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Questions and Answers
What is the primary function of the breast?
What is the primary function of the breast?
What affects the size of breast tissue?
What affects the size of breast tissue?
Where is the breast located in relation to the pectoralis major muscle?
Where is the breast located in relation to the pectoralis major muscle?
What is the Terminal DuctoLobular Unit (TDLU)?
What is the Terminal DuctoLobular Unit (TDLU)?
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How does the tissue composition of the breast change after menopause?
How does the tissue composition of the breast change after menopause?
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What are lactiferous ducts known for?
What are lactiferous ducts known for?
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In older women, what occurs in the breast tissue?
In older women, what occurs in the breast tissue?
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What is the typical composition of the breast?
What is the typical composition of the breast?
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What describes ectatic ducts in breast imaging?
What describes ectatic ducts in breast imaging?
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What is the primary purpose of mammography?
What is the primary purpose of mammography?
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What does the Breast Imaging-Reporting and Data System (BI-RADS) primarily standardize?
What does the Breast Imaging-Reporting and Data System (BI-RADS) primarily standardize?
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In what scenario would a BI-RADS 4a classification be given?
In what scenario would a BI-RADS 4a classification be given?
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Which mammographic view is directed from head to feet?
Which mammographic view is directed from head to feet?
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What does the Medio-Lateral Oblique (MLO) view primarily assess?
What does the Medio-Lateral Oblique (MLO) view primarily assess?
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What intervention utilizes a large needle for solid lesions?
What intervention utilizes a large needle for solid lesions?
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What technique is used for cystic lesions in breast imaging?
What technique is used for cystic lesions in breast imaging?
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What is the recommended follow-up for BI-RADS 3 findings?
What is the recommended follow-up for BI-RADS 3 findings?
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How does the 90° Lateral view differ from the Cranio-Caudal view?
How does the 90° Lateral view differ from the Cranio-Caudal view?
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What defines a BI-RADS 5 classification?
What defines a BI-RADS 5 classification?
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What does Short interval US follow-up refer to?
What does Short interval US follow-up refer to?
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What is a primary function of breast lesion localization?
What is a primary function of breast lesion localization?
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What should happen when a BI-RADS 0 classification is assigned?
What should happen when a BI-RADS 0 classification is assigned?
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Study Notes
Breast Anatomy and Sonography
- The breast is a modified sweat gland, primarily functioning to secrete milk for lactation.
- It sits anterior to the pectoralis muscle and ribs, lateral to the sternum, and medial to the axilla.
Breast Anatomy
- Breast tissue size varies based on age, functional state, and individual tissue amount.
- Puberty and pregnancy increase tissue size due to estrogen.
- Post-menopause, tissue decreases (atrophy) with often fatty replacement.
- Breasts consist of 4-20 lobes of parenchymal tissue and supporting tissue (fat, fibrous connective tissue).
- Lobes are made up of lobules and ducts, and small branch ducts.
Functional Unit of the Breast
- The Terminal DuctoLobular Unit (TDLU) is the origin site of most breast pathologies and cancers.
- It contains lobules, ductules, intralobular terminal ducts, fibrous tissue (stroma), and extralobular terminal ducts.
- Most breast carcinomas emerge from terminal ducts near the junction of the intralobular and extralobular segments.
Ducts and Sinuses
- Smaller ducts combine to form larger ducts, ultimately becoming lactiferous ducts.
- These ducts may function as milk reservoirs.
- Normal duct size is less than 2 mm and can be sonographically visualized.
Breast Zones
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Pre-mammary zone (AKA Subcutaneous zone): The most superficial zone, located between the skin and anterior fascia.
- Lesions in this zone are typically not breast-related (e.g., lipomas or cysts).
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Mammary zone: The middle zone, situated between the anterior and posterior mammary fascias.
- Contains lobar ducts, duct branches, TDLUs, and the majority of fibrous stromal elements.
- This zone accounts for most true breast pathology.
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Retro-mammary zone: The deepest zone, located behind the posterior mammary fascia and in front of the pectoral muscle.
- Contains fat, blood vessels, and lymphatics.
Areola/Nipple Complex
- The nipple is a raised area on the anterior surface, consisting of closely spaced duct openings (lactiferous ducts).
- The areola is a pigmented circular area surrounding the nipple and contains sebaceous glands.
Cooper's Ligaments
- Suspensory ligaments, continuous with mammary fascia, run between lobules and support the breast from deep muscle to skin.
Blood Supply and Drainage
- Arterial supply: Internal thoracic (mammary) artery, lateral thoracic artery, and intercostal arteries.
- Venous drainage: Superficial and deep veins.
Lymphatic Drainage
- Most drainage is towards axillary lymph nodes.
- Sentinel lymph nodes are the first site of nodal metastases and often removed with breast lesions.
- Intra-mammary nodes may exist within the breast, sometimes mistaken for breast pathology.
Breast Physiology
- Breast growth and development are fueled by estrogen and progesterone.
- Milk production is controlled by anterior pituitary and hypothalamus glands.
- Hypothalamus produces prolactin-inhibiting factor (during non-production phase).
- Anterior pituitary produces prolactin (for milk production during and after childbirth).
- Additional hormone oxytocin stimulates milk secretion (lactation). Lactation is also stimulated by infant suckling, which contracts lactiferous ducts.
- After menopause, reduced hormones cause breast tissue atrophy.
Breast Sonography
- Ultrasound (US) is not a primary breast screening tool.
- US has lower sensitivity compared to mammography, making microcalcification detection problematic.
- US may present pseudo-lesions and its interpretation is highly operator-dependent.
- US should supplement mammography (e.g., after mammogram)
Indications for Breast Ultrasound
- Identify and evaluate masses seen in mammograms.
- Differentiate between cysts and solid masses.
- Asses palpable masses.
- Diagnose patients with radiation contraindications (e.g., pregnant/lactating women).
- Analyze infected breast abscesses.
- Investigate nipple discharge.
- Examine issues from breast implants.
- Guide biopsy and other interventional procedures.
Breast Ultrasound Examination Details
- Patient position: Varies by quadrant (inner/outer) and may require supine/oblique/ipsilateral arm positioning, and occasionally upright.
- Equipment: Requires 7-15 MHz linear transducers (frequently including a stand-off pad) with gel application. Image optimization using techniques like split-screen imaging, document compression, mobility, and color assessment (including power/harmonic), and Extended FOV.
Breast Ultrasound Annotation
- Annotation must include: breast laterality, scan plane (various), quadrant, clock position, distance from the nipple, breast body markers.
Scan Planes
- LG and TR: Standard planes.
- RAD: Radial plane, useful for evaluating ducts (oriented radially from nipple).
- ANTIRAD: Anti-radial plane, perpendicular to RAD.
Quadrant Method
- Divides the breast into four quadrants (UOQ, UIQ, LOQ, LIQ).
O'Clock Method
- Each breast region is assigned to a clock face position.
Distance from the Nipple
- Distance to the nipple is measured for lesion location in centimeters.
- Some facilities use additional zones (e.g., subareolar and axillary)
Special Breast Techniques
- Compression can vary to evaluate lesion compressibility and internal mobility (including ballottement).
- Heel-toeing technique is used for perpendicular incidence on Cooper's ligaments for better visualization.
- Positional changes facilitate visualization of different quadrants.
- Peripheral compression is helpful for evaluating under nipple/areola areas.
- Rolled nipple technique is used on patients with nipple discharge while the nipple is rolled under the probe.
- Two-handed technique helps with compressing the nipple/areola region between the hand and the transducer.
Other Sonographic Techniques
- Elastography: Uses lesion stiffness to assess malignancy likelihood (color-coded images), via operator compression.
- Shear wave elastography: Uses transducer force for quantitative assessment of stiffness.
- 3D: Hand-held or Automated Breast Ultrasound System (ABUS).
- CEUS: Contrast-enhanced ultrasound; further research is needed.
Sonographic Appearance (Breast)
- Depends on factors such as age and functional state of the woman.
- Visually appears in 3 layers (pre-mammary, mammary, and retromammary); (not always distinguishable).
- Pre-mammary layer demonstrates skin complex (hypoechoic band between two hyperechoic lines, <2 mm thick).
- The nipple/areolar complex may create shadows when scanning directly over the nipple.
- Fatty lobules are hypoechoic and elongate upon compression.
- The mammary layer presents homogeneous glandular tissues (medium to hyperechoic echoes).
- Ducts and ductules are anechoic, hypoechoic, or isoechoic, and tubular or round.
- Cooper's ligaments are echogenic and linear.
- Retromammary layer features fat lobules, blood vessels, lymphatics, and hypoechoic pectoral muscle. Ribs appear as curved echogenic structures with shadowing .
- Age-related changes impact appearance (younger: more parenchymal tissue, denser, echogenic; older: more fatty tissue, more hypoechoic).
Correlating US to Mammogram
- Ensure mammographic and ultrasound findings pertain to the same lesion.
- Sonographers should understand basic mammographic principles for accurate correlation.
Mammography (Basics)
- Radiographic procedure for breast examination.
- Uses ionizing radiation.
- Gold standard for breast screening, utilizing compression paddle.
- Multiple positions/views are captured for comprehensive evaluation.
Mammography (Standard Views)
- Cranio-caudal (CC): X-ray directed from head to feet, determining medial/lateral lesion location.
- Medio-lateral oblique (MLO): X-ray directed from medial to lateral, determining superior/inferior lesion location.
Mammography-US Correlation (Basic Lesion Location)
- Correlate lesion location in mammogram with ultrasound identification.
- Indicate superior/inferior/medial/lateral position in both modalities.
Mammography (Alternate Views)
- 90° Lateral: Perpendicular to craniocaudal view.
- Spot compression: Focal compression on suspected lesions for detailed evaluation.
BI-RADS Nomenclature
- American College of Radiology developed system.
- Standardized breast lesion reporting.
- Guides management decisions based on defined categories (0-6).
Breast Interventions
- Offers methods for addressing breast lesions (e.g., biopsies, cyst aspiration, needle localization).
- Biopsies: Large-needle biopsies target solid lesions, while thin-needle biopsies target cysts.
- Localization: Used prior to surgery; places a marker in the lesion for precise removal.
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Description
This quiz covers essential aspects of breast anatomy, focusing on the functional units and structural components of breast tissue. It also explores how various physiological states like puberty and menopause affect breast morphology. Understanding these details is crucial for professionals in the medical field, particularly in sonography.
