Approach to breast lumps Flashcards

1
Q

What are 4 causes of breast lumps?

A

Inflammatory:
1) Abscess
2) Fat necrosis

Fibrocystic change (3)

Benign neoplasm:
4) Fibroadenoma
5) Phyllodes tumour
6) Papilloma

Malignant neoplasm:
7) Invasive ductal carcinoma
8) Invasive lobular carcinoma
9) Mucinous carcinoma

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2
Q

What is the diagnostic triad for breast lumps?

A

1) Clinical examination
2) Radiology (US, MMG, MRI)
3) Pathology (FNA, CORE BX, Excision BX)

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3
Q

True or false: All phyllodes tumours are benign.

A

False

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4
Q

What are some key features of a breast lump Hx?

A

HPI:
1) SOCRATES (eg. timing w menstrual cycle)
2) Discharge
3) Skin ▲
4) Breast ▲

DH:
5) Blood thinners
6) Hormone therapy
7) Oral Contraceptives

FH:
7) esp F (familial eg. BRCA1/2)
8) No. children

PMH:
9) Early menarche
10) Late menopause
11) Previous radiation

SH:
12) Obesity
13) Alcohol

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5
Q

What are 8 risk factors for breast neoplasms?

A

1) Old age
2) Early menarche
3) Late menopause
4) Nulliparous
5) First child born >30
6) Not breast feeding
7) HRT
8) OCP
9) FH
10) Syndromes (eg. Li-fraumeni)
11) Previous radiation
12) Obesity
13) High alcohol intake

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6
Q

What are some visible changes to a breast that may be indicative of breast cancer?

A

Skin abnormalities:
1) Tethering
2) Ulceration
3) Redness
4) Orange peel skin

Nipple abnormalities
3) Discharge
4) Inversion
5) Paget’s
6) Rashes

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7
Q

What are some key features of a physical examination for a px with a suspicious breast lump?

A

1) Lumps
2) Discharge
3) Palpable lymph nodes
4) Organomegaly
5) Ascites
6) Neurological symptoms/assessment
7) Spinal MSK exam
8) Auscultate lungs

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8
Q

What are the 2 positions for a mammogram and how are they differentiated post imaging?

A

1) Craniocaudal (CC)
- cannot see pectoralis muscles

2) Mediolateral oblique
- can see pectoralis muscles

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9
Q

What are the visible features of the breast on a mammogram?

A

1) Nipple
2) Retroareolar region
3) Mammary parenchyma
4) Retromammary space
5) Mammary fat
6) Skin
7) ±Pectoralis muscle

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10
Q

What are the visible features of the breast on a US?

A

1) Skin
2) Premammary zone
3) Mammary zone
4) Retromammary zone
5) Cooper’s ligament

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11
Q

What is a digital breast tomosynthesis?

A

Digital breast tomosynthesis (DBT) is a 3D imaging technology used in mammography that takes multiple X-ray images of the breast from different angles (-7.5° to 7.5°) to create a detailed, layered view, improving cancer detection and reducing false positives.

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12
Q

How does an invasive ductal carcinoma present on a (i) PE (ii) mammogram (iii) US?

A

Invasive ductal carcinoma → desmoplasia → dense collagenous stroma →
PE: palpable lesion
MMG: Hyperdense
US: Hyperechoic

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13
Q

How does an invasive lobular carcinoma present on a (i) mammogram (ii) US?

A

Invasive lobular carcinoma → uniform cells → infiltrative growth (linear/”indian file” pattern) →
MMG/US: difficult to detect
NEED contrast modality (MRI/CESM) to “delineate neoangiogenesis”

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14
Q

What are 3 differences between fine needle aspiration and core needle biopsy?

A

FNA:
1) No LA req. + can be done @ clinic
2) Relatively non-invasive
3) Can only assess cytology (CANNOT differentiate between in-situ and invasive carcinoma)

Core needle biopsy:
1) LA req.
2) Image guidance req.
3) Can assess for invasion (CAN differentiate between in-situ and invasive carcinoma)
4) Can insert clip (as guide/marker for further procedures)
5) More invasive

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15
Q

What are 4 salient histological features that differentiate a malignant breast tumour from a benign one?

A

Malignant:
1) Infiltrative
2) Solid nests with variable lumen formation
3) Epithelial only (loss of myoepithelial cells)
4) Enlarges nuclei w prominent nucleoli
5) Moderate nuclear pleomorphism
6) ±Necrosis

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16
Q

What are 3 key histological features of invasive ductal carcinoma of the breast/

A

1) Invasive glandular/ductal structures
2) Desmoplastic stroma
3) Cytological features of malignancy (nuclear pleomorphism, loss of cohesion, irregular 3D clusters)

17
Q

What are 6 histological findings/features of a breast cancer biopsy with prognostic value?

A

1) Tumour type
2) Local extent (T staging)
3) Lymphovascular invasion
4) Nodal status
5) Grade (tubule formation, nuclear pleomorphism, mitotic rate)
6) Hormonal status (ER/PR)
7) HER2 status
8) Margins

18
Q

What is the clinical significance of a breast tumour being ER and PR positive?

A

Correlates w better prognosis and opens option of adjuvant endocrine therapy using SERMS (selective estrogen receptor modulators) eg. tamoxifen

19
Q

What is the clinical significance of a breast tumour being HER2 positive?

A

Correlates w worse prognosis but opens option of neoadjuvant use of anti-HER2 targeted therapy (eg. trastuzumab/Herceptin)

20
Q

What are the 2 histological tests for HER2?

A

1) IHC (membrane bound)
2) FISH (nuclear)