Breast Anatomy and Investigation PDF

Breast By Dr. NOOR Aljbory Lec 1.  Lec. content Introduction Anatomy Investigation Triple assessment  Anatomy of breast Breast is a modified sweat gland Originally it is from the embryonic ectoderm So it is can be found in the mamma...

Breast By Dr. NOOR Aljbory Lec 1.  Lec. content Introduction Anatomy Investigation Triple assessment  Anatomy of breast Breast is a modified sweat gland Originally it is from the embryonic ectoderm So it is can be found in the mammary line (milk line between the limp bud from axilla to the inguinal region ) So accessory breast tissues can be found along this line It is located in the superficial fascia of the ant. Chest wall.  Breast extend from Superiorly 2nd. Intercostal space Inferiorly 6th. Intercostal space. Medially lateral border of sternum Laterally mid axillary line Posterior border of it rest upon portion of the fascia of (pectoralis major. Minor serratus ant. and external oblique muscles. anteriorly breast tissue extend into the ant. Axillary fold (this is important in performing mastectomy since the aim is to remove the whole breast tissue Structurally: – 15 to 20 lobes of tubulo-alveolar glandular tissue – fibrous connective tissue support the lobes (sespensory ligament of Cooper and adipose tissue ,blood vessels ,nerves, lymphatics ) – adipose tissue that resides in parenchyma between the lobes.  Areola and nipple Contain involuntary muscle arranged in concentric rings as well as radially in the subcutaneous tissue/ Circular muscle fibers constitute Sappeys muscle(cause nipple erection ) Longitudinal fibers from Myerholts muscle (causes nipple retraction ) The areolar epithelium contains numerous sweat glands and sebaceous glands enlarged during pregnancy and serves as lubricating during lactation (Montgomery gland) Nipple covered by thick skin and in it openings for lactiferous ducts Multiple nipples called polythelia (supernumerary nipple) congenital absent of nipple called Athelia The majority of the breast consists of glandular (milk-producing) and fatty tissues. However, the ratio of the glandular to fatty tissue varies among individuals. The breast is heavily influenced by the sex hormone estrogen. As menopause approaches, the levels of estrogen declines which also decreases the glandular tissues. Blood supply and venous drainage Breast blood supply comes from three sources: Branches of the axillary artery supply the lateral part of the breast. These are the superior thoracic, thoracoacromial, lateral thoracic and subscapular arteries. Branches of the internal thoracic artery, supply the medial part of the breast as the medial mammary arteries. Perforating branches of second, third and fourth intercostal arteries contribute to the supply of the entire breast. Breast veins follow the mentioned arteries. They drain into the axillary, internal thoracic and second to fourth intercostal veins...  Lymphatic drainage of the breast Recent description of lymphatic drainage claims that the role of the lymphatic plexuses is negligible and that the lymphatic vessels accompany the major blood vessels to reach the following L.N. directly 75% pass to axillary L.N. (mainly to pectoralis, central, apical ) 20% pass to internal mammary L.N. 5% pass to supra, infra-clavicular, subscapular, intercostal L.N.  Axillary lymph nodes groups They are 20-30 in number arranged in 5 groups Anterior group (pectoral group) Posterior (subscapular group) Lateral (humeral group) Central (in the upper central part of axilla) Apical (at the apex of axilla at the upper part of axillary vein )..  Surgical classification of axillary L.N. 1 L.Ns above the pectoralis minor (apical and infra-clavicular L.Ns 2 L.Ns deep to pectoralis minor (central group) 3 L.Ns below the level of pectoralis minor (ant ,post., lateral groups)..  Investigation of the breast Mammography it is soft tissue X-ray low voltage and high- amperage X-ray The dose of radiation is 1mGy per film and therefore it is very safe inv. Ultrasound particularly useful in young females with dense breast in whom mammography is difficult to interpret and in distinguishing cysts from solid lesions. MRI it is useful in – 1 distinguishing scar from recurrent in pt. whom undergo previous surgery although it is not accurate during 9 months of radiotherapy – 2 gold standard for imaging for pt. with breast implants – 3 in screening for high risk woman – 4 it is important in evaluation of axilla post treatment for both primary or secondary metastasis  Inves. Cont. Fine needle aspiration (FNA) it is easily performed, rapid, inexpensive ,requires no incision but it cannot distinguish between insitu and invasive cancer and tumor markers are not available (ER,PR ,Her-2-neu ) True cut biopsy also does not need incision, can be read by any cytopathologist, tumor markers are available and can distinguish between invasive or non invasive ca Both above investigations must done under us guide Core needle biopsy it done under local anesthesia under image guidance using large-diameter core needle biopsy devise (15G for breast tissue , 18G for axilla)......  Triple assessment It is the most important step in dx. Of breast problems The triple assessment for a lump in the breast is standard practice and the robustness of assessment towards the diagnosis of breast cancer is crucial. The combination of the modalities, physical examination, imaging (mammogram and ultrasound), and fine- needle aspiration cytology (FNAC) is more accurate than any modality alone. The accuracy of triple assessment can reaches 99,9 for diagnosis. History physical exam. Imaging. THANK YOU  Question 45 years old female want to check for her breast and she asked you what is the best imaging for her ? A- us B- MRI C- Mammogram