9 Breast Disease CT

Question 1

What is Triple assessment of the breast

Answer 1

Clinical (History + Examination)
Radiological (mammography + USG) and
Pathological (core biopsy) evaluation of a breast lump

Question 2

What is the screening process for breast issues

Answer 2

Specialist breast clinic (‘one-stop’ clinics)
Multidisciplinary team
Triple assessment:

Question 3

What to consider when taking breast history

Answer 3

Duration and nature of the presenting symptom including relationship to menstrual cycle
Increase or decrease in size or a change in symmetry
New or persistent skin changes
New nipple inversion or discharge
Breast pain or mass/lump
History of trauma to the breast

Family History

Question 4

What factors affect lifetime oestrogen exposure

Answer 4

Age of menarche/menopause
Parity and breastfeeding
Oral contraception (OCP) or hormone replacement therapy (HRT) use
IVF fertility treatment

Question 5

What age is mammography appropriate for?

Answer 5

Mammography in those aged 40 or over (breast pancake x-ray)
Breast tissue too dense in younger patients
Sensitivity 50% <40 years old
Sensitivity 95% >60 years old

Question 6

How many breast cancers are missed by mammography screening

Answer 6

5% cancers missed on mammography population screening

Question 7

When is ultrasound used for breast symptoms

Answer 7

Ultrasonography for all palpable lumps
Helpful to differentiate cystic from soft tissue masses
First choice for image guided breast or axillary nodal biopsy

Question 8

When is MRI used on breasts

Answer 8

MRI – highly selective use only
Women with breast implants or dense breasts on mammography
Can help differentiate recurrent cancer from scar tissue
Used to assess extent of disease
Invasive lobular carcinoma
Screening for patients under 40 where needed

Question 9

What type of biopsy is used for breast histology

Answer 9

Core biopsy (not FNI anymore)
US guided/vacuum

Question 10

What may be looked at in histology of breast lump

Answer 10

Invasive cancers – establish grade
DCIS – high, low or intermediate
ER/PR/HER2 status
Lymphovascular invasion
Lymph node assessment – metastatic or not

Question 11

How common is breast pain

Answer 11

Very common symptom
70% women at some point

Question 12

What subtypes of breast pain are there

Answer 12

Sub-categories: cyclical, noncyclical, and extramammary (e.g. chest wall – most common presentation in breast clinic)