Breast 1 Flashcards
US Features of Simple Cyst
avascular
anechoic
oval, or round
posterior enhancement and an imperceptible wall
US Features of Complex Cyst
internal echoes or thin septations
thickened or irregular walls
and lack of posterior enhancement
patients younger than 30, a palpable mass should be evaluated initially with
ultrasonography, followed by mammography if there is clinical suspicion for malignancy
patients 30 years or older
mammography is usually performed first with attention to the palpable area
'’mammography cannot accurately distinguish cysts from solid masses’’
Nipple Adenoma
type of intraductal papilloma
benign tumor of the ductal epithelium
'’Diagnosis made by surgical excision’’
MRI screening as an adjunct to mammography in women
BRCA mutation
first-degree relative who is a BRCA carrier
prior history of mantle irradiation
a lifetime risk of breast cancer of at least 20 to 25% based
multianalyte genetic expression profiles
For a patient with a node negative, hormone receptor positive, HER2 negative breast cancer
to predict outcome and assist in making decisions about adjunct therapy.
occult breast cancer
approximately 1% of all breast cancers still present as axillary adenopathy without a known breast primary
MRM OR whole breast radiation with axillary lympadenectomy are equally recommended
Workup Mammo, US , MRI
Physiologic, or benign nipple discharge
bilateral
from multiple ducts
provoked,
character of fluid is milky or dark green
due to pregnancy, breastfeeding, medications, or benign hyperplasia and typically does not require workup other than a detailed history and breast examination.
Pathologic nipple discharge
unilateral
from a single duct,
typically spontaneous and persistent
character of fluid is serous (clear, yellow, orange) or bloody
caused by papilloma or benign duct ectasia. Malignancy, including ductal carcinoma in situ and invasive ductal carcinoma, is much less frequently encountered
pathologic nipple discharge workup
history and physical examination
mammography and ultrasound
‘‘ultrasound is performed even when mammography is normal’’
galactography
Breast MRI
Cyclical mastalgia
Hormonal therapies include tamoxifen, bromocriptine, and danazol.
tamoxifen has the fewest side effects and is considered a first-line therapy
in BRCA1 or BRCA2, incidence of metachronous contralateral breast cancer
up to 47%
Without BRCA > Less than 10 %
Tamoxifen effective in BRCA 1 or 2 ? and Why
effective for BRCA 2 (higher incidence of ER-positive)
tamoxifen reduced breast cancer incidence among BRCA2 patients by 62% but did not reduce breast cancer incidence in patients with BRCA 1 mutations
Patient with calcifications involved with (LCIS) treatment vs Incidental LCIS
-Lumpectomy followed by raloxifene (post menopause) or tamoxifen (Pre menopause), NO SLNB
In case incidental finding no need lumpectomy for LCIS but to keep Surveillance Mammo + MRI and may start hormone
Cause of nonlactational abscess
can be peripheral or periareolar
periareolar abscesses occur more often in smokers
The cause is related to “squamous metaplasia” or a flattening out of the cells within the terminal ducts beneath the nipple. This is often manifested clinically as a central cleft in the nipple
Patient with ADH did excision Bx, then results no Cancer whats next ?
chemoprevention with either raloxifene or tamoxifen would be a risk-reduction strategy.
Given the risk of nearly 30% of a future breast cancer, annual breast MRI could be used for future surveillance.
Predictors for breast Abscess Aspiration Failure
-Abscesses greater than 5 cm in size
-chronic or long durations of infection
-multiloculated collections
Patient with diagnosed with inflammatory Breast CA then what next before Sx
Staging
CT Brain, Chest , Abdomen and Pelvis
when to do Digital breast tomosynthesis (DBT)
recommended when digital mammography shows dense breasts and the patient is at high risk for breast cancer
