BREAST ARDMS Exam Questions With Verified
Answers
Fremitus
While using power doppler to evaluate a lesion, the patient hums to produce a vibration effect within
the tissue. Benign pathology will light up the same as the surrounding tissue. Malignant pathology will
stay fixed in place and; therefore will not light up with the surrounding tissue.
Echo palpation
Technique used to isolate a palpable mass. A sonographer immobilizes a mass between two fingers
while scanning with the opposite hand.
Ballottement
alternating compression and release that can be helpful in demonstrating the mobility of echoes in
ducts or cysts. Use color to evaluate ectatic ducts with debris->"color swoosh". Area in which there is
a lack of "swoosh" indicates there is a solid lesion present in the duct (ex. papilloma)
Where does the breast lie on the chest?
Lies inferior to the 1st and 2nd rib, superior to the 7th rib (2nd-6th) in the vertical plane. Extends from
the sternal ridge to the mid axillary line in the horizontal plane.
Sebaceous (Montgomery) Glands
play an important role in pregnancy and breastfeeding. Secrete oily substance following pregnancy
which protects nipple from irritation.
Skin
composed of epidermis and dermis layers. Normal thickness <2mm. Nipple-dense connective tissue
and erectile muscle. Contains sensory nerve endings, 15-20 collecting lactiferous duct openings).
Areola-consists of smooth muscle (responsible for contraction), contains Montgomery glands.
Subcutaneous layer
(premammary fat) consists of fatty tissue, which can increase with age, pregnancy, and obesity, and
cooper ligaments.
Mammary layer
(glandular or parenchymal layer) composed of stroma, supportive tissue consisting of interlobular fat
and connective tissue (Cooper ligaments, loose and dense connective tissue), and epithelium,
functional tissue consisting of acini, lobules, terminal ductal lobular unit (TDLU), 15-20 lobes, and
lactiferous ducts.
Axillary tail of Spence
Normal extension of breast tissue into the underarm area.
Cooper's ligaments (& Cooper's droop)
(suspensor ligaments) Part of the stroma and supportive tissue of the mammary layer. Provide the
architectural framework of the breast. Runs between the superficial and deep layers of the superficial
fascia (from chest toward nipple).
, Droop-ligaments stretch out over time due to genetics, body mass index, size of the breast, age,
weight fluctuation, and cigarette smoking.
Acini
Smallest functional unit of the breast which give rise to ductules or terminal ducts. Milk producing
gland. Hundreds in each breast.
Lobule
composed of approximately 30 acini, intralobular terminal ducts, and intralobular stromal tissue
(loose connective tissue)
Terminal duct lobular unit (lobules)
includes lobular, extralobular, and intralobular terminal duct. Usually measure 2.0mm or less. Nearly
all breast pathology originates in the TDLU
Lobe
consist of several lobules (TDLUs). 15-20 lobes in each breast. One lactiferous duct emerges from each
lobe and travels toward the nipple.
Lactiferous ducts
transport milk from the acini to the nipple. Lined with a double layer of epithelial cells (inner epithelial
and outer myoepithelial cell layer [propels milk within the ducts toward the nipple]). The cells are
supported by a basement membrane which is the outer fibrous portion of the duct.
The duct enlarges slightly beneath the areola forming the lactiferous sinus, which then flow into the
collecting duct (empties milk from the nipple).
Nipple composed of mainly fibrous and erectile muscles.
Intra-, and extralobular terminal ducts, and interlobular ducts.
Intra-within the lobule
Extra-outside the lobule
Inter-travel between lobes
Retromammary layer
consists of fatty tissue, cooper ligaments, pectoralis major and minor muscles, ribs, and chest wall.
Amount of fat increases with age, pregnancy, and obesity. Also contains deep layer of the superficial
fascia which allows movement of the breast over the chest wall.
Pectoralis major and minor and serratus anterior muscles
major-arises from the clavicle and costal cartilage of the sternum attaching to the proximal humerus.
Anterior to the minor.
minor-arises from the 3rd, 4th, and 5th ribs attaching to the scapula.
Serratus-located deep to the lateral third of the breast forming the medial wall of the axilla.
Chest wall
ribs located posterior to pectoral muscles. Intercostal muscles located within the rib spaces. Deep to
the chest wall are the lungs.
Answers
Fremitus
While using power doppler to evaluate a lesion, the patient hums to produce a vibration effect within
the tissue. Benign pathology will light up the same as the surrounding tissue. Malignant pathology will
stay fixed in place and; therefore will not light up with the surrounding tissue.
Echo palpation
Technique used to isolate a palpable mass. A sonographer immobilizes a mass between two fingers
while scanning with the opposite hand.
Ballottement
alternating compression and release that can be helpful in demonstrating the mobility of echoes in
ducts or cysts. Use color to evaluate ectatic ducts with debris->"color swoosh". Area in which there is
a lack of "swoosh" indicates there is a solid lesion present in the duct (ex. papilloma)
Where does the breast lie on the chest?
Lies inferior to the 1st and 2nd rib, superior to the 7th rib (2nd-6th) in the vertical plane. Extends from
the sternal ridge to the mid axillary line in the horizontal plane.
Sebaceous (Montgomery) Glands
play an important role in pregnancy and breastfeeding. Secrete oily substance following pregnancy
which protects nipple from irritation.
Skin
composed of epidermis and dermis layers. Normal thickness <2mm. Nipple-dense connective tissue
and erectile muscle. Contains sensory nerve endings, 15-20 collecting lactiferous duct openings).
Areola-consists of smooth muscle (responsible for contraction), contains Montgomery glands.
Subcutaneous layer
(premammary fat) consists of fatty tissue, which can increase with age, pregnancy, and obesity, and
cooper ligaments.
Mammary layer
(glandular or parenchymal layer) composed of stroma, supportive tissue consisting of interlobular fat
and connective tissue (Cooper ligaments, loose and dense connective tissue), and epithelium,
functional tissue consisting of acini, lobules, terminal ductal lobular unit (TDLU), 15-20 lobes, and
lactiferous ducts.
Axillary tail of Spence
Normal extension of breast tissue into the underarm area.
Cooper's ligaments (& Cooper's droop)
(suspensor ligaments) Part of the stroma and supportive tissue of the mammary layer. Provide the
architectural framework of the breast. Runs between the superficial and deep layers of the superficial
fascia (from chest toward nipple).
, Droop-ligaments stretch out over time due to genetics, body mass index, size of the breast, age,
weight fluctuation, and cigarette smoking.
Acini
Smallest functional unit of the breast which give rise to ductules or terminal ducts. Milk producing
gland. Hundreds in each breast.
Lobule
composed of approximately 30 acini, intralobular terminal ducts, and intralobular stromal tissue
(loose connective tissue)
Terminal duct lobular unit (lobules)
includes lobular, extralobular, and intralobular terminal duct. Usually measure 2.0mm or less. Nearly
all breast pathology originates in the TDLU
Lobe
consist of several lobules (TDLUs). 15-20 lobes in each breast. One lactiferous duct emerges from each
lobe and travels toward the nipple.
Lactiferous ducts
transport milk from the acini to the nipple. Lined with a double layer of epithelial cells (inner epithelial
and outer myoepithelial cell layer [propels milk within the ducts toward the nipple]). The cells are
supported by a basement membrane which is the outer fibrous portion of the duct.
The duct enlarges slightly beneath the areola forming the lactiferous sinus, which then flow into the
collecting duct (empties milk from the nipple).
Nipple composed of mainly fibrous and erectile muscles.
Intra-, and extralobular terminal ducts, and interlobular ducts.
Intra-within the lobule
Extra-outside the lobule
Inter-travel between lobes
Retromammary layer
consists of fatty tissue, cooper ligaments, pectoralis major and minor muscles, ribs, and chest wall.
Amount of fat increases with age, pregnancy, and obesity. Also contains deep layer of the superficial
fascia which allows movement of the breast over the chest wall.
Pectoralis major and minor and serratus anterior muscles
major-arises from the clavicle and costal cartilage of the sternum attaching to the proximal humerus.
Anterior to the minor.
minor-arises from the 3rd, 4th, and 5th ribs attaching to the scapula.
Serratus-located deep to the lateral third of the breast forming the medial wall of the axilla.
Chest wall
ribs located posterior to pectoral muscles. Intercostal muscles located within the rib spaces. Deep to
the chest wall are the lungs.
