Breast 1 Flashcards
Typical breast cancer patient?
White wealthy, single obese woman, with late full-term pregnancy and the history of breast cancer
Strong risk factors for breast cancer (more than 4x increase in relative risk)
- Old age
- Previous history of cancer
- Family history of premenopausal bilateral breast cancer
Differences in breast cancer screening in high-risk versus low-risk patients?
Breast exam twice yearly starting at 25 versus every 2-3 years from age 20-39
Initial mammogram at age 40 versus 30
Mammograms every 1-2 until age 50 (Then yearly) versus mammograms every 1-2 years until age 40 (then yearly)
Mortality reduction in mammograms in women over 50 years of age?
30%
Risks of mammograms?
- Radiation exposure (2-6 times CXR)
2. False-negative rate (10-20%), higher in young women
Types of mammographic abnormalities?
- Masses
- Asymmetric densities
- Microcalcifications
Causes of asymmetric density on the mammogram?
- Cancer
- Previous surgery
- Previous radiation
- Previous infection
Suspicious finding on mammogram – next step?
Core-needle biopsy
Patient’s mammogram shows 1 cm area of pleomorphic microcalcifications with no associated mass. Suspicious for? Next step?
Ductal carcinoma in situ
- Stereotactic-guided core needle biopsy (especially if indeterminate or less suspicious)
- localization and open surgical biopsy (Especially for highly suspicious lesion, because it may provide adequate therapy with one procedure)
- FNA maybe nondiagnostic and should not be used
Patient has a mammogram which reveals amorphous calcifications. Has stereotactic core biopsy. Management if biopsy shows ductal carcinoma in situ? Should you node section?
- Simple mastectomy for diffuse and multicentric DCIS
- Wide excision and radiotherapy for smaller visions if pathology-free margins
- Node section is not necessary unless comedo variant (then use sentinel node approach)
Risk of infiltration at time of excision? mortality if untreated?DCIS histologic pattern with highest malignant potential?
10-20% of DCIS lesions have infiltrative component at excision.
30% mortality over 10 years
Comedo (Unlike other variants, may have axillary metastasis)
Lobular carcinoma in situ – usual discovered how? Management? Risk of malignant disease? Risk of of axillary metastasis?
Incidental finding at histopathology (not apparent on mammography)
Close observation, with mammography every six months .7 years (if high-risk, bilateral simple mastectomies)
15-20% chance of developing invasive disease
Almost no risk of axillary metastasis
Sclerosis adenosis - usually manifests as? Work up? Management?
Clustered microcalcifications on mammography
Core Biopsy
Routine follow-up
Atypical ductal hyperplasia – risk of cancer? Management?
4-5 times higher
Needle localization and excision
Relatively high-risk (8-10x) for invasive breast carcinoma? Moderate (4-5x) risk? Slightly increased (1.5-2x) risk? No increased risk?
High risk – LCIS and DCIS
Moderately increased risk – atypical ductal hyperplasia/atypical lobular hyperplasia
Slightly increased risk – sclerosing adenosis, papilloma, hyperplasia
No risk – apocrine change, ductal ectasia, mild epithelial hyperplasia
Postmenopausal women with breast mass – likely diagnosis? Work up?
If woman is aged 35-60?
If woman is younger than 30?
Carcinoma
- Mammogram affected and contralateral breast
- Ultrasound if cystic (if positive, aspiration)
- Biopsy if solid (wide excision)
Same as above
Increased benign lesions and higher risk of radiation from mammography
- Ultrasound before mammogram for cystic lesion (if positive aspirate)
- If solid, suspect fibroadenoma (observe or elective removal without prior core biopsy)
- Mammography if clinical examination or US suggest cancer
- If lump appears physiologic, can observe patients for 1-2 menstrual cycles
- If Mass persists, larges, or appears suspicious, core needle biopsy
35 y/o woman with tender breasts before menstrual periods. Complains of lumps – likely diagnosis? management?
fibrocystic disease of the breast
- Eliminate caffeine, and supplement of vitamin E
- If dominant painful cyst, aspirate
- If diagnosis is unclear, biopsy
20-year-old woman presents with 1.5 cm mass that is firm, rubbery, nontender, and freely movable. Opposite breast and axillae are normal. Likely diagnosis? Management?
Fibroadenoma
- Excisional biopsy
- Observation for small lesions
20-year-old woman presents with 14 cm mass that is firm, rubbery, nontender, and freely movable. Opposite breast and axillae are normal. Likely diagnosis? Other physical findings that will help distinguish from other types of masses? Management?
Cystosarcoma phyllodes/Giant cell fibroadenoma
Occasional ulceration of overlying skin
- Local excision with generous margins that are free of disease
Patient with bloody nipple discharge – likely diagnosis? Management?
Intraductal papilloma
1 Examined for mass or mammographic abnormality
- Surgical biopsy (cannulate duct, and excise)
- Can use ductogram (radiographic dye in duct) to localize affected duct and define extent of process
