Skin Fat Glandular Tissue Pectoral Muscle Ribs Lymph nodes Fibroadenoma Appearance Amazia Breast Layers/Components on U/S Invasive Papillary Carcinoma

Breast Layers/Components on U/S

Breast Ultrasound

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Biology - Pathology

user_lira_cofre Created by 9 mon ago

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Dense breast tissue - Family history

Palpable lump - Pain - Skin/nipple change - Correlate to mammo or MRI - Implant rupture - Post surgical/radiation - Detection or biopsy of abnormal axillary lymph nodes

1) Radial or antiradial 2) cm from nipple 3) Right or left 4) Clock face position

Malignant masses are more likely to be stiffer

Have patient hum while using power doppler - Benign lesions should fill, malignant should not

A & B are not dense - C & D are dense and U/S is indicated

Irregular shape - Indistinct - Spiculated - Angular - Microlobulated - Not parallel - Shadowing - Hypoechoic - Calcifications *** 4+ needs biopsy

Development begins at 5th week of gestation - Primary mammary buds and lactiferous ducts forms by 20 weeks

Adult breast tissue lies on anterior chest wall over pectoralis major - Spreads from lateral edge of sternum into axilla through the Tail of Spence

Skin Fat Glandular Tissue Pectoral Muscle Ribs Lymph nodes

***Cooper's Ligaments

Superficial, between skin and anterior mammary fascia - Skin, fat, connective tissue containing cooper's ligaments - Cooper's: strands of fibrous tissue that extend from deep dermis to pectoral muscle

Middle layer - Between anterior mammary fascia and posterior mammary fascia - Acini cells, lobules, TLDUs, loves, lactiferous ducts, lactiferous sinuses, fat, cooper's

Deepest - Retromammary fat - Pectoralis major/minor - Ribs - Chest wall - Lymphatics

Sac like structures which make milk

Composed of acini and intralobular terminal ducts - May consist of 1 duct and 1 gland

Terminal duct lobular units = Smallest functional unit of the breast - Lobule + Extralobular terminal duct - Site of origin of most breast pathology and aberrations of development and involution

Collection of lobules - 15 to 20 lobes in each breast - Vary in size - About half will enlarge and function during lactation - Pyramidal in shape, radiating from areola w/ apex pointing toward areola

Drains each lobe to the nipple - Dilate to form lactiferous sinuses, which are milk reservoirs during lactation

Mammary Zone

the terminal duct near the junction of the intralobular and extralobular segments

Pectoral nodes near Tail of Spence - Intramammary nodes - Internal Mammary/Parasternal nodes - Axillary Nodes

Absence of breast tissue, areola, and nipple

Absence of functional breast tissue

Absence of nipple and areola

Insufficient glandular tissue

More than 2 breasts

More then 2 nipples

Mostly seen on mammo - Most are benign but can indicate early cancer depending on type, number and positioning

1) Flat epithelial atypia 2) Atypical ductal hyperplasia

1) Milk of calcium 2) Vascular 3) Oil cyst 4) Degenerating fibroadenoma

May present as palpable lump - Anechoic, well circumscribed w/ posterior enhancement - NO INTERNAL COTENTS

May present as palpable lump - May be related to hemorrhage within cyst or inflammation - Has internal debris but no solid components - Galactocele if filled with milk

May have irregular, thickened wall - May contain thin septations - Internal echoes - No solid components

No exclusive to breasts - Obstruction of sebaceous glands or hair follicle - Painless superficial lump

Superficial - Circumscribed mass - Contains low level echoes - Visible track to skin

Predominantly cystic but contains solid components - 20 to 30% are malignant

Most common solid breast mass - Younger women - Palpable lump - Multiple and B/L - Growth stimulated by estrogen

Solid, smooth, round margins - Low level homogeneous echoes - Iso to hypoechoic - May enhance - May have calcs if degenerating

Fatty tumor anywhere in the body - Middle aged to post menopausal - May grow large before found

Smooth wall - Isoechoic to breast tissue - May enhance - Easily compressible

Usually follows trauma, surgery, radiation, or mastitis

Complex and irregular area - Can be confused with malignancy - May shadow - May contain fluid

Inflammation of breast tissue - Infectious or noninfectious - Usually in lactating women

Painful, tender localized area - Skin may be red - Elevated WBCs

Worse pain - Larger area - Fever chills - Abscess

Pain, swelling, redness, fever, enlarged axillary lymph nodes - Mammo probably intolerable

Hypoechoic to anechoic - Heterogeneous fluid pockets with irregular borders - Echogenic parenchyma around pocket - Skin thickening - Increased color doppler around but not in pocket

Within major lactiferous duct, usually subareolar - Spontaneous clear or bloody nipple discharge

Dilated duct with iso or hypoechoic solid lesion - May be intracystic: small mass growing inside lumen of cyst

Borderline between benign and malignant - 5 to 25% malignant - Usually very large and fast growing - Women 42 to 45 years old - Must be removed due to malignant potential - Recur 27% of the time

Well defined solid mass - Looks like fibroadenoma on U/S and under microscope

Most common non invasive carcinoma of breast - Confined to ductal structures - Usually no symptoms, occasional palpable mass or nipple discharge

Possible small, hypoechoic mass with hazy echogenic outline - May see microcalcs - Intraductal mass/irregular ductal dilation ** Usually not seen on U/S

Premenopause - In duct - No discrete mass - Usually incidental finding - Greater risk for breast cancer but lumpectomy not recommended

B/L - Multicentric

Most common invasive breast cancer - Starts in duct but spreads to adjacent stroma - Mets potential

Asymptomatic - Hard, fixed, palpable - Nipple discharge - Skin thickening/dimpling - Axillary adenopathy

Hypoechoic mass, spiculated, and poorly defined - Taller than wide - Hypoechoic shadow - Microlobulations - Microcalcs - Mass extending thru duct - Fascial plane disruption

2nd most common invasive breast cancer - B/L - Multicentric and multifocal - Same treatment as LCIS - Spiculated mass mimicking IDC on U/S

Rare - Aggressive - Usually presents with skin changes; "Peau d'orange" red and warm

Non-focal, can look like edema, U/L

Circumscribed, non tender lump, often large - More in younger women - Mimic fibroadenoma

Solid, hypoechoic, oval or lobulated - Homogeneous - Posterior enhancement - Hemorrhage or cystic degeneration possible

Hypoechoic or isoechoic - Homogeneous - Possible microcalcs

Palpable lump in elderly patients - Skin retraction or dimpling

Hypoechoic - Cystic spaces - Appearance of hemorrhage

Variant of DCIS - Found at nipple - Nipple/areolar skin thickening, pruritus, cracking, reddening, scaling - No sono findings

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