Breast Flashcards

1
Q

DCIS microinvasion definition?

A

Invasion of basement membrane, < 1mm
T1 mi stage

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2
Q

DCIS growth patterns?

A

Solid, Cribriform, Papillary, Micropapillary

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3
Q

DCIS high- risk features?

A

High grade
Tumor infiltrating lymphocytes
Periductal fibrosis
Size

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4
Q

DCIS mammographic features?

A

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

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5
Q

DCIS multicentric definition?

A

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

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6
Q

DCIS upgrade rate on core bx?

A

20%

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7
Q

DCIS recurrence rates?

A

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

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8
Q

Benefit of RT in DCIS?

A

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

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9
Q

Benefit of endocrine threapy in DCIS?

A

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

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10
Q

Tamoxifen vs anastrozole for DCIS?

A

NSABP 35
Anastrozole superior in < 60 yrs

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11
Q

LCIS risk of cancer %/yr?

A

1% per year

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12
Q

Indications for Oncotype?

A
  • 0.5-5 cm HR + tumor
  • 1-3 positive axillary nodes
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13
Q

MRI for DCIS?

A

Does not increase negative margins or decrease mastectomy

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14
Q

Percentage of recurrence after dcis surgery that are invasive?

A

50 %

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15
Q

MRI for DCIS?

A

Does not increase negative margins or decrease mastectomy

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16
Q

DCIS criteria for ABPI?

A
  • Screen detected
  • Low to intermediate grade
  • < 2.5 cm
  • Margins > 3 mm
17
Q

BCS N0 indications for LN radiation?

A
  • Central/medial tumors
  • T3 tumors
  • T2 with high risk features (Grade 3, LVI, HR neg)
18
Q

BCS omiting all radiation?

A

> 70
T1, HR + tumors
Endocrine therapy

19
Q

Oncotype score to omit chemotherapy?

A
  • <26 post menopausal
  • <15 pre menopausal
20
Q

ACT regimen?

A

Adriamycin, Cyclophosphamide, Taxane
AC 4 cycles
T 12 cycles

21
Q

TCHP regimen?

A

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

22
Q

ALH vs LCIS?

A

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

23
Q

ADH vs DCIS

A

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

24
Q

Synchronous breast cancer rate

A

3 %
Half are non palpable

25
Q

DCIS ABPI indications?

A

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

26
Q

Breast cancer radiation dose?

A

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

27
Q

ABPI dose

A

30 Gy in 5 fractions

28
Q

Risk of contralateral breast cancer ?

A

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

29
Q

Nipple-sparing mastectomy indications

A

> 2 cm from nipple
Clinically negative axilla

30
Q

Targeted axillary dissection false negative rate

A

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

31
Q

Rate of clipped node being a non-sentinel node

A

23%

32
Q

Breast PCR rates after NACT?

A

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

33
Q

Pregnancy associated breast cancer agents to avoid

A

Monoclonal antibodies
Taxanes
Anti estrogens
Methylene blue