Breast Imaging Yisela Andrea Niño Vanessa Atuesta

Embryology
1. 6ta.Week - Primitive Breast Line
  1. 8va week - Breast Buttons
2. 9na. Semana - Regresión de los puntos mamarios (solo persiste el 4) - Boton mamario.
  1. 5to Mont - Epithelial buds
Anatomy
1. It is a modified sweat gland
2. It rests on the pectoralis major muscle
3. Breast lobe Lobule Milk ducts Breasts milk phores Mammary areola Montgomery glands
4. Subclavian artery Axillary Thoracoacromial trunk Acromial thoracic Mammary branches Piercing
5. Axillary nodes 75%
6. Supraclavicular branches of the superficial cervical plexus
Histologia
1. Epithelial
  1. A more important fabric that is responsible for upholstering or covering the interior of the ductual and lobular-acinar system.
    1. Galactophoric system formed by a set of 15 to 20 lobules for each breast, which in turn has lobules
      1. They drain through linked interlobular ducts into the galactophoric duct.
        They drain into the galactophore or lactiferous sinus and flow into the nipple producing lactopoiesis (production and secretion of milk Subtopic
2. Conjunctive
  1. It is made up of 3 types
    1. Loose located between the ductoacinar system or intralobular stroma
      1. Dense Made up of Cooper's ligamentous system
        Fat occupies the subcutaneous, intraglandular and retroglandular space.
Stages of breast growth
1. https://www.canva.com/design/DAEqeqmufHs/F-_3aaH1vrAucyjN38rf8Q/view?utm_content=DAEqeqmufHs&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink
Benign pathologies and malignant of the gland
1. It consists of the growth of cells or tissues benign in the breast area. They are growths that do not have a carcinogenic nature, composed of breast tissue and to help support the breast.
2. Benign Tumors of Mother
  1. Phyllodes tumor
    1. They are little breast tumors common originating in connective tissue (stroma).
    2. Clinical manifestations
      1. Protrusion towards the skin
        Bulky tumor fast increase
    3. Diagnosis
      1. Mammography
        Breast ultrasound
        Through a biopsy by thick needle puncture, but sometimes it is necessary remove the tumor by full
    4. Treatment
      1. Mastectomy radical modified
    5. Phyllodes tumors are more common in women of 41 to 49 years of age, although they can present in women of any age.
3. Cysts
  1. They are fluid-filled sacks that are form within the breasts.
  2. Diagnosis
    1. Breast ultrasound
      1. Nodules anechoic with precise limits
    2. Mammography
      1. Circumscribed margins
  3. Clinical Malformations
    1. Most asymptomatic
      1. Volume Increase
        Pain
        Rounded mass and mobile
  4. Treatment
    1. Rounded mass and mobile
      1. It is not necessary in simple cysts and asymptomatic
        Aspiration of the liquid
        Frequent recurrence
  5. Surgical
    1. If there are signs worrying or blood
4. Ductal ectasia
  1. Women between 40 and 60 years old
    1. More frequent in smokers
      1. Benign (non-cancerous) condition of the sinuses that occurs when a duct milk widens and its walls become thicken
  2. Manifestations
    1. Pain
      1. Secretion by the nipple
        Retraction nipple
  3. Diagnosis
    1. Sensitivity to touch and redness
      1. Retraction of nipple
  4. Treatment
    1. Warm compresses and antibiotics
      1. Remove the duct abnormal
5. Cancer
  1. Diagnosis
    1. Physical exploration
    2. Clinical Chart
    3. Imaging studies
  2. Treatment
    1. Surgery
Different techniques of exploration of the breast and diagnostic applications.
1. Palpation
  1. It is done with the palm of the hand or with the fingertips, in gentle and methodical way, to look for lesions in the breasts, armpits and supra and subclavicular regions.
  2. "Sweep" of the chest wall. The patient meets the arms loose at the sides. The palm of the right hand of the examiner is positioned between the right clavicle and the sternum of her, and slides down to the nipple to perceive possible superficial lumps.
    1. Manual digital palpation. One hand is placed with the palmar surface facing up under the right breast of the patient; with the fingers of the other hand is passed over the breast tissue to locate possible lumps, compressing them between the fingers and with the extended hand.
  3. Lymph node palpation
    1. Axilares centrales. Exploración de ganglios axilares: con la superficie palmar de los dedos agrupados e introducidos en la axila hasta el fondo, se deben colocar justo detrás de los músculos pectorales.
      1. Supraclavicular node scan: hooked fingers over the clavicle and rotated over the supraclavicular fossa in its entirety.
  4. Patient in supine position
    1. Delimitation of tumors: size, shape, consistency, mobility, edges, surface, pain, bilaterality and position.
    2. 2nd, 3rd and 4th fingertips slightly flexed.
      1. Gentle and firm pressure on the chest wall.
        Mental division of the breast into quadrantss
        Parallel lines method: first down and then up to the nipple.
    3. Radial lines method: from the edge of the hemisphere breast to the nipple.
      1. Circular lines method: start at the outer edge of the breast tissue with spiral movements towards the nipple.
        Gentle expression of the nipple: at the end of the examination it should be "squeezed" over the breast towards the nipple.
2. It is important to perform a correct technique of the breast examination to detect suspicious lumps and, if it were the case, perform the diagnosis and start the timely treatment
3. Mammography
  1. Mammography consists of a diagnostic examination of X-ray imaging of the mammary gland, using equipment called mammograms.
    1. Screening mammogram: recommended in one patient asymptomatic without any risk factor and without any clinical finding, which attends the consultation for any other reason and is in the age range of 50-69 years.
      1. Diagnostic mammogram: it is that mammogram that is requests in a patient who attends the consultation with breast symptoms or presents findings on examination clinical.
4. Ultrasound
  1. Breast ultrasound is an imaging technique that translates the different frequencies of sound generated by an organ, in this case the mammary gland, at from the emission of ultrasound by a device called a transducer, which receives the generated echo and makes a two-dimensional or three-dimensional representation of the breast.
    1. BIRADS classification for the ultrasound
      1. Ultrasound pattern: describes the composition of the breast
        Mass: defined as a space occupying lesion
        Calcifications
        Special cases: these are injuries that present a specific ultrasound appearance
        Vascularization
5. Resonance magnetic
  1. Diagnostic imaging tool, which is based on waves of radiofrequency emitted by the protons of the tissue examined, after being exposed to a magnetic field
    1. Categories
      1. Focus: puntiform uptake
        Mass: three-dimensional space-occupying lesion
        Associated findings: they may appear isolated or associated with an anomalous uptake
        Location
        Uptake kinetics: initial phase and tariff phase
6. Recommendations for conducting the scan
  1. Consent of the patient.
    1. You can come on any day of the menstrual cycle
      1. You can go during the gestational and lactation periods.
        The clinical examination should be performed without gloves, since when using them loses sensitivity.
        You should consider the signs and symptoms of the period before and transmenstrual (the menopausal woman is performed on any day of the month).

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Breast Imaging Yisela Andrea Niño Vanessa Atuesta

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