- 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
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
- 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
- Usually __-__ cm is sufficient for imaging all
- ____ 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
- ____ Doppler is more sensitive to low
- Doppler ____ distinguish between benign and
- 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
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
- 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
- _____ associated with a solid/malignant
- ____ 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
- From anterior to posterior, the layers of the breast are:
- ______/premammary layer
or glandular layer
- ______ space/fat
layer (pectoralis major and minor)
- Chest wall (ribs,
- 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
- Circular area of ___ pigmentation seen around the
- Consists of _____ muscle
- Slightly ____
than surrounding skin
- Contains _____ glands seen as small
bumps in the areola
- Lies just beneath the ____. Extends to the mammary
- Is ___ seen posterior to the nipple
- Primarily consists of ____
- Amount of fat will ____
with age, pregnancy
- Subcutaneous layer also contains
- ____ _____- 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.
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
ligaments run between the _____ and _____ layers of the
- Also called acinus or acinar cells
- The _____
functional unit of the breast
- These are the glands that
- ______ are in each breast
- Each acini
gives rise to a ____ or a terminal duct
- Composed of approximately ___ acini cells, intralobular
- ______ stromal tissue (loose connective
Lobule; intralobular; extralobular
Terminal Duct Lobular Unit: TDLU
- Made up of
- _____, _____ terminal ducts, _____
- Usually measure __ cm or less
NEARLY ___ BREAST PATHOLOGY ORIGINATES IN THE
- 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.
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
- Contains a thin layer of ____
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
- Ribs are located _____ to the pectoral muscles
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
- Once the fetus is born, the breast tissue is
_____ until puberty
- Breast _______ may be seen in newborns due to maternal hormonal
- 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
- _____ of one or both breasts
- _____ breast or more than two breasts
- _____ of the breast tissue with development of
- Nipple _____ or nipple _____
- Unilateral early ripening
- _____ breast growth at
- Two main arteries supply blood to the breast.
lateral _____ artery
- Arises from the _____ artery
- Internal ____ artery
from the _____ artery.
mammary; thoracic; axillary; subclavian
There are two venous systems that drain the breast tissue
- Located just ____ to the superficial
- Include small branches
that drain into the internal ____ vein, lateral _____ vein, ____
vein, ____ vein, and intercostal veins.
- The ____ and ____ venous systems communicate within the breast
- 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%
- External mammary group
- Located along the lateral
- Scapular group
with the _____ vessels
- Axillary group
- Run with the _____ vessels
- Central group
- Run with the _____ vessels
- Subclavicular group
- Run with the ____
- Interpectoral (rotter’s nodes)
- Found between the pectoralis ____ and _____ muscles
- The remaining ___% of lymphatic drainage for breast tissues
- Internal _____ lymph nodes
- ____ lymph
- Flow to the ____ breast
- _____ lymph
- _____ lymph nodes
fatty; thins; prominent
- Each lymph node is ____ in shape (like a kidney)
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.
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
- Level 2
- Nodes lie _____ to the
- Level 3
- Nodes lie
posterior_____ to the muscle
- A complicated network of nerves serve the breast tissue, chest
muscles and surrounding areas.
- These include:
- Thoraco-dorsal nerve
- ___ and ___ branches of the cervical
- 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
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
- At the onset of menses, the breast tissues return
- During pregnancy, there is a lot of change in the breast
- The TDLUs ____ in size and _____ begins to
- ____ 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.