B8.034 Fibrocystic Breast Mass Flashcards
screening recommendations from ACR for average risk women 40-75
lifetime risk <15%
annual screening with either mammogram or digital breast tomosynthesis
breast US may be appropriate
screening recommendations from ACR for intermediate risk women 40-75
lifetime risk 15-20%
personal history of breast cancer, lobular neoplasia, or atypical ductal hyperplasia
annual screening with either mammogram or digital breast tomosynthesis
breast US or MRI may be appropriate
screening recommendations from ACR for high risk women 40-75
lifetime risk >20%
BRCA mutation or untested first degree relative
history of breast irradiation (10-30 years of age)
annual screening with mammogram, digital breast tomosynthesis, or breast MRI
breast US may be appropriate
risk factors for breast cancer
age: increased risk with increased age
gender: breast cancer rate in females is 100x that of males
race: highest in whites
weight/height: higher BMI, higher risk in postmenopausal women
relevant PMH to breast cancer risk
things that contribute to estrogen exposure over time
- menarche
- menopause
- pregnancy
- breast feeding
- DES exposure
relevant social history to breast cancer risk
alcohol use
smoking
night shift work
family history relevant to breast cancer risk
fam history of breast cancer
in utero exposure to DES
inherited mutations
benign breast mass on imaging
round, oval or circumscribed
equal or low density on mammography
homogenously hypoechoic or isoechoic solid mass
malignant breast mass on imaging
irregular shape ill-defined or spiculated margins high density on mammography nonparallel orientation posterior acoustic shadowing
most common benign breast findings
fibroadenoma cyst galactocele fat necrosis breast abscess fibrocystic changes
fibroadenoma characteristics
most common
women 15-35
benign solid tumors containing glandular as well as fibrous tissue
fibroadenoma on physical exam
well-defined, solid mass that is mobile
fibroadenoma on US
well defined mass with benign features
cyst characteristics
fluid filled round or ovoid mass
common in women 35-50
cyst on physical exam
widely variable - can be smooth, firm or could be a collection of smaller masses that are poorly defined
cyst on imaging
ultrasound best way to delineate
fat necrosis characteristics
usually after trauma or surgery
difficult from a malignancy on physical exam
-irregular borders, adherent to underlying tissue
imaging of fat necrosis
mammography
may need to be biopsied to confirm not malignant
nonproliferative fibrocystic changes
cells are normal in number and size
no increased risk for cancer in the future
examples of nonproliferative fibrocystic changes
fibrocystic changes fibrocystic disease chronic cystic mastitis mammary dysplasia simple breast cysts
proliferative fibrocystic changes without atypia
cells are normal in size but increased in number
slight increase in risk for future breast cancer (1.5-2x the general population)
examples of proliferative fibrocystic changes without atypia
ductal hyperplasia intraductal papillomas sclerosing adenosis radial scars fibroadenomas
atypical hyperplasia
cells are increased in number and are not normal
moderate increased risk of breast cancer (>2 times the general population)
management of atypical hyperplasia
recommend risk reduction - yearly mammogram, avoid hormones, etc.
examples of atypical hyperplasia
atypical ductal hyperplasia (ADH)
atypical lobular hyperplasia (ALH)
differential for breast tenderness
galactocele
mastitis
breast abscess
galactocele
cystic collection of retained milk, usually from an obstructed duct
imaging for galactocele
US
treatment of galactocele
drainage
mastitis
localized inflammation of the breast that is associated with fever, myalgias, breast pain, and redness
mastitis on physical exam
erythematous, tender area on breast, patient may be febrile
treatment for mastitis
warm compresses
express milk frequently
DO NOT stop breast feeding
breast abscess
similar causes as for mastitis
less common in breastfeeding mothers
breast abscess on physical exam
discrete area of tenderness with fluctuance
breast abscess on imaging
US if necessary
treatment of breast abscess
antibiotics
may need I&D
how to counsel a patient with dense breast tissue
increased risk of breast cancer: 4-5x
makes it difficult for radiologists to interpret mammograms
some recommend patients get supplemental screening with US and/or breast MRI
