Approach to breast lumps Flashcards
What are 4 causes of breast lumps?
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
What is the diagnostic triad for breast lumps?
1) Clinical examination
2) Radiology (US, MMG, MRI)
3) Pathology (FNA, CORE BX, Excision BX)
True or false: All phyllodes tumours are benign.
False
What are some key features of a breast lump Hx?
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
What are 8 risk factors for breast neoplasms?
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
What are some visible changes to a breast that may be indicative of breast cancer?
Skin abnormalities:
1) Tethering
2) Ulceration
3) Redness
4) Orange peel skin
Nipple abnormalities
3) Discharge
4) Inversion
5) Paget’s
6) Rashes
What are some key features of a physical examination for a px with a suspicious breast lump?
1) Lumps
2) Discharge
3) Palpable lymph nodes
4) Organomegaly
5) Ascites
6) Neurological symptoms/assessment
7) Spinal MSK exam
8) Auscultate lungs
What are the 2 positions for a mammogram and how are they differentiated post imaging?
1) Craniocaudal (CC)
- cannot see pectoralis muscles
2) Mediolateral oblique
- can see pectoralis muscles
What are the visible features of the breast on a mammogram?
1) Nipple
2) Retroareolar region
3) Mammary parenchyma
4) Retromammary space
5) Mammary fat
6) Skin
7) ±Pectoralis muscle
What are the visible features of the breast on a US?
1) Skin
2) Premammary zone
3) Mammary zone
4) Retromammary zone
5) Cooper’s ligament
What is a digital breast tomosynthesis?
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.
How does an invasive ductal carcinoma present on a (i) PE (ii) mammogram (iii) US?
Invasive ductal carcinoma → desmoplasia → dense collagenous stroma →
PE: palpable lesion
MMG: Hyperdense
US: Hyperechoic
How does an invasive lobular carcinoma present on a (i) mammogram (ii) US?
Invasive lobular carcinoma → uniform cells → infiltrative growth (linear/”indian file” pattern) →
MMG/US: difficult to detect
NEED contrast modality (MRI/CESM) to “delineate neoangiogenesis”
What are 3 differences between fine needle aspiration and core needle biopsy?
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
What are 4 salient histological features that differentiate a malignant breast tumour from a benign one?
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
