Assessment of Breast Lumps Flashcards
Label 1-8
- Chest wall
- Pec major (breast sits on top of this)
- Lobule (gland that makes milk)
- Nipple
- Areola (more pigmented area around nipple)
- Lactiferous duct (ducts that converge and form a branched system connecting the nipple to the lobules)
- Adipose tissue
- Skin
Histology of breast tissue
Histology of breast tissue
What % of breast lumps are due to benign breast disease?
80%
What is the NICE guidance for breast lumps?
Refer using suspected cancer pathway (appointment within 2 weeks) if person 30 or older and has unexplained breast lump (consider referring if <30 years)
What is the ‘triple assessment’ for breast lumps?
- Clinical –> examination
- Imaging –> ultrasound mammography
- Pathology –> biopsy and/or cytology
What is a fibroadenoma?
Benign tumour composed of proliferation of glandular elements of the stroma
What is a hamartoma?
Benign breast lump (normal elements in an unorganised way)
What is a lipoma?
Benign tumour of fat
Potential types of breast lumps:
- Fibroadenoma
- Hamartoma
- Lipoma
- Cyst
- Fibrocystic change
- Carcinoma (malignant)
Features of a lump?
- Mobile or fixed?
- Well defined or not?
- Smooth or irregular?
- Firmness?
- Location?
Defining location of lump
Breast split into quadrants and ‘oclock’
How should the nipple be examined when assessing breast lumps?
- Inversion?
- Rash?
- Discharge? (blood, milky, greeny)
What skin changes should be looked for during breast lump assessment?
- Tethering / retraction? (i.e. skin pulled in over lump)
- Oedema?
- Peau d’orange (looks like skin of orange)
- Ulceration / fungating lesion
Clinical P code:
- P1 Normal
- P2 Benign lesion
- P3 Atypical, probably benign lesion
- P4 Atypical, probably malignant lesion
- P5 Malignant
How does ultrasound imaging work?
- High frequency sound waves which bounce back (echo) from the various tissues
- Identify lesions:- size; solid or fluid-filled; shape; edge
Appearance of fat during US?
Hypoechoic –> white
Appearance of fibroglandular breast tissue during US?
Echogenic –> black
What does a mammogram involve?
- X-ray of breast from several angles
- Identifies masses/asymmetries, also calcifications
Clinical Case:
- 40 year old lady
- GP referral with breast lump
- Clinical examination:
- 2cm firm smooth mobile mass in right breast UOQ
- No skin changes
- Longstanding right nipple inversion
- Ultrasound result:
- 15mm x 5mm well-defined lobulated lesion suggestive of a fibroadenoma
Diagnosis? What would then be suggested?
- Diagnosis: P2 lump, likely fibroadenoma, R2 benign
- Referred for ultrasound guided core biopsy
- B2
Clinical Case:
- 35 year old lady
- GP referral with breast lump
- 3cm firm smooth mobile mass in left breast LIQ
- Unremarkable overlying skin and nipple
- No lymph nodes palpable in axilla
- Though to be P2 lump, likely large fibroadenoma
- Ultrasound:
- 32mm well-defined solid lesion, consistent with a fibroadenoma
- R2 benign
- Referred for ultrasound guided core biopsy
- Then found to be malignant
- 32mm well-defined solid lesion, consistent with a fibroadenoma
Diagnosis?
- 1st likely diagnosis from clinical examination: P2 lump, likely large fibroadenoma
- 2nd likely diagnosis from ultrasound: R2 benign
- Actual diagnosis from biopsy: malignant B5
- Plan: Review in clinic; assess axilla radiologically
- Discuss surgical options with patient and assess for family history
Clinical Case:
- 47 year old lady
- GP referral with breast lump
- 2.6cm firm irregular mass in the central area of the right breast with some indrawing of the nipple
- No definite lymph nodes felt in axilla
- Mammogram:
- Irregular 3.5cm mass with coarse calcifications
- Ultrasound:
- Equivocal node in axilla
- Clinical core biopsy of breast and US-guided FNAC of axilla
1st likely diagnosis from clinical examination: P5 malignant
2nd likely diagnosis from imaging: R5 malignant
3rd final diagnosis from biopsy: invasive carcinoma B5 and metastatic carcinoma in lymph node C5
How does oestrogen play a key role in the development of breast cancer?
Stimulates the growth of tumours that express oestrogen receptors (ER positive)
What is Her2?
- Her2 is one of the human epidermal growth factor receptors
- The Her2 gene is amplified in 20-25% of breast cancers and predicts poorer prognosis
What is axillary node clearance?
Axillary Node Clearance is an operation to remove the lymph nodes under the armpit. Breast cancer sometimes spreads to the lymph nodes, and if this has happened it is important to remove the lymph nodes to remove the cancer in your armpit.
What is Sentinel lymph node biopsy?
Sentinel node biopsy is a surgical procedure used to determine whether cancer has spread beyond a primary tumor into your lymphatic system. It’s used most commonly in evaluating breast cancer and melanoma. The sentinel nodes are the first few lymph nodes into which a tumor drains.
