Breast

Question 1

What is triple assessment for breast lump?

Answer 1

• Clinical: history and physical examination
• Radiological: ultrasound or mammography
• Pathological: cytology (fine-needle aspiration) or histological (Tru-Cut biopsy)

Question 2

BI-RADS classification

Answer 2

> Breast Imaging Reporting and Data System

• 0: Need additional imaging
• 1: Negative
• 2: Benign
• 3: Probably benign
• 4: Suspicious, biopsy should be considered
• 5: Highly suggestive of malignancy
• 6: Known malignancy

Question 3

FNAC vs Core biopsy

Answer 3

> FNAC

• Less invasive, less painful, do not required LA
• Only cells are obtained with no histology
• Cannot differentiate between in-situ can invasive cancer

> Core biopsy

• More invasive, painful, required LA
• Can obtain tissue specimen (differentiate between invasive and non-invasive cancer)
• Risk of complicaiton higher (improper angling can cause puncture of lung or heart)
• Can stain for ER/ PR status -> better diagnostic value

Question 4

Structure removed in modified radical mastectomy

Answer 4

• Entire breast (skin, areola, nipple)
• Most axillary lymph nodes
• Pectoralis major muscle spared

Question 5

Difference between Paget’s disease and Eczema

Answer 5

> Paget disease

• Unilateral breast
• Destroys the nipple
• Associated with underlying DCIS or invasive carcinoma

> Eczema

• Bilateral
• Does not destroy the nipple
• Dramatic improvement with steroids

Question 6

Sign of locally advance breast cancer

Answer 6

• Axillary adenopathy
• Skin erythema
• Skin thickening
• Dimpling of the overlying skin (peau d’orange)

Question 7

Risk factor for breast cancer

Answer 7

> Non-modifiable

• Old age
• Female sex
• Earlier menarche or later menopause
• Family history of breast cancer

> Modifiable

• Obesity
• Nulliparity
• Increasing age at first full-term pregnancy
• Alcohol use and smoking

Question 8

TMN staging of breast cancer

Answer 8

> Tumor
- 0: Nil
- 1: <=2cm
- 2: >2cm but <5cm
- 3: >=5cm
- 4: any size with direct extension to chest wall or skin (dermis alone does not qualify)
a: chest wall extension
b; ulceration/ edema of skin that does not meet criteria for inflammatory carcinoma
c: both a and b present
d: inflammatory carcinoma

> LN (Ipsilateral)

• 0: Nil
• 1: Movable axillary LN
• 2: Fixed/ Matted axillary LN OR mammary LN w/o axillary
• 3: Infraclavicular (with/ without axillary); mammary (with axillary); supraclavicular (with/ without axillary or internal mammary)

> Mets

• 0: Nil
• 1: Distance mets

Question 9

Pathophysiology of Peau d

orange

Answer 9

• due to invasion of the axillary lymphatics by tumor producing obstruction
• subsequently, oedema of the skin;
• suspensory ligament pull on the skin, cannot swell leading to the appearance

Question 10

4 mammogram features of breast cancer

Answer 10

• Irregular, indistinct margin
• Group microcalcifications
• Spiculated
• high-density mass

Question 11

4 contraindication of breast conserving surgery

Answer 11

• Clinical diagnosis of inflammatory breast cancer (IBC) or the presence of extensive skin changes or dermal lymphatic involvement consistent with IBC
• Multicentric disease with 2 or more primary tumour in separate quadrants of the breast
• Diffuse malignant microcalcification on mammography
• First trimester of pregnancy (contraindication to the use of breast irradiation)

Question 12

Most common age for gynecomastia

Answer 12

• Infancy
• Puberty
• Middle-aged to older men

Question 13

Pathological causes of gynecomastia

Answer 13

• Drugs (eg: spironolactone, estrogen, 5-alpha-reductase inhibitor)
• Cirrhosis
• Male hypogonadism (eg: Klinefelter syndrome, testicular trauma)
• Testicular neoplasm (eg: germ cell tumour)