ARDMS Breast Registry Review Study Guide
feature: Oval or Ellipsoid -
Benign
Benign or malignant feature: Horizontal Orientation -
Benign - aka wider than tall
Benign or malignant feature: Smooth, well defined or circumscribed -
Benign
Benign or malignant feature: Macrolobulation -
Benign
Benign or malignant feature: Thin, echogenic pseudocapsule -
Benign. Caused by compression or rimming of adjacent tisues around the lesion (opposite of invasion)
What benign structure is anechoic? -
Simple cyst
What benign structures are hyperechoic? -
Fibroglandular Pseudomass or Lipoma
What benign structures are mildly hypoechoic, isoechoic, or mildly hyperechoic? -
Solid, benign tumors **some highly cellular malignant lesions may appear homogenous
Acoustic enhancement -
-Most are cysts
-Solid benign tumors may enhance
-Good visulization of the posterior tumor wall
-Some highly cellular malignant tumors may enhance
Benign solid masses demonstrate __________ flow or are ______________. -
no , hypovascular
Ducts generally measure less than ____,mm, and ______ in size as they run toward the nipple. -
3, increase
Causes of duct dilatation or duct ectasia -
3rd trimester of pregnancy, lactation, perimenopause
Some dict dilatation may be ass'd with ductal carcinoma or papillary carcinoma
Large calcification causing shadowing artifact are typically a ____________ characteristic. -
benign
Calcifications may arise from what? -
scarring, necrosis, hemorrhage, cysts, or fibroadenomas
Small curvilenar calcs in the dependent portion of a cyst likely represent what? -
Milk of calcium
Clustered microcalcifications are common with what? -
Breast cancer
Benign or malignant feature: Irregular shape -
Malignant
,Benign or malignant feature: Spiculated -
Malignant
Benign or malignant feature: Vertical orientation -
Malignant - aka Taller than wide
Benign or malignant feature: Microlobulation -
Malignant - multiple small lobulations usually 2mm
Benign or malignant feature: Ill-defined margins -
Malignant. Usually indicates tumor invasion into surrounding tissue
Benign or malignant feature: Angular margins -
Highly sensitive for malignancy
***Extension of a tumor into a duct coursing toward the nipple. -
***Duct extension
***Extension of a tumor into a duct coursing away from the nipple - usually involves multiple ducts. -
***Branch pattern
***A thick echogenic halo is usually _____________. -
Malignant
***Thick echogenic halo which usually indicates tumor invasion with fibrotic host response. -
***Desmoplasia
Benign or malignant feature: Mildly to markedly hypoechoic. Also described as "almost anechoic" -
Malignant--highly suspicious for malignancy
Benign or malignant feature: Heterogeneous texture -
Malignant. Except benign complex cysts and benign tumors with internal fibrosis, degeneration or
calcifications.
Benign or malignant feature: Causes shadowing -
Malignant. Most solid malignant tumors demonstrate some degree of shadowing. This may arise from
only part of the lesion.
Exception: Cooper's ligaments may cause shadowing due to refraction.
Exception: Some benign lesions such as calcifed fibroadenoma, radial scar, and fat necrosis may cause
shadowing.
The ability of a malignancy to develop new blood vessels. -
Angiogensis
You can/cannot distinguish benign vs. malignant based on Doppler signals within a lesion. -
Cannot. Inflammation may demonstrate hypervascularity with an increased Doppler signal.
These lack a basement membrane or adventitia--giving them only two layers to their walls. -
Tumor vessels.
Skin dimpling, skin thickening, nipple retraction, and retraction of Cooper's ligaemnts are all __________
indicators. -
Malignant
Crossing fibrous planes is an indicator of ___________ disease. -
Malignant
,Ductal dilatation, internal echoes or debris within ducts, and tumor extension within the duct are all signs
of a _________ lesion. -
Malignant
BUS may be able to see ___________ ____________ within a tumor, however mammography is superior in
visualizing these. -
Clustered microcalcifications
Lymph node features that indicate malignancy -
1. Loss of fatty hilum
2. Enlargement >2cm
3. Microcalcifications
4. High resisitve Doppler waveform
Simple cysts may regress after menopause, but may perisist in women taking _______. -
HRT
Result from obstructed lactiferous ducts due to fibrosis or proliferative changes in the duct epithelium. Or
can result from hormonal dilatation. -
Cysts
Mammographic appearance of a cyst. (4) -
1. Round or oval
2. Smooth (circumscribed) margins
3. Radiopaque - Water Density
4. Halo Sign (lucent rim of fat)
Sonographic appearance of a cyst -
*Round or oval, anechoic, *well circumscribed, *acoustic enhancement, may have edge shadowing,
occasionally lobulated, compressible, no internal doppler signal.
These three criteria are required to classify a cyst as "simple"
Three criteria required for a cyst to be classified as simple. -
Round or oval
Anechoic
Acoustic enhancement
Only _______% of breast cysts are simple. -
11
Artifacts within a cyst may be caused by... (9) -
1. TGC
2. Overall gain
3. Focal position
4. Small size
5. Superficial location (use standoff)
6. Deep location
7. Side or grating lobe artifact
8. slice (section) thickness artifact
9. Volume averaging artifact
Types of non-simple cysts ((5) -
1. Complicated cysts
2. Complex cysts
3. Clustered microcysts
, 4. Septated cysts
5. Calcified cysts
Cyst containing homogeneous low level internal echoes with fluid-fluid or fluid-debris levels which react to
gracity. Malignancy is 0-1.4%. -
Complicated cyst
Refer to chart on page 75 to list the types of complicated cysts and their contents. -
Do it.
No Doppler flow will be detected within the debris of a __________ cyst. -
Complicated
_________ can reveal the true nature of the complicated cyst. -
Cytology (upon aspiration)
Cysts which contain a solid component. -
Complex Cyst -- **managed differently than complicated cysts due to higher malignancy rate.
What is the malignancy rate for a complex cyst? -
23%
Cyst with partial or total wall calcification. -
Calcified cyst
Cyst that contains one or several internal septations. -
Septated cyst
Commonly seen as fibrocystic changes on mammography and sonography. May be difficult to distinguish
from a hypoechoic mass. -
Clustered microcysts
A milk filled cyst caused by the obstruction of a lactiferous duct. Usually ass'd with childbirth, affecting
both breast feeding and non breast feeding mothers. -
Galactocele
A galactocele is typically located where? -
The subareolar region
A galactocele may be what echogenicity? -
Hypoechoic to isoechoic -- but will be homogeneous, wil enhance, and will have no Doppler signal.
What else may be present with a galactocele? -
Dilated ducts, mastitis, abscess
Results from an obstructed sebaceous gland associated with the skin of the breast. -
Sebaceous cyst
Sebaeceous cysts are commonly associated with what? -
Montogomery glands of the areola or found at the inframammary fold
***The most common disorder of the breast which accounts for nearly half of all surgical procedures. -
***Fibrocystic changes
Fibrocystic changes affect what percentage of females from age 20-40? -
60-90%
feature: Oval or Ellipsoid -
Benign
Benign or malignant feature: Horizontal Orientation -
Benign - aka wider than tall
Benign or malignant feature: Smooth, well defined or circumscribed -
Benign
Benign or malignant feature: Macrolobulation -
Benign
Benign or malignant feature: Thin, echogenic pseudocapsule -
Benign. Caused by compression or rimming of adjacent tisues around the lesion (opposite of invasion)
What benign structure is anechoic? -
Simple cyst
What benign structures are hyperechoic? -
Fibroglandular Pseudomass or Lipoma
What benign structures are mildly hypoechoic, isoechoic, or mildly hyperechoic? -
Solid, benign tumors **some highly cellular malignant lesions may appear homogenous
Acoustic enhancement -
-Most are cysts
-Solid benign tumors may enhance
-Good visulization of the posterior tumor wall
-Some highly cellular malignant tumors may enhance
Benign solid masses demonstrate __________ flow or are ______________. -
no , hypovascular
Ducts generally measure less than ____,mm, and ______ in size as they run toward the nipple. -
3, increase
Causes of duct dilatation or duct ectasia -
3rd trimester of pregnancy, lactation, perimenopause
Some dict dilatation may be ass'd with ductal carcinoma or papillary carcinoma
Large calcification causing shadowing artifact are typically a ____________ characteristic. -
benign
Calcifications may arise from what? -
scarring, necrosis, hemorrhage, cysts, or fibroadenomas
Small curvilenar calcs in the dependent portion of a cyst likely represent what? -
Milk of calcium
Clustered microcalcifications are common with what? -
Breast cancer
Benign or malignant feature: Irregular shape -
Malignant
,Benign or malignant feature: Spiculated -
Malignant
Benign or malignant feature: Vertical orientation -
Malignant - aka Taller than wide
Benign or malignant feature: Microlobulation -
Malignant - multiple small lobulations usually 2mm
Benign or malignant feature: Ill-defined margins -
Malignant. Usually indicates tumor invasion into surrounding tissue
Benign or malignant feature: Angular margins -
Highly sensitive for malignancy
***Extension of a tumor into a duct coursing toward the nipple. -
***Duct extension
***Extension of a tumor into a duct coursing away from the nipple - usually involves multiple ducts. -
***Branch pattern
***A thick echogenic halo is usually _____________. -
Malignant
***Thick echogenic halo which usually indicates tumor invasion with fibrotic host response. -
***Desmoplasia
Benign or malignant feature: Mildly to markedly hypoechoic. Also described as "almost anechoic" -
Malignant--highly suspicious for malignancy
Benign or malignant feature: Heterogeneous texture -
Malignant. Except benign complex cysts and benign tumors with internal fibrosis, degeneration or
calcifications.
Benign or malignant feature: Causes shadowing -
Malignant. Most solid malignant tumors demonstrate some degree of shadowing. This may arise from
only part of the lesion.
Exception: Cooper's ligaments may cause shadowing due to refraction.
Exception: Some benign lesions such as calcifed fibroadenoma, radial scar, and fat necrosis may cause
shadowing.
The ability of a malignancy to develop new blood vessels. -
Angiogensis
You can/cannot distinguish benign vs. malignant based on Doppler signals within a lesion. -
Cannot. Inflammation may demonstrate hypervascularity with an increased Doppler signal.
These lack a basement membrane or adventitia--giving them only two layers to their walls. -
Tumor vessels.
Skin dimpling, skin thickening, nipple retraction, and retraction of Cooper's ligaemnts are all __________
indicators. -
Malignant
Crossing fibrous planes is an indicator of ___________ disease. -
Malignant
,Ductal dilatation, internal echoes or debris within ducts, and tumor extension within the duct are all signs
of a _________ lesion. -
Malignant
BUS may be able to see ___________ ____________ within a tumor, however mammography is superior in
visualizing these. -
Clustered microcalcifications
Lymph node features that indicate malignancy -
1. Loss of fatty hilum
2. Enlargement >2cm
3. Microcalcifications
4. High resisitve Doppler waveform
Simple cysts may regress after menopause, but may perisist in women taking _______. -
HRT
Result from obstructed lactiferous ducts due to fibrosis or proliferative changes in the duct epithelium. Or
can result from hormonal dilatation. -
Cysts
Mammographic appearance of a cyst. (4) -
1. Round or oval
2. Smooth (circumscribed) margins
3. Radiopaque - Water Density
4. Halo Sign (lucent rim of fat)
Sonographic appearance of a cyst -
*Round or oval, anechoic, *well circumscribed, *acoustic enhancement, may have edge shadowing,
occasionally lobulated, compressible, no internal doppler signal.
These three criteria are required to classify a cyst as "simple"
Three criteria required for a cyst to be classified as simple. -
Round or oval
Anechoic
Acoustic enhancement
Only _______% of breast cysts are simple. -
11
Artifacts within a cyst may be caused by... (9) -
1. TGC
2. Overall gain
3. Focal position
4. Small size
5. Superficial location (use standoff)
6. Deep location
7. Side or grating lobe artifact
8. slice (section) thickness artifact
9. Volume averaging artifact
Types of non-simple cysts ((5) -
1. Complicated cysts
2. Complex cysts
3. Clustered microcysts
, 4. Septated cysts
5. Calcified cysts
Cyst containing homogeneous low level internal echoes with fluid-fluid or fluid-debris levels which react to
gracity. Malignancy is 0-1.4%. -
Complicated cyst
Refer to chart on page 75 to list the types of complicated cysts and their contents. -
Do it.
No Doppler flow will be detected within the debris of a __________ cyst. -
Complicated
_________ can reveal the true nature of the complicated cyst. -
Cytology (upon aspiration)
Cysts which contain a solid component. -
Complex Cyst -- **managed differently than complicated cysts due to higher malignancy rate.
What is the malignancy rate for a complex cyst? -
23%
Cyst with partial or total wall calcification. -
Calcified cyst
Cyst that contains one or several internal septations. -
Septated cyst
Commonly seen as fibrocystic changes on mammography and sonography. May be difficult to distinguish
from a hypoechoic mass. -
Clustered microcysts
A milk filled cyst caused by the obstruction of a lactiferous duct. Usually ass'd with childbirth, affecting
both breast feeding and non breast feeding mothers. -
Galactocele
A galactocele is typically located where? -
The subareolar region
A galactocele may be what echogenicity? -
Hypoechoic to isoechoic -- but will be homogeneous, wil enhance, and will have no Doppler signal.
What else may be present with a galactocele? -
Dilated ducts, mastitis, abscess
Results from an obstructed sebaceous gland associated with the skin of the breast. -
Sebaceous cyst
Sebaeceous cysts are commonly associated with what? -
Montogomery glands of the areola or found at the inframammary fold
***The most common disorder of the breast which accounts for nearly half of all surgical procedures. -
***Fibrocystic changes
Fibrocystic changes affect what percentage of females from age 20-40? -
60-90%
