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Questions and Answers
What is a significant limitation of fine needle aspiration (FNA)?
What is a significant limitation of fine needle aspiration (FNA)?
Which biopsy technique is performed under local anesthesia and uses a large-diameter needle?
Which biopsy technique is performed under local anesthesia and uses a large-diameter needle?
What is the main advantage of true cut biopsy over fine needle aspiration?
What is the main advantage of true cut biopsy over fine needle aspiration?
What is the main purpose of the triple assessment in breast problems?
What is the main purpose of the triple assessment in breast problems?
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Which imaging modality is considered the best practice for breast screening in a 45-year-old female?
Which imaging modality is considered the best practice for breast screening in a 45-year-old female?
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What is the accuracy rate of the triple assessment for breast cancer diagnosis?
What is the accuracy rate of the triple assessment for breast cancer diagnosis?
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Which embryonic tissue is the breast originally derived from?
Which embryonic tissue is the breast originally derived from?
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What is the purpose of Sappey's muscle in the breast?
What is the purpose of Sappey's muscle in the breast?
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Which of the following structures primarily anchors the lobes of the breast?
Which of the following structures primarily anchors the lobes of the breast?
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What anatomical feature does the breast extend from superiorly to inferiorly?
What anatomical feature does the breast extend from superiorly to inferiorly?
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What type of tissue primarily decreases in the breast as menopause approaches?
What type of tissue primarily decreases in the breast as menopause approaches?
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Which arteries are primarily responsible for supplying the lateral part of the breast?
Which arteries are primarily responsible for supplying the lateral part of the breast?
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What are supernumerary nipples referred to as?
What are supernumerary nipples referred to as?
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What role do Montgomery glands play in the breast?
What role do Montgomery glands play in the breast?
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The areolar epithelium contains numerous glands during which phase of life?
The areolar epithelium contains numerous glands during which phase of life?
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What primarily supplies the medial part of the breast?
What primarily supplies the medial part of the breast?
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Which drainage route accounts for the majority of lymphatic drainage from the breast?
Which drainage route accounts for the majority of lymphatic drainage from the breast?
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How many groups are the axillary lymph nodes arranged into?
How many groups are the axillary lymph nodes arranged into?
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Which imaging technique is considered the gold standard for evaluating patients with breast implants?
Which imaging technique is considered the gold standard for evaluating patients with breast implants?
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What is the radiation dose of mammography per film?
What is the radiation dose of mammography per film?
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What percentage of lymphatic drainage from the breast passes to internal mammary lymph nodes?
What percentage of lymphatic drainage from the breast passes to internal mammary lymph nodes?
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Which group of axillary lymph nodes is located at the apex of the axilla?
Which group of axillary lymph nodes is located at the apex of the axilla?
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Which investigation is particularly useful for young females with dense breast tissue?
Which investigation is particularly useful for young females with dense breast tissue?
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What lymph nodes do the lymphatic vessels accompany to drain from the breast?
What lymph nodes do the lymphatic vessels accompany to drain from the breast?
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Which surgical classification group includes lymph nodes deep to pectoralis minor?
Which surgical classification group includes lymph nodes deep to pectoralis minor?
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Study Notes
Breast Anatomy
- The breast is a modified sweat gland, originating from embryonic ectoderm.
- It follows a milk line, found between the axilla and inguinal region.
- Accessory breast tissues can be found along the milk line.
- Located in the superficial fascia of the anterior chest wall.
Breast Structure
- The breast comprises 15-20 lobes of tubulo-alveolar glandular tissue.
- Fibrous connective tissue (Cooper's ligaments) supports the lobes and provides structure.
- Adipose tissue occupies spaces between lobes, giving breasts their shape and cushioning them.
Breast Blood Supply
- The breast receives blood from three main sources: the branches of the axillary artery, including superior thoracic, thoracoacromial, lateral thoracic, and subscapular arteries.
- The internal thoracic artery also supplies blood, particularly to the medial portion of the breast, via medial mammary arteries.
- Perforating branches of intercostal arteries also supply the breast.
- Venous drainage follows the arterial supply, with vessels draining into the axillary, internal thoracic, and intercostal veins.
Breast Lymphatic Drainage
- Lymphatic drainage from the breast primarily goes to the axillary lymph nodes.
- Approximately 75% drains to the axillary nodes (pectoralis, central, and apical groups).
- About 20% drains to the internal mammary lymph nodes.
- A small percentage (5%) drains to supraclavicular, infraclavicular, subscapular, and intercostal lymph nodes.
- Axillary lymph nodes are grouped into anterior (pectoral), posterior (subscapular), lateral (humeral), central, and apical groups.
Breast Investigation
- Mammography: A low-voltage, high-amperage X-ray that is useful for assessing the breast. The radiation dose is low, making it safe to use repeatedly.
- Ultrasound: Particularly useful for young women with dense breasts or when mammography is not effective to distinguish between cysts and solid lesions.
- MRI: Useful for distinguishing scar tissue from recurrence in patients who have undergone breast surgery, particularly after radiation therapy. Also useful for patients with breast implants or for high-risk patients and for evaluating the axilla after breast cancer treatment.
Breast Investigations (continued)
- Fine Needle Aspiration (FNA): A rapid, inexpensive procedure that is a helpful initial diagnostic tool. However, it cannot distinguish between in-situ and invasive cancers, and does not provide tumor markers.
- True-Cut Biopsy: Also does not require incision, it is examined by a cytopathologist and it allows obtaining tumor markers; helping the physician distinguish invasive or non-invasive cancers.
- Core Needle Biopsy: Performed under local anesthesia, using a large-core biopsy device.
- Triple Assessment: A process combining physical examination, imaging (mammography and ultrasound), with fine-needle aspiration cytology (FNAC). It has a high diagnostic accuracy reaching 99.9%.
Additional Information
- The breast is mainly composed of glandular (milk-producing) and fatty tissue. The ratio of these varies between individuals and can be heavily influenced by the hormone estrogen.
- Areola and nipple contain involuntary muscles that cause nipple erection and retraction. The areolar epithelium also contains Montgomery glands, which produce lubrication during lactation.
Question
- A 45-year-old woman wants to undergo a breast imaging exam. What is the best imaging to use?
- Mammogram is generally the best option for women in this age group.
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Description
Test your knowledge on breast anatomy, biopsy techniques, and assessment methods related to breast problems. This quiz covers significant concepts such as the advantages of true cut biopsy and the purpose of the triple assessment. Perfect for students in medical or nursing fields.
