Mammography

Quiz
1. Skin thickening can be malignant but could also be caused by nonmalignant factors such
as
Ans: sarcoidosis
2. A rare form of cancer that presents with swelling, warmth, or erythema and
mammographically with skin thickening describes
Ans: inflammatory carcinoma
3. The 5-year survival rate for a patient with a stage 0 breast cancer is about
Ans: 100%
4. All women above the age of _______ should perform a BSE regularly
Ans: 20
5. Morgagni tubercles are usually found
Ans: on the areola
6. Sometimes described as an oil cyst, this lesion represents an encapsulated area on the
mammogram and can be caused by surgery, biopsy, trauma, or radiation therapy
Ans: fat necrosis
7. A benign self-limiting breast tumor that is the result of new disorganized cell growth is
Ans: hamartoma
8. An asymptomatic patient presents with an oval, lobulated tumor with unsharp margins.
There is no evidence of a halo sign
Ans: The lesion could be malignant
9. The American College of Surgery recommends that
Ans: new masses or lumps in the breast should be checked by a health-care provider
10. A Breast Self Examination should be done regularly by
Ans: the patient
11. A woman with the greatest risk of developing breast cancer is
Ans: above age 50
12. For a menstruating woman, when is the best time of the month to perform a BSE?
Ans: when the breast is least tender
13. Computer Aided Diagnosis (CAD) is used to
Ans: analyze or preread the image
14. Lymph drainage from the medial half of the breast is generally directed to the
Ans: internal mammary lymph nodes
15. Immediately behind the nipple, there is a widened area of the collecting duct called the
Ans: lactiferous sinus
Modules
Which statement is correct?
Ans: a. The structure of the male breast is nearly identical to that of the female breast.
What happens to the breasts at menopause?
Ans: d. Declining estrogen levels at the menopause make breast tissue dehydrated and less
Elastic
What cyclical changes happen to the breasts during the menstrual cycle?
Ans: c. Changes in breast texture.
What is the first visible sign of breast development?
Ans: c. The breast becomes rounded and only the nipple is raised.
It is describe as the first breastfed receive by baby.
Ans: b. Colostrum
What happens during perimenopause?
Ans: b. Estrogen levels dramatically decrease. This leads to many of the symptoms commonly
linked to menopause.
What symptoms experience by women taking hormone during peri menopause?
Ans: c. on and off menstrual bleeding.
It is the time in woman's life when her period stops.
Ans: c. Menopause.
Describes the secretion of milk from the mammary glans and the period of time the mother
lactates to feed her young.
Ans: a. Lactation.
It is a period of time after a woman has not bled for an entire year.
Ans: c. Post menopause
What is the code for, Malignant tumor 10 o’clock, right breast?
Ans: a. C504, superior lateral.
What is the code for, Metastatic tumor, 4 o’clock , left breast?
Ans: b. C505, inferior outer lower lateral
Which of the following statement is correct?
Ans: c. BI-RADS 2: benign, 0% probability of malignancy
d. BI-RADS 3: probably benign, <2% probability of malignancy short interval follow-up
suggested
Which of the following statement is correct?
Ans: a. BI-RADS 0: incomplete, need additional imaging evaluation (additional mammographic
views or ultrasound) and/or for mammography, obtaining previous images not available at the
time of reading
b. BI-RADS 1: positive, symmetrical and no masses, architectural distortion, or suspicious
calcifications
c. BI-RADS 2: benign, 0% probability of malignancy
Which of the following statement is correct?
Ans: b. BI-RADS 1: negative, symmetrical and no masses, architectural distortion, or suspicious
calcifications
c. BI-RADS 2: benign, 0% probability of malignancy
What BI-RAD 3 indicates?
Ans: b. negative, symmetrical and no masses, architectural distortion, or suspicious
calcifications
How many percent BI-RADS 5 indicate for malignancy?
Ans: c. >95%, highly suggestive malignancy.
What BI-RADS Category 6 indicates?
Ans: a. known biopsy-proven malignancy
What BI-RADS stands for?
Ans: d. Breast Imaging Reporting and Database System Score
What does BIRADS 2 categorize?
Ans: b. Benign.
Which of the following is the correct answer?
Ans: b. Axillary Tail of Spence: variable in size, is a narrow part of the mammary gland that
extends to the axilla.
Which of the following is the correct answer?
a. Nipple: The nipple protrudes inward from the outer area of the areola.
b. Axillary Tail of Spence: variable in shape, is a narrow part of the mammary gland that
extends to the axilla.
c. Skin: The breasts are covered by mammary glands.
d. Inframammary fold (IMF): zone of distal from superficial fascial system to the underlying
chest wall.
Ans: NOTA
Which of the following is the correct answer?
Ans: b. Axillary Tail of Spence: variable in size, is a narrow part of the mammary gland that
extends to the axilla.
c. Skin: The breasts are covered by skin.
It is anatomically defined as the area where the skin of the lower pole of glandular breast
tissue meets the chest wall.
Ans: d. Inframammary fold (IMF)
It is a gland that produce and secrete substances onto an epithelial surface by way of a duct.
Ans: b. Sweat glands
These ligaments maintain the shape and structure of your breasts and help to prevent
sagging
Ans: d. Cooper's ligaments
It store the excess energy and release it when required by the body.
Ans: a. Adipose Tissue
Its function is to conduit for milk.
Ans: a. Luminal Cells
They suppress stromal invasion of tumor cells by the secretion of various anti-angiogenic
and anti-invasive factors.
Ans: b. Myoepithelial Cells
What is the transport system for milk?
Ans: d. Milk ducts
It forms the outer layer of luminal cells and basement membrane
Ans: b. Myoepithelial Cells
Which statement is correct.
Ans: c. Breast development begins during second month of gestation.
Which statement is correct.
Ans: c. Breast development begins during second month of gestation.
It provides majority of the breast volume.
Ans: c. Interlobular stroma
What TLDU stands for?
Ans: d. Terminal Ductal Lobular Unit
It is surrounds and supports acini of TDLU
Ans: c. Intralobular stroma
Which statement is correct.
Ans: a. Myoepithelial cells help produce and maintain basement membrane which lesions of
myoepithelial cells often associated with matrix production.
Bacteria invades the breast through small erosions in the nipple of a lactating woman and
abscess can result.
Ans: d. Acute Mastitis
It is a condition for having largest breast.
Ans: b. Macromastia
It is lack of muscle development on one side of the body also characterized by lack of chest
wall.
Ans: d. Poland Syndrome
It is malignant cells multiplying abnormally in the breast, eventually spreading to the rest of
the body if untreated.
Ans: c. Breast Cancer
Breast cancer in the duct cells that has not invaded deeper or spread through the body.
Ans: a. Ductal Carcinoma in situ
A breast biopsy may show normal-appearing, noncancerous ductal cells multiplying
abnormally
Ans: b. Breast Hyperplasia
Enlargement of breast in male.
Ans: c. Gynecomastia
It is considered as most challenging of congenital anomalies in breast.
Ans: d. Macromastia
A rare, usually large, rapidly growing breast tumor that looks like a fibroadenoma on
ultrasound.
Ans: d. Tuberous Breast Deformity
Inflammation of the breast, causing redness, pain, warmth, and swelling.
Ans: b. Mastitis
It is a congenital anomalies which the deformity is a result of a constricting ring at the base
of the breast causing the vertical and horizontal deficiencies.
Ans: b. Tuberous breast deformity
It is a growth of tissue that develops within the breast.
Ans: c. Lumps
It is a non-cancerous tumor made of an abnormal mixture of normal tissues and cells from
the area in which it grows.
Ans: d. Mammary Hamartoma
It is a common sign of inflammatory breast cancer which draws its name from inflamed
appearance
Ans: b. Breast dimpling
Redness of the skin of the breast
Ans: a. Breast erythema
Common congenital malformations that consist of nipple and related tissue in addition to
the nipples normally appearing on the chest
Ans: b. Polythelia
It is a benign uncommon form of stromal overgrowth within breast tissue.
Ans: a. Pseudoangiomatous stromal hyperplasia
It is caused by bacterial infection which is painful build up.
Ans: b. Abscess
A condition on which one or both breast of the mammary glands is absent.
Ans: c. Amazia
Bacteria invades the breast through small erosions in the nipple of a lactating woman and
abscess can result.
Ans: d. Acute Mastitis

Possible Questions
A lesion located in the upper outer quadrant of the right breast is located in the
1. 5-o'clock position
2. 2-o'clock position
3. 10-o'clock position
4. 7-oc'clock position
Ans: 10-o'clock position
An inverted nipple
Ans: sometimes indicates breast cancer
Compression of the breast is most effective and most comfortable when applied against the
Ans: inferior and lateral aspects
The normal breast may have
Ans: 15-20 lobes
The structure that gives the breast its support and shape is called
Ans: Cooper ligament
The breast extends vertically from the
Ans: second through the sixth rib
The thickest portion of the breast is the
Ans: tail of Spence
Cooper ligaments attach anteriorly to the
Ans: fascia of the skin
Typically, a pt with dense fibrous and glandular tissue throughout the entire breast on a
baseline mammogram is
Ans: below 45
Fatty tissue is generally _____ and on the mammogram is seen as areas of _____optical
density.
Ans: radiolucent/higher
Glandular tissue is usually found in the ____ of the breast.
Ans: central and upper outer quadrant
The portion of the breast that holds the milk-producing element is the
Ans: lobule
Veins are normally located
Ans: in the periphery of the breast
The TDLU consists of the
Ans: both the ETDs and the ITDs
A pt began taking synthetic hormones 6 months prior to her current mammogram. The
mammogram is most likely to
Ans: show increased glandular tissue compared to her previous mammogram
A baseline mammogram shows that the pt's breast consists primarily of adipose tissue. This
pt is most likely to be
Ans: above 60
Which of the following will affect the ratio of glandular tissue to total breast tissue?
1. the woman's genetic predisposition
2. ratio of total body adipose tissue to total body
weight
3. drastic weight gain or weight loss
Ans: 1, 2, and 3
A woman is referred to as nullipara. This means
Ans: she has never given birth to a viable offspring
Hormone replacement therapy could be recommended to?
1. relieve insomnia symptoms
2. prevent osteoporosis
3. reduce weight gain
Ans: 1 and 2 only
Characteristics of a malignant stellate tumor include which of the following?
1. The spicules are generally bunched together.
2. The presence of a central tumor mass.
3. the larger the tumor, the longer the spicules.
Ans: 2 and 3 only
The radial scar or sclerosing duct hyperplasia
1. can sometimes be mistaken for carcinoma
2. sometimes has a solid dense central tumor
3. is usually not associated with skin thickening
or dimpling over the lesion
Ans: 1 and 3 only
A mammogram shows a low-density radiopaque tumor. It is oval, lobulated, and a halo is
seen along one border only. The next step should be
Ans: ultrasound
An infusa-port can be used to
Ans: allow repeated access to the venous system
The biggest risk factor for breast cancer is
Ans: gender
One of the minor risk factors for breast cancer could be
Ans: not breastfeeding
What is the approximate risk of developing breast cancer for a woman whose sister has the
disease?
Ans: higher than normal risk
Symptoms of a possible breast disease that will not be demonstrated on the mammogram
may include
Ans: nipple discharge
Symptoms of very early DCIS may include
Ans: None of the above
Risks factors associated with taking hormone replacement therapy (HRT) include
Ans: increased risks for breast cancer
A health care provider should evaluate which of the following breast changes?
1. lumps or swellings
2. skin irritation or dimpling
3. milky discharge from the nipple
Ans: 1 and 2 only
It is necessary for the technologist to document which of the following?
Ans: all of the above
Pre-examination instructions that can be given to the patient include
Ans: A and B
Benefits of communication with your patient include
Ans: all of the above
In developing patient rapport, the technologist should strive to enhance the patient's self-
esteem. This means that the technologist should
Ans: offer reassurance and encouragement if the patient is confused or unable to help herself
The two-step method of BSE is to
Ans: look and feel for changes in the breast
When visually inspecting the breast, the changes that should be recorded include:
1. changes in breast size and shape
2. changes in texture or color of the breast
3. indentations on the skin of the breast
Ans: 1, 2, and 3
Stressing the importance of the BSE can be controversial because:
Ans: BSE can cause unnecessary anxiety in women
Postmenopausal obesity is associated with
Ans: circulating estrogen that is produced in fatty tissue
The patient's medical history and documentation will
1. provide the radiologist with information on the patient's risk factors for breast cancer
2. give the radiologist information about general symptoms of breast cancer
3. provide information about possible benign breast conditions of the patient
Ans: 1 and 3 only
Which of the following are methods used in BSE?
1. using the pads of the three middle fingers to palpate the entire breast
2. palpating around the breast in a vertical pattern
3. using varying degrees of pressure while palpating of the breast
Ans: 1, 2, and 3
Which of the following statements is true?
1. Breast cancer death rates in the United States are going down.
2. Breast cancer is the leading cause of cancer-related deaths among women in the United
States.
3. The second leading cause of cancer-related deaths among women in the United States is
breast cancer.
Ans: 1 and 3 only
In routine mammography, the glandular dose per projection is generally about
Ans: 1-2 mGy (0.1-0.2 rad)
Which age group is likely to get the most radiation dose during mammography?
Ans: 20 to 35 years
During mammography, which of the following will affect the average glandular dose per
breast?
1. degree of breast compression
2. the half-value layer (HVL) of the x-ray beam
3. breast size and composition
Ans: 1, 2, and 3
In breast imaging, the dose calculation is based on
Ans: dose absorbed by the glandular tissue of the breast
What is the purpose of requesting the patient to provide prior mammograms before starting
the mammogram examination?
Ans: to provide the radiologist with an additional aid
Patients who are allowed to play an active role in applying compression are usually
1. less likely to tolerate the compression
2. more likely to tolerate the compression
3. more relaxed during the compression
Ans: 2 and 3 only
The age of a woman taking HRT is likely to be:
Ans: over 40 years
The term primipara refers to a woman who
Ans: carried a pregnancy to over 20 weeks but had a stillbirth
In mammography, information included on the medical history documentation includes
which of the following as they relate to the breast?
1. patient's history of trauma
2. history of surgery
3. unusual skin condition
Ans: 1, 2, and 3
All of the following are forms of subjective patient data except
Ans: patient has a palpable lump in the right breast
When questioning a patient to obtain an accurate patient history
Ans: start with open-ended questions and then follow up with more direct inquiries
Which of the following are positive questioning skills that the radiographer can use when
verifying the accuracy of patient information?
Ans: repeating information
What is the purpose of "probing" questions used when interviewing patients?
Ans: clarifies information by asking for specific details
In gathering more information on a patient's complaint of pain, a good probing question to
ask would be
Ans: "If the pain comes and goes, how often does it occur, and what is the time span between
occurrences?"
When questioning your patient, what is the purpose of repetition?
Ans: to summarize
There are two types of data collection processes. If your patient says he or she has a bruise
on the left breast, this information is regarded as
Ans: objective
"Where is your pain?" is an example of
Ans: an open-ended question
Which of the following will not result in increased breast cancer risks?
Ans: having a first child before age 30 years
An informed consent is required before performing which of the following examination?
Ans: fine-needle biopsy (FNB)
Phone consent is an example of
Ans: oral consent
The patient has to sign an informed consent
1. when there are significant risks associated with the procedure or test
2. for all diagnostic examinations in the imaging department
3. if the procedure is invasive
Ans: 1 and 3 only
Which kind of consent is binding but difficult to prove?
Ans: oral
Which of the following is not required information that must be included on any informed
consent?
Ans: patient height and weight
Methods of acknowledging the patient and treating the patient courteously can included all
of the following except
Ans: avoiding eye contact
The glandular dose is
Ans: associated with dose to the radiosensitive cells of the breast
The technologist should review the previous mammography report to
Ans: confirm the type of exam (screen or diagnostic) needed
Two disadvantages of mammography screening include
1. the granularity of the breast can impact visualization of cancers
2. mammography will not image all cancers
3. the radiation dose from mammography is dangerous
Ans: 1 and 2 only
Having a dense breast will
Ans: increase the risk of breast cancer
Why should the patient remove deodorant before mammography?
Ans: Deodorant can mimic malignant calcifications.
Generally when is the best time to do a BSE?
Ans: The patient should perform BSE 5 to 10 days after the start of the menstrual period or
when the breasts are not tender or swollen.
In gathering more information on a patient's complaint of pain, a good open ended question
to ask would be
Ans: "When did the pain first occur?"
During a mammogram, which of the following will affect the average glandular dose per
breast?
1. Degree of breast composition
2. The HVL of the X-ray beam
3. Breast size and composition
Ans: 1, 2, and 3
A health care provider should evaluate which of the following breast changes?
1. Lumps or swelling
2. Skin irritation or dimpling
3. Milky discharge from the nipple
Ans: 1 and 2
Which of the following hormones is responsible for lobular proliferation and growth?
Ans: Progesterone
The first step in evaluating a woman with suspected breast cancer is a:
Ans: Complete medical history and CBE
Sclerosing duct hyperplasia (radial scar):
1. Can sometimes be mistaken for carcinoma
2. Sometimes has a solid dense central tumor
3. Is usually not associated with skin thickening or dimpling over the lesion
Ans: 1 and 3
The first step in evaluating a woman with suspected breast cancer is a:
Ans: Complete medical history and CBE
A radiolucent implant used in breast reconstruction is the:
Ans: TRAM flap implant
A patient with breast cancer in one breast will have ________ risk of developing cancer in
the opposite breast
Ans: Greater
A technique describing reshaping of the breast is called:
Ans: Mammoplasty
Breast reconstruction options include:
1. Flap surgery
2. Implants
3. TRAM flap
Ans: 1, 2, 3
Of the three basic types of biopsy procedures, which is used to evaluate no palpable lesions
which will likely go to surgery?
Ans: Needle localization
During a CBE, lumps or masses in the armpit may indicate the spread of breast cancer to
lymph nodes in the:
1. Axilla
2. Collarbone
3. Arm
Ans: 1 and 2
MR is a 42 y.o. female with newly diagnosed inflammatory right breast cancer. What is the
best option for primary therapy at this time?
Ans: Chemotherapy.
The estimated risk for breast cancer is which of the following?
Ans: 1 in 8
Most women with breast cancer present with:
Ans: A painless lump in the breast.
Which of the following are considered risk factors for developing breast cancer?
Ans: Age, hormone replacement therapy, first pregnancy after age 30.
Which of the following hormonal therapies is most appropriate for adjuvant treatment in a
premenopausal woman?
Ans: Tamoxifen
What is the most common type of breast lump?
Ans: Fibrocystic Change
What is the most common benign tumor of the breast?
Ans: Fibroadenoma (in women <40 yo)
What is the Etiology of fibroadenomas?
Ans: Estrogen-dependent --> 3rd decade of life (young women)
What are the gross morphologic characteristics of Fibroadenomas?
Ans: small, firm, well-circumscribed
Are fibroadenomas firm or freely movable?
Ans: freely movable
What is significant about ducts in fibroadenomas?
Ans: gross and histologcial appearance show flattened ducts from fibrotic tissue expansion
What are the histological findings of fibroadenomas?
Ans: 1.biphasic fibroepithelial lesions, fibrous and epithelial component, stromal proliferation
and non-neoplastic epithelial cells line ducts
2. Loose fibroblastic stroma w/ductlike structures
What are the two forms of a fibroadeoma?
Ans: 1. Pericanalicular Fibroadenoma (open)
2. Intracanalicular Fibroadeoma (closed)
What is the clinical significance of fibroadeomas?
Ans: 1. palpable mass --> painful or painless
2. size/tenderness change w/menstrual cycle
Is there any risk of fibroadenoma and CA?
Ans: NO unless:
1. +atypical changes
2. Family History BCA
Are fibroadeomas isolated masses?
Ans: NO --> 10-20 % have multiple
50% women takin WHAT medication after WHAT procedure develop firboadenomas?
Ans: cyclosporine after Renal Transplants
What is a phyllodes tumor?
Ans: tumor of stromal cell origin
Are phyllodes tumors benign or malignant?
Ans: Usually benign but can become malignant
Malignant signs --> stromal hypercellularity and increased mitosis
What is the most common type of benign breast lesion which demonstrates a broad range of
histological features?
Ans: Fibrocystic Change
What is the most common painful breast mass in women under 50yo?
Ans: Fibrocystic Change
What are "blue-domed" cysts?
Ans: Hemorrhage into the cystic space
What are the gross features of fibrocystic change?
Ans: ill-defined, firm tissue, blue-domed cysts
What are the different kinds of fibrocystic change?
proliferative and non-proliferative fibrocystic change
What are the features of non-proliferative fibrocystic change?
Ans: Cysts, Fibrosis, Apocrine Metaplasia
What is the key component about cystic change in fibrocystic change?
Ans: cysts are lined by two epithelial layers not one (CA)
What is the eosinophilic (pink) component of fibrocystic change?
Ans: Collagen
What are the features of Proliferative Fibrocystic Change?
Ans: Epithelial hyperplasia w/w/o Atypia, Sclerosind Adenosis, Radial Scar, Papilloma
What is Sclerosing Adenosis?
Ans: Fibrotic stroma w/markedly distorted ducts and lobules --> proliferation of small
ductules/acini in lobule
What other histological findings are associated with sclerosing adeonosis?
Ans: microcalcifications
Is Sclerosing Adenosis benign?
Ans: Yes! But higher risk for developing CA versus non-proliferative fibrocystic change
What is the clinical significance of fibrocystic change?
Ans: 1. palpable mass
2. mimicks CA clinically, grossly, and even histologically
What histological markers mean minimal or no increased risk for developing CA?
Ans: Fibrosis, Cysts, Apocrine Metaplasia, Adenosis, Mild Hyperplasia, Fibroadenoma w/o
complex features
What histological markers show slightly increased risk of developing CA?
Ans: Sclerosing Adenosis, Radial Scar, Papilloma, Fibroadenoma with complex features,
Moderate hyperplasia
What histological markers significantly increase risk for developing CA from Fibrocystic
Change?
Ans: Atypical ductal hyperplasia and Atypical lobular hyperplasia
Does FH increase risk of developing BCA?
Ans: Yes, in all categories. However, only 13% of pts w/ first degree relative w/BCA go onto
develop BCA
What percentage of pts with FH BCA DO NOT go on to develop BCA?
Ans: 87%
What is an intraductal Papilloma?
Ans: neoplastic papillary growth within a lactiferous duct or sinus
What is the most common cause of bloody nipple discharge females < 50?
Ans: intraductal papilloma
What are the distinctive Histological features of intraductal papilloma?
Ans: 1. Many ducts involved
2. papillae lined by cuboidal/cylindrical cell
What is the histological features of fat necrosis?
Ans: foamy histiocytes, fibrosis, and dystrophic calcification
What is the most common cancer in women?
Ans: breast carcinoma
What percentage of women diagnosed with BCA die from it?
Ans: 20%
What are the different types of breast carcinoma?
Ans: Non-Invasive and Invasive
What ethnicities are affect more by BCA than others?
Ans: North Americans/Europeans>>Asians and Blacks
What are the age associations with BCA?
Ans: BCA risk increases after 30yo and plateau's after 64
What are the markers for hereditary BCA?
Ans: BRCA1(17q11) and BRCA2(13q12.3)
What are the lifetime risk for BRCA1/BRCA2 carriers?
Ans: 60-85% chance of developing BCA
Median diagnosis of hereditary BCA?
Ans: 20 yrs prior to normal individual
Hereditary Familial BCA has a higher risk for what other diseases?
Ans: 1. Ovarian CA (BRCA1 20-40%)
2. Male BCA (BRCA2)
What other CA's are hereditary BCA pts at risk of developing?
Ans: Prostate, Colon, Pancreas, ect.
What menstrual hx affects BCA?
Ans: early menarche (x<12yo)
late menopause (x>55yo)
What other risk factors exist for BCA?
Ans: nulliparity, Exogenouse Estrogen Use, Obesity, High-Fat diet, ETOH, smoking
What are some of the genetic mutations of BCA?
Ans: Her2/Neu, c-ras, c-myc, p53
What are some hormonal influences of BCA?
Ans: Progesterone/Estrogen receptor expression
What are the two types of BCA?
Ans: ductal and lubule
What are the two types of non-invasive breast carcinoma
Ans: DCIS and LCIS
What are the two types of invasive BCA?
Ans: invasive ductal carcinoma and invasive lobular carcinoma
What is DCIS/LCIS?
Ans: ductal/lobular carcinoma confined to the lobules or ducts and has not invaded the BM
What is another name for DCIS?
Ans: intraductal carcinoma
Where does DCIS/intraductal carcinoma arise?
Ans: ductal epithelium
Of total BCA, what percentage is ductal carcinoma?
Ans: 20-25%
What is the gross morphology of DCIS?
Ans: either mass or invisible
Name four types of ductal carcinoma:
Ans: 1. solid
2. papillary
3. cribiform
4. micropapillary
What is the name of DCIS involving the epidermis?
Ans: Paget's Disease
What is the histological mark of Paget's Disease of the breast?
Ans: proliferation of epithelial cells along dermal/epidermal layer
What is significant about Paget's Disease of the breast?
Ans: There must be underlying disease. Proliferative cells of dermis/epidermis must have come
from the ducts or lobules.
Where does Lobular carcinoma in situ (LCIS) arise?
Ans: acinic or terminal ducts
What are some characteristics of LCIS?
Ans: multifocal (more than one), bilateral (both breasts), 1/3 followed by invasive ductal
carcinoma
What are the gross features of LCIS?
Ans: usually not visible
What is the histological appearance of LCIS?
Ans: neoplastic epithelial cells in lobules, distended lobules, expanded lobules
What is the most common form of BCA?
Ans: invasive ductal carcinoma (70%)
Where does invasive ductal carcinoma arise form?
Ans: ductal epithelium --> tumor cells --> break through BM
What are the gross features of invasive ductal carcinoma?
Ans: ill defined, firm, tan/white, (scirrhous)
What are the histological features of invasive ductal carcinoma?
Ans: tumor cells --> form glands/ducts in stroma
What Histological hallmark should be noticed on invasive ductal carcinoma?
Ans: ducts/glands in stroma should only have one epithelial layer
Where does invasive lobular carcinoma arise?
Ans: epithelium of lubules or terminal ducts
What is the gross appearance of invasive lobular carcinoma?
Ans: ill defined, dense, fibrotic mass
What are the histological markers of invasive lobular carcinoma?
Ans: 1. tumor cells do not form glands
2. individually infiltrate collagen and line up single file
3. signet-ring morphology
What other types of breast carcinoma exist?
Ans: 1. Tubular
2. Mucinous
3. Inflammatory
4. Papillary
5. Medullary
What is the staging of DICS, LCIS, and Paget's Disease?
Ans: Stage Tis
What is the 5-yr survival of DCIS, LCIS, and Paget's Disease?
Ans: 92%
What is the staging of a tumor<2cm with no metastasis?
Ans: stage I
What is the staging of a tumor > 2cm but < 5cm with lymph node metastasis but no distant
metastasis?
Ans: stage II
What is the 5yr survival of stage I BCA?
Ans: 87%
What is the 5yr survival of Stage 2 BCA?
Ans: 75%
What is the staging of a tumor > 5cm w/w/o local spread, fixed or not?
Ans: Stage III A
What is the staging of a tumor 5cm or larger with homolateral local spread?
Ans: Stage IIIB
What is the 5yr survival rate for Stage III A/B?
Ans: 46%
What is the staging of a 5cm tumor w/w/o local spread with distant metastasis?
Ans: Stage IV
What is the 5yr survival rate of Stage IV BCA?
Ans: 13%
What is the most important prognostic factor of BCA?
Ans: axillary lymph involvement
What is significant about Her2/neu?
Ans: poor prognostic, good predictor
What percentage of BCA has Her2/neu amplification?
Ans: 20%
Composition of the breast
Ans: glandular and fibrous tissue embedded within a fatty tissue matrix w/ blood vessels,
lymph, and nerves
Location of the breast
Ans: the breast is located in the superficial fascia (subcutaneous tissue) over the pectoralis
major muscle. It extends from the sternum to midaxillary line and from the 2nd rib to the 6th
rib
Sweat gland in the breast for milk production and secretion
Ans: modified apocrine gland
Located at the prominence of the breast
Ans: nipple
Located at the level of the 4th intercostal space
Ans: nipple
Circular pigmented area surrounding the nipple
Ans: areola
Allows movement of the breast on pectoral fascia
Ans: retromammary space
Connect lobules to the tip of the nipple
Ans: Lactiferous ducts
Dilated portion of the lactiferous ducts deep to the areola that accumulates milk in the
lactating mother
Ans: Lactiferous sinus
Supply the breast, Arteries derived from the internal thoracic arteries which branch off of
the subclavian artery
Ans: Medial mammary branches
Arteries that supply the breast and are derived from the axillary artery
Ans: Lateral thoracic branches
Arteries that supply the breast
Ans: Median mammary branches and the lateral thoracic branches
Veins which the breast vessels drain into
Ans: Axillary vein and internal thoracic vein
Components of the lymphatics in the breast
Ans: Subareolar lymphatic plexus, axillary lymph nodes, parasternal lymph nodes
Carries lymph drainage from nipple, areola, and lobules in the breast
Ans: Subareolar lymphatic plexus
Located in the medial breast quad. Pass deeply to abdominal lymph nodes
Ans: Parasternal lymph node
Drain most of the lateral portion of the breast to the subclavian lymphatic trunk then to the
right or left lymphatic ducts
Ans: Axillary lymph nodes
Condition that suggest the possibility of breast cancer and are important in early detection
of breast cancer
Ans: Enlargement of axillary lymph nodes
Anterior rami carrying sensory from skin of breast and sympathetic fibers to blood vessels in
breast and smooth muscle in overlying skin and nipple
Ans: Intercostal nerve T4-T6
Anatomical division of the breast
Ans: 4 quads : sup and inf lateral sup and inf medial
4 quad division is used for
Ans: Description for tumor and cysts
The major part of the breast tissue is situated between the _________ & _________ rib
superiorly
Ans: 2nd & 3rd
The ______ and ________costal cartilage inferiorly
Ans: 6th & 7th
The __________ axillary line laterally, and the ___________border medially.
Ans: anterior sternal
Extension of the breast tissue into axillary region
Ans: Tail of Spence.
The surface is dominant by the nipple surrounded by______________
Ans: areola
Where would supernumerary nipples occur
Ans: along mammary milk line
3 layers located between skin and Pectoral major muscle
Ans: Subcutaneous, The mammary/glandular layer, Retro mammary layer:
Subcutaneous
Ans: Consists of fat surrounded by connective tissue septa known as Coopers ligament
Cooper"s ligaments
Ans: Connects the fascia around the ducts and glands and extends out to the skin
US appearance of subcutaneous layer
Ans: fat layer appears as hypo echoic surrounded by echogenic septa
Mammary (Glandular) layer
Ans: functional portion of the breast and the surrounding supportive (stromal) tissue
Glandular tissue of breast
Ans: 15 to 20 glandular lobes that are responsible for the production of milk during lactation.
Each lobule contains___________ (milk producing glands), which are clustered on the
terminal ends of the _________
Ans: acini, ducts
What do The terminal ends of the duct and the acini form?
Ans: terminal ductal lobular units (TDLUs)
What are the terminal ductal units surrounded by
Ans: loose and dense connective tissue
Normal TDLU's measure
Ans: 1-2mm
Retro mammary layer of breast
Ans: Posterior layer containing retromammary fat muscle and deep connective tissue
bordered posterior early by pectoralis major muscle
Retro mammary layer appears sonographically
Ans: hypoechoic band located anterior to an echogenic rib
How many lobes in your breast?
Ans: 15-20
What are the ligaments that separate the fat in the breast called?
Ans: coopers ligament
Sonographic appearance of the normal breast
Ans: The boundaries of the breast are the skin line, nipple, and retromammary layer. These
generally give strong, bright echo reflections
Sonographic appearance of the internal nipple
Ans: low to bright reflections with posterior shadowing, and it has a variable appearance
The sonographic appearance of the mammary layer
Ans: If little fat is present, a uniform with an architecture with a strong echogenic pattern
The breast gets more __________ with age
Ans: dense
The main arterial supply to the breast comes from
Ans: internal mammary and lateral thoracic arteries
Lymphatic drainage from all parts of the breast generally flows to the
Ans: axillary lymph nodes
Gynecomastia
Ans: Abnormal development of breast tissue in males (male breast cancer) deadly
Mammogram fibroadenoma is known as
Ans: popcorn
2 types of ductal carcinoma
Ans: 1. In situ (second most common)
2. Infiltrating (more common)
Phyllodes tumor
Ans: Rare, Solid tumor, benign or malignant
Phyllodes tumor is more common in
Ans: women 30-50
Lymphoma is more common in
Ans: 50 - 60 years old
Sono appearance of lymphoma
Ans: Single or multiple, Hypoechoic
Breast cancers are usually a type of cancer called adenocarcinoma, which means it originates
in _______________.
Ans: glandular tissues (ducts and lobes of the breast)
About 80% of invasive breast cancers are ______________.
Ans: infiltrating ductal carcinomas (IDC)
Cancer cells may have ____________________.
Ans: all choice listed below
Group 4 (Basal-like) includes tumors that are ER negative, PR negative and HER2 negative,
also called _________________breast cancer.
Ans: triple-negative
A reduction in breast cancer incidence of nearly 7% decrease was seen from 2002 to 2003 as
the result of __________________.
Ans: a decrease in the use of menopausal hormone therapy associated with the results of the
WHI Study
The American Cancer Society points out that the mortality rate from breast cancer in the
Unite States has _________________ since 1989, which translates to 322,600 deaths
avoided.
Ans: dropped 39%
_______________________ is the term used to describe enlarged lymph nodes in the axilla.
Ans: Adenopathy
The average doubling time for a breast cancer cell is 90 to 100 days, which means the cancer
existed for _________________ before becoming clinically evident.
Ans: 8 to 10 years
Nipple retraction is significant _________________________.
Ans: only if it represents a recent change from what the patient considers to be normal
A previous surgical biopsy could result in an area of __________________of the skin.
Ans: focal thickening
An example of diffuse (widespread) thickening of the skin is in the
_______________________, which is often accompanied by trabecular thickening.
Ans: radiated breast
A visual increased prominence of _____________________ on the surface of the breast is a
clinical finding that is suggestive of angiogenesis of a tumor.
Ans: blood vessels
The symptoms of ___________________ begin when cancer cells block the lymphatic
channels in the skin of the breast resulting in the building of lymphatic fluid under the skin.
Ans: inflammatory breast cancer
A/An ___________________ is the most common benign breast mass in women between
the ages of 35 to 50 years, but can occur at any age.
Ans: simple cyst
A _________________ is the most common benign mass found in pregnant or lactating
women who present with a palpable lump.
Ans: galactocele
A ________________ is the most common benign SOLID mass occurring in women of all
ages.
Ans: fibroadenoma
Calcified fibroadenomas are often referred to as ____________________ calcifications
Ans: coarse or popcorn-like
A __________________ is described as a fatty tumor and is always considered to be a benign
finding on mammography.
Ans: lipoma
A __________________ is also referred to as 'breast-within-a-breast' because it is an
encapsulated mass that contains a mixture of fibrous, glandular and fatty tissue, just like a
normal breast.
Ans: hamartoma or fibroadenolipoma
A benign papilloma is the most common cause of a/an __________________.
Ans: spontaneous, clear or bloody/clear (serosanguineous) nipple discharge
The clinical findings of inflammation and an abscess may mimic __________________, so
malignancy must be excluded.
Ans: Inflammatory Breast Cancer (IBC)
______________________ calcifications are typically round with radiolucent centers and are
most commonly seen along the inframammary fold, parasternal, overlying the axilla, and
around the areola.
Ans: Benign skin / dermal
__________________ calcifications are found within the lumen of the duct.
Ans: Large rod-like
The calcifications associated with _______________ are benign and gravity-dependent.
Ans: milk of calcium
___________________ represents 85% of breast masses in male patients and is the most
common abnormality of the male breast.
Ans: Benign gynecomastia
When a breast infection occurs ______________, it is referred to as lactational mastitis.
Ans: while the patient is breastfeeding
The most important thing to remember about ___________ is that it is not considered to be
a true cancer.
Ans: Lobular Carcinoma in situ (LCIS)
Atypical ductal hyperplasia (ADH) is the stage of cancer development that precedes DCIS, so
it is classified as a/an _____________________.
Ans: high-risk lesion
Ductal Carcinoma in situ (DCIS) is commonly detected on routine screening mammograms in
asymptomatic patients by the visualization of suspicious _________________.
Ans: microcalcifications
A common clinical finding with inflammatory carcinoma is a pitting appearance on the
surface of the breast, referred to as _______________ because the skin resembles an orange
peel.
Ans: peau d'orange
The patient with Paget disease of the breast typically complains of redness, scaling,
bleeding, and erosion to the _____________________.
Ans: nipple and areola regions
From the list below, identify the type of calcifications that are NOT associated with a higher
probability of malignancy.
Ans: Rim calcifications
Male breast cancer represents ___________ of all diagnosed breast cancers.
Ans: less than 1%
As a general rule, hard lumps with ______________ that are fixed in place and cannot be
moved around within the breast tissue are suspicious for breast cancer.
Ans: irregular margins
Ductal Carcinoma in Situ (DCIS), a cancer often detected on a screening mammogram, is
classified as _______________________.
Ans: Stage 0
An ____________ is identified when a patient presents with a new palpable lump in her
breast within one year of a negative screening mammogram and the lump is diagnosed as
cancer following biopsy.
Ans: interval cancer
________________, which occur in women with few or no family members with a history of
breast cancer, represents about 70% of breast cancer cases.
Ans: Sporadic breast cancer (SBC)
The breast is called a
Ans: mammary gland
External landmarks of the breast
Ans: nipple, inframammary fold, and axilla
Location of the base of the breast
Ans: portion adjacent to the chest wall
Location of the apex of the breast
Ans: the nipple
Four named quadrants that describe location in the breast
Ans: Upper outer quadrant, Upper inner quadrant, Lower inner quadrant, Lower outer
quadrant
Triangulation
Ans: render the quadrant and approximate clock time of the abnormality
Where is the skin thickest and thinnest of the breast?
Ans: thickest at base, thinnest at nipple
Where does the breast lie along the pectoralis major muscle?
Ans: anterior
Which direction does the pectoralis major muscle lie?
Ans: in an oblique line from the humerus to midsternum
What separates the breast from the pectoral muscle?
Ans: a layer of adipose [fat] tissue and connective fascia [ fibrous tissue enclosing a muscle or
other organ]
What occupies the skin of the body of the breast?
Ans: Sweat glands, sebaceous (oil) glands, and hair follicles that open to form pores
A small gland in the skin which secretes a lubricating oily matter (sebum) into the hair
follicles to lubricate the skin and hair
Ans: Sebaceous gland
A small gland that secretes sweat, situated in the dermis of the skin
Ans: sweat gland
Area of skin that is darker than the rest of your breast skin
Ans: Areola
Small bumps on the areola may be?
Ans: Montgomery's glands or hair follicles.
Center part of the breast at the apex
Ans: nipple
Specialized sebaceous type glands providing lubrication during lactation
Ans: Montgomery's glands, Sebaceous glands are microscopic exocrine glands in the skin that
secrete an oily or waxy matter, called sebum, to lubricate and waterproof the skin and hair of
mammals
Shapes of the nipple
Ans: flat, inverted or prominent
The crevices on the nipple are called
Ans: orifices collecting ducts
Function of collecting ducts
Ans: transfer milk from the lactiferous ducts
The presence of one or more "extra" nipples that might be present on a person's body
Ans: supernumerary nipple, accessory nipples
Common location for accessory nipples
Ans: 6:00 o'clock position near or below the inframammary fold
An extension of breast tissue that extends into the axilla
Ans: Tail of Spence or axillary tail
The place where the breast and the chest meet
Ans: Inframammary fold IMF {6th or7th rib}
Elevations formed by the openings of the ducts of the Montgomery glands located near the
periphery of the areola
Ans: Morgagni tubercles aka Montgomery tubercles
Connective tissue that surrounds all mammary tissues and separates the breast into
superficial and deep tissues
Ans: fascia
2 layers of breast fascia
Ans: Superficial layer (superficial fascia) within the premammary layer.
Deep layer (deep fascia) lies posterior to the mammary layer within the retromammary space
The _______ layer of breast fascia sits immediately on top of the pectoralis muscle, and
the_________ layer sits just under the skin
Ans: deep, superficial
A layer of adipose tissue and connective fascia that separates the breast from the pectoral
muscle and allows breast motion over the chest wall
Ans: retromammary fat space
A band of fatty tissue apparent posterior to the glandular island in most women
Ans: Retroglandular fat space
What are the margins of the breast?
Ans: lies anterior to and courses along the pectoral muscle. Its margins can reach the clavicle
superiorly, the latissimus dorsi muscle laterally, and the sternum medially; it extends into the
axilla
Include ligaments, supportive tissues (stroma), and scar tissues and can become more
prominent than the fatty tissues in an area of the breast, possibly resulting in a firm or
rubbery bump
Ans: fibrous tissue
All the cells of that area that have an essential function.
Ans: the parenchyma of an body part
Breast parenchyma include
Ans: milk ducts and the glands that produce the milk glandular tissues, Lymphatic network
Scientific term for all of the tissue on the breast that is not part of the parenchyma
Ans: stroma
Atrophy [wasting away] of glandular tissue begins medially and posteriorly, working its way
to the________
Ans: nipple
When the breast increases in size during pregnancy or by weight gain then weight loss..what
happens to cooper's ligament
Ans: Cooper's droop
Other tissues that give the breast structures support are?
Ans: extralobular and intralobular stroma
What does the extralobular stroma hold?
Ans: larger ductal structures
What is a specialized tissue that gives the lobule its shape and definition
Ans: intralobular stroma
Adult women have 15-20 _______ in each breast
Ans: lobes
Each lobe has 20-40 ________
Ans: lobules
Ducts that join together like branches of grape stems, gradually forming into larger ducts.
Ans: Small milk ducts are attached to the lobules
There are about 10 duct systems in each breast, each with its own opening at the ________
Ans: nipple
The 15 to 20 lobes extend from the nipple in a radial pattern allowing normal milk flow.
What might be indicated if the flow looks changed
Ans: possible pathology
Because the pattern and distribution of the glandular tissue is essentially the same
bilaterally. The tissue from one breast will __________ the opposite breast with minor
variations
Ans: "mirror"
What lines the lumen [inside space] of the ducts and smaller ductal structures
Ans: Two layers of epithelial cells changes that take place in the breast mostly occur here
The layer beneath the epithelial layer?
Ans: myoepithelium
A type of smooth muscle that contracts the acini [functional epithelial cells that produce
milk] and ducts to empty these structures of milk produced during lactation
Ans: myoepithelium
The outer layer that lines the lumen [inside space] of the ducts and smaller ductal structures
Ans: basement membrane
Extending from the nipple orifice, the duct starts as a collecting duct that immediately
widens into the lactiferous sinus (ampulla), a pouch-like structure that again narrows as it
joins one or more segmental ducts
Ans: lactiferous sinus (ampulla)
The pouch-like structure that narrows as it joins one or more segmental ducts
Ans: lactiferous sinus (ampulla-a flasklike dilatation of a tubular structure)
The minute (1 to 2 mm) portion of the duct that holds the milk-producing elements of the
breast
Ans: lobule
Small duct just outside and leading to the lobule
Ans: extralobular terminal duct
The extralobular terminal duct divides into the?
Ans: intralobular terminal ducts
The intralobular terminal ducts end at the?
Ans: terminal ductules, numbering anywhere from 10 to 100 in any lobule
The functional unit of the breast
Ans: 20-40 terminal ductal lobular units (TDLU)
What is the TDLU [terminal ductal lobular unit] responsible for?
Ans: milk production and hormonal and nutritional exchange
What happens to the TDLU during life cycle changes, menstrual cycle, and hormone
fluctuation
Ans: increases and decreases in number and size
Most types of breast cancer, arises from the
Ans: TDLU
Resting breast means
Ans: no pregnancy or lactation
Two most prominent hormones active in breast physiology
Ans: estrogen and progesterone
Hormone responsible for ductal proliferation [rapid reproduction of a cell]
Ans: estrogen
Hormone responsible for lobular proliferation and growth
Ans: progesterone
Hormone present only during initial breast growth, pregnancy, and lactation
Ans: Prolactin
Abnormal growth and change in the breast are partially due to
Ans: over- or underproduction of hormones
Central raised portion where milk is excreted when lactating
Ans: nipple
Pigmented skin that surrounds the nipple
Ans: areola
Breast tissue extending superior/laterally toward axilla
Ans: tail of spence
Oblique line extending from axilla to symphysis pubis long which supranumberary nipples
may be located
Ans: mammary milk line
Layer of breast tissue. just under the skin, very thin. made up of fat surrounded by septae of
connective tissue
Ans: subcutaneous layer
Layer of breast tissue. makes up majority of breast thickness, functional layer (glandular and
ductal) and supporting tissues.
Ans: mammary layer
Layer of breast tissue just anterior to chest wall, very thin. made up of fat and surrounded
by septae of connective tissue
Ans: retromammary layer
In the mammary layer. produces milk. 15-20 lobes in each breast. each lobe has a central
duct with branches leading out to acini.
Ans: glandular tissue
Actual milk producing glands located in glandular tissue in mammary layer
Ans: acini
Located in mammary layer. ducts from each lobe carry milk to nipple
Ans: ductal tissue
Located in mammary layer. supporting structures, located between and within the lobes.
loose connective tissue, dense connective tissue, fat, and cooper's ligaments
Ans: stromal elements
There are 15-20 major ---- that open to the nipple. each one and its tributaries define a lobe
of the breast. the major ones dilate into the lactiferous sinuses. the deeper ones branch
further until they form the terminal that enter into the lobule. the lobule and terminal duct
are called the TDLU
Ans: ducts
Small lobular units made up of terminal ducts and their acini. each is surrounded by loose
and dense connective tissue. suspended within the skeleton of the cooper's ligaments.
normal size 1-2 mm. site of origin of nearly all pathologic processes that occur in the breast
Ans: terminal ductal lobar unit (TDLU)
Some of these pathologic processes originate in the ------. Fibrocystic changes,
fibroadenomas, atypical ductal hyperplasia, lobular neoplasia, ductal carcinoma in situ,
infiltrating ductal carcinoma, and lobular carcinoma.
Ans: TDLU
The functional tissue of the breast is divided into --- to ---- major lobes arranged in a radial
fashion and converging at the nipple
Ans: 15-20
The lobar collecting ducts, which drain each segment, are ---- in diameter and lead into
subareolar lactiferous sinuses that average 5-8 mm in diameter
Ans: 2 mm
The --- to --- terminal ducts (lactiferous ducts) open at the nipple and are composed of 10-
100 secretory or acinar ducts
Ans: 20-40
The arteries supplying the breast arise from: the ----- of the axillary artery, the --------- of the
descending thoracic aorta, and the -------- from the subclavian artery
Ans: thoracic branches, posterior intercostal branches, internal mammary artery
The veins form a circular pathway around the areola called the ----- which branch into the
peripheral portions of the gland draining into the axillary and internal mammary veins.
Ans: circulus venosus
One of the major routes of lymphatic drainage. receive most of the lymph stream
Ans: axillary
What are the 3 major drainage routes for lymphatics?
Ans: axillary, interpectoral (trans), internal mammary
Breast lymphatics. located in armpit; most of lymph fluid drainage from breast occurs in
these nodes
Ans: axillary
Breast lymphatics. alternate channels that lead from one breast to the other; inner quadrant
drains via this route
Ans: internal mammary chain
Breast lymphatics. also called Rotter's nodes; located deep in the chest between the
pectoralis muscles
Ans: interpectoral nodes
What is the physiologic function of the breasts?
Ans: Lactation
Largely due to prolactin hormone anterior pituitary. under influence of progesterone and
estrogen
Ans: milk secretion
Occurs in presence of oxytocin from posterior pituitary, released by stimulation of infant
sucking
Ans: milk ejection
---- from ovary stimulates development of breasts
Ans: estrogen
----- influences formation of lobules after ovulation
Ans: progesterone
During reproductive years, breasts are composed of mainly ----- tissue
Ans: fibroglandular
Upon delivery of baby, lactation begins, stimulated by ------
Ans: prolactin
Menopause, glandular tissue atrophies and breasts become mainly composed of ----- tissue
Ans: fatty
What does TRAM flap stand form?
Ans: transverse rectus abdominis myocutaneous
Reconstruction surgery done after mastectomy. pieces of tissue removed from lower
abdomen and tunneled up through the abdomen over a period of weeks to the breast area
with blood vessels intact. very painful, but have normal looking/feeling breast without
foreign material.
Ans: TRAM flap