Breast

Question 1

DCIS microinvasion definition?

Answer 1

Invasion of basement membrane, < 1mm
T1 mi stage

Question 2

DCIS growth patterns?

Answer 2

Solid, Cribriform, Papillary, Micropapillary

Question 3

DCIS high- risk features?

Answer 3

High grade
Tumor infiltrating lymphocytes
Periductal fibrosis
Size

Question 4

DCIS mammographic features?

Answer 4

Microcalcifications
Linear branching type (usually higher grade)
Fine, granular (usually lower grade)

Question 5

DCIS multicentric definition?

Answer 5

> 5cm from index lesion or discontinuous growth in another quadrant

Question 6

DCIS upgrade rate on core bx?

Answer 6

20%

Question 7

DCIS recurrence rates?

Answer 7

Mastectomy (2.6%)
BCT with RT (13.6%)
BCT with RT and Tamoxifen (9.7%)
No survival benefit to mastectomy

Question 8

Benefit of RT in DCIS?

Answer 8

NSABP B-17, RTOG 9804
Reduces both invasive and non-invasive tumors by 50-70%

Question 9

Benefit of endocrine threapy in DCIS?

Answer 9

NSABP B-24
50% reduction in breast cancer with Tamoxifen for 5 years

Question 10

Tamoxifen vs anastrozole for DCIS?

Answer 10

NSABP 35
Anastrozole superior in < 60 yrs

Question 11

LCIS risk of cancer %/yr?

Answer 11

1% per year

Question 12

Indications for Oncotype?

Answer 12

• 0.5-5 cm HR + tumor
• 1-3 positive axillary nodes

Question 13

MRI for DCIS?

Answer 13

Does not increase negative margins or decrease mastectomy

Question 14

Percentage of recurrence after dcis surgery that are invasive?

Answer 14

50 %

Question 15

MRI for DCIS?

Answer 15

Does not increase negative margins or decrease mastectomy

Question 16

DCIS criteria for ABPI?

Answer 16

• Screen detected
• Low to intermediate grade
• < 2.5 cm
• Margins > 3 mm

Question 17

BCS N0 indications for LN radiation?

Answer 17

• Central/medial tumors
• T3 tumors
• T2 with high risk features (Grade 3, LVI, HR neg)

Question 18

BCS omiting all radiation?

Answer 18

> 70
T1, HR + tumors
Endocrine therapy

Question 19

Oncotype score to omit chemotherapy?

Answer 19

• <26 post menopausal
• <15 pre menopausal

Question 20

ACT regimen?

Answer 20

Adriamycin, Cyclophosphamide, Taxane
AC 4 cycles
T 12 cycles

Question 21

TCHP regimen?

Answer 21

Taxane (docetaxel), Carboplatin, Herceptin, Pertuzumab
6 cycles neoadjuvant (every 3 weeks)

Question 22

ALH vs LCIS?

Answer 22

ALH- not all acini are filled or distorted
LCIS- all acini filled or distorted, but overall architecture maintained

Question 23

ADH vs DCIS

Answer 23

ADH- less than 2 mm
DCIS- > 2 mm or extending to > 2 lobules

Question 24

Synchronous breast cancer rate

Answer 24

3 %
Half are non palpable

Question 25

DCIS ABPI indications?

Answer 25

Screen-detected DCIS Low to intermediate nuclear grade Tumor size ≤2.5 cm Margins negative at >3 mm.

Question 26

Breast cancer radiation dose?

Answer 26

40-42 Gy in 16-18 fractions Can be increased to 45-50.4Gy in 25-28 fractions Boost 10-16 Gy in 4-8 fractions

Question 27

ABPI dose

Answer 27

30 Gy in 5 fractions

Question 28

Risk of contralateral breast cancer ?

Answer 28

Overall twice the risk as general population 5 yr cumulative 1% for ER positive tumor to 1.89 in ER negative tumors

Question 29

Nipple-sparing mastectomy indications

Answer 29

> 2 cm from nipple Clinically negative axilla

Question 30

Targeted axillary dissection false negative rate

Answer 30

10 % SNLB alone 4.2 % excision of clipped node alone 2% TAD

Question 31

Rate of clipped node being a non-sentinel node

Answer 31

23%

Question 32

Breast PCR rates after NACT?

Answer 32

63 % triple negative with Pembro Up to 65% with TCHP

Question 33

Pregnancy associated breast cancer agents to avoid

Answer 33

Monoclonal antibodies Taxanes Anti estrogens Methylene blue