Chapter 21 Breast PPT first 1/2
- A _____ transducer should be used.
- Produces a rectangular shaped image
- Allows direct contact scanning _____ to the chest wall
- Accurate measurements can be recorded by avoiding beam _____ artifact
- Interventional procedures can be accurately guided with a linear array probe.
- A ______ transducer may be used to supplement the sonographic examination if a mass is too large to fit on a linear image
- Using a ___ frequency linear probe provides a large field of view at the expense of resolution.
- Depth should be sufficient to visualize the breast tissue from skin to ___ ___
- Breast size varies from one patient to the next. Depth should be set according to the size of the breast.
- Usually __-__ cm is sufficient for imaging all structures.
- ____ focal zones
- If a single focus is used, the focus should be set at the depth of the area of interest (such as a mass) or below the mammary layer for general scanning.
- Both ____ Doppler and ____ Doppler can be useful in breast imaging
- ____ Doppler is more sensitive to low velocity flow
- Doppler ____ distinguish between benign and malignant masses
- Both benign and malignant masses can exhibit blood flow
- Solid vs. cystic masses
- Positive flow within a lesion confirms that it is ____
- Negative internal flow does not confirm that a lesion is ____
- Inflammed vs. noninflammed tissue
- The Doppler signal will _____ due to increased flow in areas of inflammation
- Complex cyst vs. intraductal papilloma
- Doppler signals may be _____ within a papilloma and ____ in the debris of a complex cyst
Optimizing Doppler Imaging:
- In order to optimize doppler imaging, the sonographer should establish a technique for ___ velocity flow states.
- This includes:
- ___ velocity scale
- ____ filter setting
- Optimal doppler gain setting
- ____ PRF for high velocities
- Artifacts exist in breast sonography as they do in other areas of the body
- Some artifacts may be helpful in
determining characteristics of the tissues.
- _____ _____ associated with cystic structures or highly cellular benign lesions
- _____ associated with a solid/malignant lesion
- ____ shadowing
- Shadowing may
be eliminated in this area by angling the transducer posterior
to the nipple or by using the “rolled nipple” technique
- With this technique you place a large “glob” of gel on the nipple to eliminate shadowing from air around the nipple
- Shadowing may be eliminated in this area by angling the transducer posterior to the nipple or by using the “rolled nipple” technique
- From anterior to posterior, the layers of the breast are:
- ______/premammary layer
- Mammary or glandular layer
- ______ space/fat
- Muscle layer (pectoralis major and minor)
- Chest wall (ribs, intercostal muscles)
- The skin is composed of the _____ and ____ layers.
- Normal skin thickness is between __-__ mm
- The skin is slightly thicker in _____ women and ____ as patients age
- Consists of dense connective tissue and _____ muscle
- It contains many sensory ____ endings
- __-__ lactiferous duct openings may be seen (each of these arise from a breast lobe)
- Circular area of ___ pigmentation seen around the nipple
- Consists of _____ muscle
- Slightly ____ than surrounding skin
- Contains _____ glands seen as small bumps in the areola
- Lies just beneath the ____. Extends to the mammary layer
- Is ___ seen posterior to the nipple
- Primarily consists of ____
- Amount of fat will ____ with age, pregnancy
- Subcutaneous layer also contains ____ ligaments.
- ____ _____- small ligaments that stretch between the skin and subcutaneous fascia.
- The breast tissue is completely contained between the layers of the ____ fascia.
- At the breast, the superficial fascia divides in to the ____ and ____ layers.
- The superficial layer is simply known as the superficial fascia.
- The superficial fascia is contained within the subcutaneous layer ____ to the mammary layer.
tail of spence
- Known as the _____ or glandular layer
- A portion of the glandular tissue extends beyond the breast into the axilla. This is known as the ___ ___ ____.
- The mammary layer is composed of ___ types of tissue:
- Interlobular ___ and connective tissue
- _____ tissue
- Consists of acini, lobules, TDLUs lobes and lactiferous ducts
- ____ ligaments
- _____ ligaments
- Part of the stroma and supportive tissue of the breast
- Provides a ‘_____’ for the breast
- Coopers ligaments run between the _____ and _____ layers of the superficial fascia.
- Also called acinus or acinar cells
- The _____ functional unit of the breast
- These are the glands that produce ____
- ______ are in each breast
- Each acini gives rise to a ____ or a terminal duct
- Composed of approximately ___ acini cells, intralobular terminal ducts
- ______ stromal tissue (loose connective tissue)
Lobule; intralobular; extralobular
Terminal Duct Lobular Unit: TDLU
- Made up of
- _____, _____ terminal ducts, _____ terminal ducts
- Usually measure __ cm or less
- NEARLY ___ BREAST PATHOLOGY ORIGINATES IN THE TDLU
- Several _____ make up a breast lobe
- __-__ lobes are located in each breast
- One _______ duct emerges from each lobe and travels toward the nipple
- Tubes that Transport ____ from the ____ to the nipple
- Begin at the ___ _____ which arises from the acini.
- The ducts enlarge slightly at the areola to form the ____ _____.
- The _____ duct empties milk from the nipple
- The deep later of the superficial fascia is often referred to as the ____ fascia.
- It is located within the _____ space posterior to the mammary layer
- Maintaining integrity of the deep fascia is important in deterring the spread of ____ to the chest wall.
- Space between the ____ margin of the mammary layer and the _____ muscles
- Contains a thin layer of ____
- Amount of fat _____ with age, pregnancy and obesity
- This later allows movement of the breast over the ____ ____
- Pectoralis major:
- Arises from the ____ and costal cartilage of the ____ attaching to the proximal humerus
- Pectoralis minor:
- Arises from the 3rd, 4th, and 5th ribs attaching to the _____.
- The pectoral fascia encloses the chest muscles and may appear deep to the _____ layer
- Ribs are located _____ to the pectoral muscles
- In small breasted females, it is important not to confuse a rib with a breast mass on a physical or sonographic examination.
- _____ muscles are located within the rib spaces
- Deep to the chest wall layer is the ____
- The primitive mammary gland begins development during the ___ week of life.
- The glandular tissue of the breast begins to evolve into epithelial buds that eventually form approximately __ epithelial cords or lobes.
- At 15 weeks gestation, ____ in the male fetus prevents further breast development.
- Once the fetus is born, the breast tissue is _____ until puberty
- Breast _______ may be seen in newborns due to maternal hormonal influence.
- The breasts develop along a line extending from the axilla to the inguinal region known as the ____ line.
- Occasionally accessory or _____(extra) breasts are found along this line
- _____ of one or both breasts
- _____ breast or more than two breasts
- _____ of the nipple
- _____ nipples
- _____ of the breast tissue with development of the nipple
- Nipple _____ or nipple _____
- Unilateral early ripening
- _____ breast growth at puberty
- Two main arteries supply blood to the breast.
lateral _____ artery
- Arises from the _____ artery
- The lateral _____ artery
- Internal ____ artery
- Arises from the _____ artery.
mammary; thoracic; axillary; subclavian
There are two venous systems that drain the breast tissue
- Located just ____ to the superficial fascia
- Include small branches that drain into the internal ____ vein, lateral _____ vein, ____ vein, ____ vein, and intercostal veins.
- The ____ and ____ venous systems communicate within the breast parenchyma.
- Breast cancer most frequently spreads via ____ _____
- _____ follow roughly the same route as the veins
deep; stroma; lactiferous
Lymph flow begins ____ within the breast tissues through lymphatic vessels that originate in the ____ and _____ ducts. (deep system)
_____ lymph nodes are seen throughout the breast parenchymas part of the deep system.
areola; periareolar; subdermal
Flow direction from the deep system is toward the ____ into the ____ plexus and continues into the _____ lymphatic vessels which is the superficial system.
From the ____ vessels, lymph flows outward to the outer lymphatic chains that drain the ____
- The outer _____ chains are located in multiple areas surrounding the breast
- Approximately __% of the lymphatic drainage is to the ____.
- The axillary lymph node chain becomes very important in predicting the spread of an existing ____ ____
The axillary lymph node chain consists of __ groups of nodes (75% of drainage):
- External mammary group
- Located along the lateral _____ vessels
- Scapular group
- Run with the _____ vessels
- Axillary group
- Run with the _____ vessels
- Central group
- Run with the _____ vessels
- Subclavicular group
- Run with the ____ vessels
- Interpectoral (rotter’s nodes)
- Found between the pectoralis ____ and _____ muscles
- The remaining ___% of lymphatic drainage for breast tissues
- Internal _____ lymph nodes
- ____ lymph nodes
- Flow to the ____ breast
- _____ lymph nodes
- _____ lymph nodes
fatty; thins; prominent
- Each lymph node is ____ in shape (like a kidney)
- It has an outer ____ and a medial ____ where a small artery, vein and lymph vessel enter and exit the node.
- The vessels carry ____ into the node where it is filtered and released.
- As lymph nodes become more ____(as a patient ages), the cortex ___ and the hilum becomes more _____.
During surgical lymph node dissections, the _____ lymph nodes are divided into three levels.
- Level 1
- Nodes lie ____ to the pectoralis minor muscle
- Level 2
- Nodes lie _____ to the pectoralis muscle
- Level 3
- Nodes lie posterior_____ to the muscle
- A complicated network of nerves serve the breast tissue, chest muscles and surrounding areas.
- These include:
- Long _____ nerve
- Thoraco-dorsal nerve
- Toracic intercostal nerves
- ___ and ___ branches of the cervical plexus
- Circumflex nerve
- Subscapular nerves
- Anterior _____ nerves
- At ____, breast development occurs due to hormonal stimulation by the ovaries.
- The amount of growth and volume depend on the individual
- stimulates changes of the stromal tissues, elongation of the mammary ducts, growth of connective tissue, increase in adipose tissue(fat), and increased vascularity
- Stimulates growth of the glandular tissue
The mature female breast:
- Sensitive to the _____ cycle
- Responds to changing
hormones each month
- Early in the ____ phase of the cycle, changes in the epithelium occur.
- Later, in the ____ phase, the ducts and veins increase in size, the breasts become edematous (swollen) and the epithelium produces secretions.
- These changes may account for _____ breast discomfort.
- At the onset of menses, the breast tissues return to ____.
- During pregnancy, there is a lot of change in the breast tissue.
- The TDLUs ____ in size and _____ begins to swell.
- ____ cells enlarge in response to hormones.
- Late in pregnancy, the ______ ducts increase in size.
- Shortly after birth, the estrogen and progesterone levels _____ rapidly and _____ dominates.
- This hormone causes the acinar cells to secrete ____.
- After the termination of breast feeding, the ducts and lobules will return to their normal size in __ months.