Breast Flashcards
How is the Nottingham Prognostic Index Calculated?
(Size (cm) x 0.2) + N + G
Where:
N = 0LN=1, 1-3LN=2, >3LN=3
G1 = 1, G2 = 2, G3 = 3
What are the Nottingham Prognostic Index stage groupings?
2-2.4 - Excellent 93% 5 year survival
2.4-3.4- Good 85%
3.4-5.4 - Moderate 70%
>5.4 - Poor 50%
What are the classical characteristics of a fibroadenoma?
Highly mobile discrete breast lump typically diagnosed in teens/twenties.
Should be excised if >4cm, concerns over histopathology or patient choice
13% of all palpable breast lesions (60% of 18-25)
How are tubular adenomas of breast diagnosed?
On histopathology they are comprised almost entirely of glands with little intervening storm.
Treat similarly to fibroadenomas.
Similar to lactating adenoma in lactating women
What are the characteristic mammography findings of a hamartoma?
1) Circumscribed area of soft and lipomatous tissue
2) Surrounded by thin radiolucent zone
How frequently should patients with the BRCA1/2 gene mutations be imaged?
Annual MRI 30-49, annual mammography 40-69
What is the minimum excision margin recommended for Invasive breast cancer and DCIS?
1mm
What is the management of Paget’s disease of the Nipple?
Excision of nipple areolar complex and radiotherapy
In patients with ER positive breast cancer, which trial was suggestive of clinical benefit to Tamoxifen?
The Early Breast Cancer Trials Collaborative Group (EBCTCG) showed 5 years of tamoxifen reduces recurrence and improves overall survival for the first decade.
What dose of radiotherapy is used for the treatment of bony metastases from breast cancer?
8Gy
What classification system is used for breast capsular contractures?
Baker Classification:
1: Breast soft, impalpable implant
2: Breast solid, implant palpable but not visible
3: Breast hardened, implant is palpable and visible
4: Breast is hard, deformed and painful. Implant is palpable and clearly visible
What condition does a biopsy reported as sclerosing lymphocytic lobulitis suggest?
Diabetic mastopathy
What is the difference between Duct Ectasia and periductal mastitis?
Duct ectasia - older, non smokers creamy yellow
Periductal mastitis - younger, smokers, creamy yellow and green
What is Mondors disease?
Inflammation of breast vein, leading to erythema of overlying skin and underlying hard structure (palpable vein).
Usually treated conservatively with anti-inflammatories and generally never affects upper inside aspect of breast
What are the histological characteristics of fat necrosis?
Anucleate fat cells surrounded by histolytic giant cells
In what circumstances should breast MRI be offered to people with invasive breast cancer? (3)
1) If there is discrepancy regarding extent of disease from examination, mammography and USS
2) If density precludes accurate mammography
3) To assess tumour size if breast conserving surgery is considered in Lobular Cancer.
When should the axilla be staged?
In all patients with early invasive breast cancer, and any abnormal LNs should have USS guided FNAC
When should genetic testing be offered to women diagnosed with breast cancer?
To women <50 with triple -ve breast cancer
Testing for BRCA1 and BRCA2
When and how is SLNB performed?
In all patients with invasive cancer, no obvious nodes on USS.
In patients with DCIS if they are high risk - palpable mass, extensive disease
Dual technique - isotope and blue dye (NSABP-B32 trial showed more accurate)
When should patients be offered further axillary treatment after SLNB?
If there are MACROmetastasis i.e. >2mm present (not micro metastasis <2mm).
If there are 1 or 2 macrometasis and the patient will already be having whole breast radiotherapy and systemic therapy, it may be appropriate to omit clearing the axilla (NICE - could have POSNOC trial)
Can offer clearance or axillary radiotherapy
Isolated tumour cells only should be regarded as node-negative
What are the different patterns of complications after immediate and delayed breast reconstruction?
Immediate - lower tissue breakdown
Delayed - lower mastectomy site complications, flap or implant failure, capsular contracture
What tool is recommended for estimation of prognosis in breast cancer?
Predict 2.0 tool.
In whom is Predict less accurate? (4)
Women <30 ER+
Women ≥70
Women >5cm tumours
Men
What endocrine therapy should be offered for patients with breast cancer?
Premenopausal ER+ –> Tamoxifen
Postmenopausal ER+ low risk –> Tamoxifen
Postmenopausal ER+ medium/high risk –> Aromatase inhibitor
In premenopausal women, also consider ovarian suppression (oophrectomy or radiation menopause)