS will progress to invasive cancer in what percentage of women? - CORRECT ANSWER 30-50% DCIS may not form a distinct.... - CORRECT ANSWER tumor. What two things are commonly seen with DCIS? - CORRECT ANSWER Dilated ducts, microcalcification How is DCIS best diagnosed? - CORRECT ANSWER Mammography Low grade DCIS - slow growing and less aggressive - CORRECT ANSWER Non-comedo Non-comedo DCIS makes up what percentage of all DCIS? - CORRECT ANSWER Non-comedo Non-comedo DCIS increases risk for invasive carcinoma how much? - CORRECT ANSWER 10 fold What are the three forms of non-Comedo DCIS? - CORRECT ANSWER 1- Cribriform - perforated form (sieve like) 2- Mircopapillary - clumpy along the wal 3- Solid - occupies entire lumen of duct ***What is the most common non-invasive cancer--and the 2nd most common breast caner overall? - CORRECT ANSWER DCIS Aka high-grade DCIS --an aggressive intraductal carcinoma. Ducts completely fill and dilate with abnormal cells that quickly spread. - CORRECT ANSWER Comedo DCIS What is the characteristic feature of Comedo DCIS that distinguishes it from non-Comedo? - CORRECT ANSWER Necrosis (central necrosis within the tumor) Comedo DCIS is normally much ______ than non-Comedo DCIS. - CORRECT ANSWER Larger When cancer cells are found outside the duct with an intact basement membrane. - CORRECT ANSWER Micro-invasion Clinical features of DCIS - CORRECT ANSWER Asymptomatic Possible palp mass of varying size, shape, and consistency Possible nipple discharge Sonography appearance of DCIS - CORRECT ANSWER **Microcalcification Mass or no mass Architectural distortion Possible duct dilation Mammo appearance of DCIS - CORRECT ANSWER Mass or no mass Clustered microcalcifications Linear branch pattern microcalcifications **Mammography is the most effective imaging method for detecting _______. Sonography is not particularly useful in evaluating DCIS especially if no distinct mass is seen. - CORRECT ANSWER DCIS Represents malignant changes in the lobular epithelium without invasion outside the lobule (non-invasive cancer). - CORRECT ANSWER LCIS - Lobular carcinoma in situ Aka lobular neoplasia - CORRECT ANSWER LCIS Non-invasive cancer that generally affects premenopausal women and is usually extremely small. - CORRECT ANSWER LCIS Cancer that is non-invasive and is often bilateral and multicentric on initial diagnosis. - CORRECT ANSWER LCIS LCIS carries a ___________ risk for development of invasive carcinoma. - CORRECT ANSWER 10-fold Non-invasive cancer NOT generally associated with microcalcifications. Is, however, associate with invasive carcinoma to the opposite breast. - CORRECT ANSWER LCIS _________ is difficult to detect on Mammography and Sonography. - CORRECT ANSWER LCIS Invasive carcinoma aka... - CORRECT ANSWER Infiltrating carcinoma ***Most common type of breast cancer accounting for 75% of cases. - CORRECT ANSWER Invasive Ductal Caricinoma How does IDC metastasize? - CORRECT ANSWER Blood stream and lymphatic stream Most invasive ductal carcinomas present as _______ ______. - CORRECT ANSWER palpable mass Host response or fibrotic reaction of the tissues surrounding a cancer. Formation of fibrous connective tissue by proliferation of fibroblasts. - CORRECT ANSWER Desmoplasia Classic hard gritty textured IDC - CORRECT ANSWER scirrhous type Invasive Ca with clinical features including: palpable mass -- palpable size often larger than imaging appearance hard, gritty texture tumor is fixed - immovable skin dimpling, skin retraction, or nipple retraction - CORRECT ANSWER Invasive ductal carcinoma Mammo appearance of IDC - CORRECT ANSWER Radiopaque density Spiculated, lobulated or irregular margins Microcalcification Thickened and/or retracted Cooper's ligaments Sonographic appearance of IDC - CORRECT ANSWER -Solid mass -Irregular shape, angular, or spiculated margins -Taller than wide -Markedly Hypoechoic -Heterogeneous internal appearance -Partial or complete shadowing -Duct extension or branch pattern -Thickened, straightened, or retracted Cooper's ligaments -Fascia plane disruption -Occasionally, IDC may appear as a well circumscribed, homogeneous, -Hypoechoic mass, with no shadowing (benign appearance) Multiple tumors that all come from one original tumor - CORRECT ANSWER Multifocal Multiple tumors that are found in different sections of the breast. Less common. - CORRECT ANSWER Multicentric The second most common type of invasive breast cancer accounting for 8-15% of cases. - CORRECT ANSWER Invasive Lobular Carcinoma The most frequently missed breast cancer. - CORRECT ANSWER Invasive Lobular Carcinoma Usually non-palpable, does not have microcalcification, highly infiltrative and aggressive. - CORRECT ANSWER Invasive Lobular Carcinoma ____________________________ may produce an area of architectural distortion without a mass. - CORRECT ANSWER Invasive Lobular Carcinoma More likely to be multifocal, multicentric, and bilateral - CORRECT ANSWER Invasive Lobular Carcinoma Difficult to detect on mammography and sonography - CORRECT ANSWER Invasive Lobular Carcinoma Sonography may be more effective at demonstrating _____ than mammography. - CORRECT ANSWER ILC May appear as an ill-defined, markedly hypoechoic lesion on sonography - CORRECT ANSWER ILC May apearas a spiculated, ill defined radiopaque density on mammography. - CORRECT ANSWER ILC Accounts for approx 5% of all cancers. - CORRECT ANSWER Medullary Carcinoma ***Most commonly mistaken cancer for a benign fibroadenoma. - CORRECT ANSWER ***Medullary carcinoma ***Medullary carcinoma is more common among which ethnic groups? - CORRECT ANSWER Asian and African-American women Medullary carcinoma characteristics (7) - CORRECT ANSWER 1. Well circumscribed, soft 2. Non-tender, compressible, slightly moveable 3. Tends to be non-infiltrative 4. Not associated w/microcalcs 5. Commonly mistaken for fibroadenoma 6. More common among Asian and African American women 7. Carries a good prognosis This sonographic feature is uncommon with medullary carcinoma. - CORRECT ANSWER Shadowing Sonographic appearance of medullary carcinoma - CORRECT ANSWER 1. Large solid mass 2. Round, oval, or macrolobulated 3. Smoother borders--on close inspection borders may have microlobulation 4. May be taller than wide 5. Hypoechoic appearance 6. Homogeneous or mild heterogeneous internal appearance 7. Possible enhancement (due to highly cellular nature) 8. Shadowing is uncommon. 9. Possible central necrosis __________ ____________ represents 11% of breast cancers found in women under age 35. - CORRECT ANSWER Medullary carcinoma Colloid (Mucinous) carcinoma accounts for _____% of all breast cancers - CORRECT ANSWER 2-3% Characterisitic of Colloid carcinoma - CORRECT ANSWER 1. Slow growing, non-aggressive tumor 2. Circumscribed, soft 3. Affects elderly women 4. Carries a good prognosis and met. dz is uncommon Sonographic appearance of colloid carcinoma - CORRECT ANSWER 1. Hypoechoic or isochoic in comparison to fat 2. Well cicumscribed lesion 3. May have microlobulation 4. Homogeneous internal appearance 5. Shadowing is uncommon 6. May appear similar to a complicated or complex cyst Tubular carcinoma accounts for approximately ____ of all breast cancers. - CORRECT ANSWER 2-3% Characteristics of tubular carcinoma - CORRECT ANSWER Usually appears as a relatively small lesion Carries a good prognosis Has been associated with a benign radial scar and may not be differnetiated by imaging means. Mammographic appearance of tubular carcinoma. - CORRECT ANSWER Long spicules radiating from a small, radiolucent mass Sonographic appearance of tubular carcinoma - CORRECT ANSWER Small, hypoechoic mass Ill-defined margins Posterior shadowing A cancer that may be non-invasive or invasive, and represents that malignant version of an Intraductal Papilloma. - CORRECT ANSWER Papillary Carcinoma Non-invasive papillary carcinoma is often included in the spectrum of _________________. - CORRECT ANSWER Non-Comedo DCIS Invasive Papillary Carcinoma accounts for what percentage of all breast cancers? - CORRECT ANSWER 0.3-2% Cancer that primarily affects postmenopausal women, presents as a subareolar mass, may present with bloody nipple discharge (however this more likely indicates a benign process). - CORRECT ANSWER Papillary carcinoma Sonographic appearance of papillary carcinoma - CORRECT ANSWER -Well marginated, solid mass -May also appear complex -May have duct dilatation -May have microcalcification -If duct obstructed-- Intracystic Papillar Carcinoma may develop. This must be differentiated from a benign Intracystic Papilloma Most accurate modality in evaluating the augmented breast. - CORRECT ANSWER MRI Most accurate imaging modality in the detection of implant rupture. - CORRECT ANSWER MRI Scintimammography aka - CORRECT ANSWER Nuc Med breast imaging Involves he injection of a glucose tagged to a radioactive tracer--utilizes the fact that most cancers metabolize glucose more rapidly than normal tissue. - CORRECT ANSWER PET scan PET scan cannot detect lesions smaller than ____. - CORRECT ANSWER 1 cm aka Galactography - CORRECT ANSWER Ductography What imaging would be done in the case of suspicious single duct nipple discharge? - CORRECT ANSWER Ductography Primary indication for _______ is nipple discharge in the non-pregnant and non-lactating patient. - CORRECT ANSWER ductography Ductography utilizes what? - CORRECT ANSWER 30 gauge needle, radiopaque dye, mammo and fluro technique, CC view with light compression A filling defect on ductography usually represents what? - CORRECT ANSWER Papilloma ***The first node that drains lymphatic fluid from a specific area of the breast. Usually found in the axilla. - CORRECT ANSWER Sentinel node Uses a dye and radioisotope that are injected around a previously confirmed breast cancer. B - CORRECT ANSWER ... [Show More]

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