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Year 3 - Reproductive and Sexual Health (DP) > Breast > Flashcards

Breast Flashcards

1
Q

What risk factors result in a >4 times relative risk of breast cancer?

A

Gene mutation
Lobular carcinoma in situ
Ductal carcinoma in situ
Atypical hyperplasia

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2
Q

Who can an USS help define a solid mass particularly well in?

A

Young women

Women with mammographically dense breasts

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3
Q

What investigation is needed for definitive diagnosis of breast cancer?

A

Image-guided core-needle biopsy

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4
Q

Ductal carcinoma in situ is usually not palpable. How does it appear on screening?

A

Malignant calcifications:

  • Pleomorphic
  • Casting
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5
Q

How is ductal carcinoma in situ diagnosed definitively?

A

Stereotactic vacuum biopsy

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6
Q

How does invasive lobular carcinoma spread?

A

Diffusely

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7
Q

How does invasive lobular carcinoma appear histologically?

A

‘Indian file’ pattern (not visible or palpable early)

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8
Q

What is always required following breast-conserving surgery?

A

Radiotherapy

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9
Q

What is a modified radical mastectomy?

A

Removes entire breast including:

  • Overlying skin
  • Axillary lymph nodes
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10
Q

What is preserved in a modified radical mastectomy and why?

A

Pectoralis major:

  • Improve wound healing
  • Better reconstruction
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11
Q

What are the indications for post-mastectomy radiotherapy?

A

> 3 nodes involved
Positive surgical margins
Tumours >5cm

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12
Q

What is the first line targeted drug therapy for malignant breast cancer?

A

Bevacizumab:

- Recombinant humanised monoclonal Ab against VEGF

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13
Q

How does Lapatinib work?

A

Dual inhibitor for EGFR and HER2 tyrosine kinases

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14
Q

When and with what is Lapatinib prescribed?

A 
Advanced breast cancer and metastatic disease in those with HER+ disease and who have had previous therapy including:
- An anthracycline and
- A taxine and
- Herceptin
Prescribed with Capecitabine
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15
Q

What is Trastuzumab?

A

A HER2 inhibitor

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16
Q

How does cyclic mastalgia present?

A

Diffuse
Most intense premenstrual
Usually bilateral

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17
Q

How does non-cyclic mastalgia present?

A

Localised
Often persistent
Less responsive to treatment

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18
Q

How is mastalgia treated?

A

Evening primose oil
Tamoxifen
Topical NSAIDs

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19
Q

How does a breast cyst feel on examination?

A

Clearly defined
Soft
Mobile
Smooth

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20
Q

When is a breast cyst usually most tender?

A

Before menstruation

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21
Q

How can a breast cyst be diagnosed and treated?

A

FNA

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22
Q

How is mastitis treated?

A

Flucloxacillin 500mg PO every 6 hrs for 7 days
OR
Augmentin 625mg every 8 hrs for 7 days

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23
Q

When should antibiotics for mastitis be administered?

A

As soon as signs/symptoms:

  • Fever
  • Erythema
  • Induration
  • Tenderness
  • Swelling
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24
Q

After treating mastitis, how should examination be carried out?

A

Examine every 3 days:

  • Ensure response to therapy
  • Ensure no abscess formation
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25
Q

How is an abscess in mastitis treated?

A

Drainage

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26
Q

What can cause non-puerperal mastitis?

A

Staph. aureus
Peptostreptococcus magnus
Bacteroides fragilis

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27
Q

How is non-puerperal mastitis treated?

A

Augmentin 625mg every 8 hrs for 7 days
OR
Cephalexin 500mg PO every 6 hours

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28
Q

What is chronic mastitis associated with?

A

Subareolar abscess

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29
Q

What can occur in chronic mastitis?

A

Periareolar fistulae

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30
Q

What cells are seen in an apocrine metaplasia of breast epithelial cells?

A

Eosinophils (in the lining of a cyst)

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31
Q

What is a galactocoele?

A

Palpable milk-filled cyst

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32
Q

What are galactocoeles associated with?

A

Pregnancy

Lactation

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33
Q

How are galactocoeles diagnosed and treated?

A

FNA

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34
Q

How do lipomas appear on mammography?

A

Thin border (they are palpable)

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35
Q

What is Mondor’s Disease?

A

Phlebitis

Subsequent clot formation in superficial breast veins

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36
Q

How does Mondor’s Disease look and feel?

A

Firm, vertical, cord-like structure

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37
Q

What is Mondor’s Disease associated with?

A

Breast trauma (eg. Surgery)

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38
Q

How long does Mondor’s Disease take to resolve?

A

8-12 weeks

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39
Q

What is the routine screening for breast cancer?

A

Mammography:

  • Aged 50-70
  • Every 3 years
  • Picks up small and impalpable tumours
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40
Q

How many palpable lumps (breast cancer) are operable?

A

84%

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41
Q

What triple assessment occurs at the one stop clinic?

A 
Physical examination of the breasts
Breast imaging:
- Mammogram +/or
- USS
FNA or Needle-core biopsy if lump found
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42
Q

If breast cancer is confirmed, what further investigations are done?

A

Staging CT
Breast MRI (especially if lobular)
?Bone scan

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43
Q

How is a ductal carcinoma in situ treated?

A

Breast-conserving therapies
OR
Mastectomy

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44
Q

What radiotherapy follows the treatment of a DCIS?

A

Radiotherapy of the whole breast:

  • 40Gy in 15 sessions over 3 weeks
  • Using 2 tangential fields
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45
Q

When can the breast alone be irradiated following breast conserving surgery?

A

Negative sentinel node biopsy (SNB)
Micromets. (>0.2mm but <2mm) in SNB
<4 nodes involved in adequate axillary node clearance

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46
Q

When is there a radiotherapeutic boost to the tumour bed following breast conserving surgery?

A

Women under age 54 on day of surgery

Posterior margin <1mm for invasive disease after full thickness excision

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47
Q

When is chest wall radiotherapy carried out following mastectomy?

A

Tumour size >5cm
>=4 nodes involved
Involved resection margins
T4 disease

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48
Q

When is the ipsilateral axilla irradiated following breast surgery?

A

> 1 positive macrometastases in sentinel node biopsy

Extensive ECS post-axillary clearance

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49
Q

Following neo-adjuvant treatment, when is a node considered involved?

A

If there is a pathological response (scarring) in the node

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50
Q

Where is 5 field radiotherapy directed?

A

Whole breast OR Chest wall
Axilla
Supraclavicular fossa

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51
Q

When is tamoxifen used in breast cancer?

A

ER+ disease

Preferred in premenopausal women

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52
Q

How long can tamoxifen be given?

A

10yrs

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53
Q

When is letrozole used in breast cancer?

A

Preferred in postmenopausal women

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54
Q

How long can tamoxifen be given?

A

5yrs

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55
Q

When is trastuzumab used in breast cancer?

A

HER+ patients (as measured by IHC or FISH)

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56
Q

How many breast cancer patients are HER+?

A

25-30%

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57
Q

For locally advanced breast cancer, when is radiotherapy considered?

A

As initial therapy for a primary inoperable tumour
Patients still inoperable after primary systemic therapy
Post-surgery for all patients

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58
Q

In locally advanced breast cancer, what can be done in patients with T>4b tumours?

A

0.5cm bolus following mastectomy

Increase skin does

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59
Q

What cancers tend to metastasise to the breast?

A 
Lung
Liver
Bone
Brain
Skin
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60
Q

How are the symptoms of metastatic breast cancer treated?

A

Bisphosphonates
Radiotherapy
Chemotherapy

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61
Q

When not lactating, what is the structure of the mammary gland?

A

Secretory lobe -? Extralobular duct -> Lactiferous duct -> Lactiferous sinus -> Nipple

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62
Q

How many lobes are there per breast?

A

15-25

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63
Q

What is each lobe in the breast associated with?

A

A compound tubulo-acinar gland

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64
Q

What tissue is adjacent to lobes?

A

Dense fibrous tissue

Adipose tissue

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65
Q

What is the structure of the duct system?

A

Terminal ductules -> Intralobular collecting duct -> Lactiferous duct

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66
Q

What does the lactiferous duct expand into?

A

Lactiferous sinus

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67
Q

What is the lining of larger ducts?

A

Columnar

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68
Q

In secretory acini, what is the structure of the epithelium?

A

Cuboidal
OR
Low-columnar

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69
Q

What are the epithelial cells in secretory acini surrounded by?

A

Myoepithelial cells

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70
Q

What is the potential origination of breast lobes?

A

Modified sweat glands

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71
Q

What is the epithelium covering the nipple?

A

High pigmented keratinised stratified squamous epithelium

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72
Q

What is at the core of the nipple?

A

Dense irregular connective tissue with smooth muscle bundles

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73
Q

What is the lining of the ducts near the surface?

A

Stratified squamoues

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74
Q

What is the lining of the ducts deeper than the surface?

A

Stratified cuboidal

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75
Q

What is the lining of the deepest ducts?

A

Cuboidal (1 cell thick)

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76
Q

What glands are on the surface of the nipple?

A

Sebaceous glands

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77
Q

What happens to the structure of the breast during the luteal phase of menstruation?

A

Epithelial cells increase in height
Lumina of ducts increase in diameter
Small secretions

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78
Q

What happens to the structure of the breast following menopause?

A

Secretory cells degenerate so only ducts are left
Reduced fibroblasts:
- Reduced collagen and elastic fibres

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79
Q

What happens to the structure of the breast during the 1st trimester?

A

Elongation and branching of smaller ducts

Proliferation of gland epithelium and myoepithelial cells

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80
Q

What happens to the structure of the breast during the 2nd trimester?

A

Differentiation of secretory alveoli

Plasma cells and lymphocytes infiltrate connective tissue

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81
Q

What happens to the structure of the breast during the 3rd trimester?

A

Secretory alveoli mature

Development of extensive RER

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82
Q

What are the breast changes in pregnancy accompanied by?

A

Reduced amount of connective and adipose tissues

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83
Q

What is the main component of milk?

A

88% water

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84
Q

What are the main proteins in breastmilk?

A

Lactalbumin

Casein

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85
Q

What is the main carbohydrate in breast milk?

A

Lactose

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86
Q

What is present in small amounts in breast milk?

A

Ions
Vitamins
IgA

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87
Q

How are lipids secreted into the breast milk?

A

Secretory cell cytoplasm contains lipid droplets
As droplets bud off they are surrounded by some:
- Cytoplasm
- Plasma membrane
Apocrine secretion

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88
Q

How are proteins secreted into the breast milk?

A

Made in rER
Packaged in golgi and released via vesicles:
- Merge with apical membrane and release contents
Merocrine secretion

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89
Q

What is breast FNA cytology C1?

A

Unsatisfactory

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90
Q

What is breast FNA cytology C2?

A

Benign

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91
Q

What is breast FNA cytology C3?

A

Atypia, probably benign

92
Q

What is breast FNA cytology C4?

A

Suspicious of malignancy

93
Q

What is breast FNA cytology C5?

A

Malignant

94
Q

What is the benefit of a vacuum assisted biopsy over a needle-core biopsy?

A

Large volume/mammotome

95
Q

What is breast needle-core biopsy B1?

A

Unsatisfactory/Normal

96
Q

What is breast needle-core biopsy B2?

A

Benign

97
Q

What is breast needle-core biopsy B3?

A

Atypia, probably benign

98
Q

What is breast needle-core biopsy B4?

A

Suspicious of malignancy

99
Q

What is breast needle-core biopsy B5a?

A

Malignant:

- Carcinoma in situ

100
Q

What is breast needle-core biopsy B5b?

A

Invasive carcinoma

101
Q

What breast developmental diseases are benign?

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory niple

102
Q

What inflammatory breast diseases are benign?

A

Fat necrosis
Duct ectasia
Acute mastitis/abscess

103
Q

What non-neoplastic breast diseases exist?

A 
Gynaecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions
104
Q

How does sclerosing adenosis appear?

A

Radial scar/Complex sclerosing lesions

105
Q

What breast tumours are benign?

A

Phyllodes tumours

Intraduct papilloma

106
Q

What prescription drugs can cause gynaecomastia?

A

Cimetidine
5-alpha-reductase inhibitors
Spironolactone
Calcium channel blockers

107
Q

Apart from prescription drugs, what else can cause gynaecomastia?

A

Exogenous/Endogenous hormones
Cannabis
Liver disease

108
Q

When do the majority of breast fibrocystic changes occur?

A

Between the ages of 40-50

109
Q

How do fibrocystic breast changes affect menstruation?

A

Menstrual abnormalities
Early menarche
Late menopause

110
Q

How do fibrocystic breast changes present?

A 
Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness
Incidental finding/Screening
111
Q

How do the cysts appear in fibrocystic breast changes?

A

1mm - Several cm
Blue domed with pale fluid
Usually multiple
Associated with other benign changes

112
Q

How do fibrocystic cysts appear microscopically?

A

Cysts:
- Thin walled (maybe fibrotic)
- Lined by apocrine epithelium
Fibrosis

113
Q

How are fibrocystic breast changes treated?

A

Exclude malignancy
Reassure
Excise (if necessary)

114
Q

What is the following describing:

A circumscribed lesion composed of cell types normal to the breast but present in an abnormal pattern or distribution?

A

Hamartoma

115
Q

How does a breast fibroadenoma present?

A

Screening
Painless, firm, discrete, mobile mass:
- “Breast mouse”

116
Q

In who is a breast fibroadenoma most common?

A

African women

Peak incidence in 3rd decade

117
Q

How does a breast fibroadenoma appear on USS?

A

Solid

118
Q

How does a breast fibroadenoma appear macroscopically?

A 
Circumscribed
Rubbery
Grey-white colour
Biphasic tumour/lesion:
- Epithelium
- Stroma
119
Q

How is a breast fibroadenoma treated?

A

Diagnose
Reassure
Excise

120
Q

What are sclerosing breast lesions?

A

Benign, disorderly proliferation of acini and stroma

121
Q

How does sclerosing adenosis present?

A 
Pain,
Tenderness
Lumpiness/Thickening
OR
Asymptomatic
122
Q

Between what ages does sclerosing adenosis present?

A

20-70 years

123
Q

How big are radial scars?

A

1-9mm

124
Q

How big are complex sclerosing lesions?

A

> =10mm

125
Q

What is the pathology of a radial scar?

A

Stellate architecture
Central puckering
Radiating fibrosis

126
Q

How do radial scars appear on histology?

A

Fibroelastic core
Radiating fibres containing distorted ductules
Fibrocystic change
Epithelial proliferation

127
Q

Radiologically, what does a radial scar mimic?

A

Carcinoma

128
Q

How is a radial scar treated?

A

Excise

Sample extensively by vacuum biopsy

129
Q

What can cause breast fat necrosis?

A

Local trauma:
- Seat belt injury
- Frequently no history
Warfarin therapy

130
Q

What is the pathology behind fat necrosis?

A

Damage and disruption of adipocytes
Infiltration by acute inflammatory cells
“Foamy” macrophages
Subsequent fibrosis and scarring

131
Q

How can fat necrosis be treated?

A

Confirm diagnosis

Exclude malignancy

132
Q

What do the following clinical features describe:

  • Affects subareolar ducts (dilatation)
  • Pain
  • Acute episodic inflammatory changes (Periductal)
  • Blood +/or purulent discharge
  • Fistulation
  • Nipple retraction and distortion
A

Duct ectasia

133
Q

What is duct ectasia associated with?

A

Smoking

134
Q

How is duct ectasia managed?

A

Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts

135
Q

What organisms are indicated in mastitis/abscess in duct ectasia?

A

Mixed organisms

Anaerobes

136
Q

What organisms are indicated in mastitis/abscess during lactation?

A

Staph. aureus

Strep. pyogenes

137
Q

What are the clinical features of a Phyllodes Tumour?

A

Age 40-50

Slow growing unilateral breast mass

138
Q

What is the alternative name for a Phyllodes Tumour?

A

Cystosarcoma phyllodes

139
Q

How does a Phyllodes Tumour appear?

A

Biphasic

Stromal overgrowth

140
Q

What dictates the behaviour of a Phyllodes Tumour?

A

Stromal features

141
Q

How does a Phyllodes Tumour tend to behave?

A 
Local recurrence (if not adequately excised)
Rarely metastasise
142
Q

How does an intraduct papilloma present?

A

Age 35-60

Nipple discharge +/- blood

143
Q

How does an asymptomatic intraduct papilloma appear at screening?

A

Nodules

Calcification

144
Q

What size are intraduct papillomas?

A

2-20mm

145
Q

How do intraduct papillomas appear?

A

Papillary fronds containing a fibrovascular core

Covered by myoepithelium and epithelium

146
Q

Where do breast carcinomas arise?

A

Glandular epithelium of the terminal duct lobular unit

147
Q

What type of cancer are breast carcinomas?

A

Adenocarcinomas

148
Q

How is an in situ carcinoma confined?

A

Within basement membrane of acini and ducts

149
Q

How much of the lobule is involved in atypical lobular hyperplasia?

A

<50%

150
Q

How much of the lobule is involved in lobular carcinoma in situ?

A

> 50%

151
Q

How does the intralobular proliferation of lobular in situ neoplasms appear?

A

Small-intermediate sized nuclei
Solid proliferation
Intracytoplasmic lumens/vacuoles

152
Q

What receptors are lobular in situ neoplasms positive for?

A

ER+

153
Q

Lobular in situ neoplasms are E-cadherin negative. What does this mean?

A

Deletion and mutation of CDH1 gene on Chromosome 16q22.1

154
Q

When does the incidence of a lobular in situ neoplasm decline?

A

After menopause

155
Q

How is a lobular in situ neoplasm managed if discovered on core biopsy?

A

Excision/Vacuum biopsy to exclude higher grade lesion

156
Q

How is a lobular in situ neoplasm managed if discovered on vacuum/excision biopsy?

A

Follow up

Clinical trials

157
Q

Ductal carcinomas in situ are unicentric. What does this mean?

A

Single duct system

158
Q

What is the cytological appearance of a ductal carcinoma in situ?

A

Malignant epithelial cells

159
Q

Where are ductal carcinomas in situ confined to?

A

Basement membrane of duct

160
Q

What is Paget’s Disease of the Nipple?

A

High grade ductal carcinoma in situ extending along ducts to reach epidermis of nipple (still in situ)

161
Q

How can ductal carcinoma in situ be classified?

A

Cytological grade
Histological type
Presence of necrosis (comedo)

162
Q

What is the significance of a ductal carcinoma in situ?

A

Risk factor for invasive carcinoma

True precursor lesion

163
Q

How is a ductal carcinoma in situ managed?

A 
Diagnosis
Surgery:
- Mammographic follow-up in low risk DCIS
- Adjuvant radiotherapy
- Chemoprevention (trial)
164
Q

What is a microinvasive breast carcinoma?

A

A ductal carcinoma in situ with invasion <1mm

165
Q

How is a microinvasive breast carcinoma treated?

A

Treat as high grade ductal carcinoma in situ

166
Q

What are the low grade breast carcinomas?

A

Tubular carcinoma
Lobular carcinoma
G1 ductal carcinoma

167
Q

What are the intermediate grade breast carcinomas?

A

G2 ductal carcinoma

Pleo Lobular carcinoma

168
Q

What is the main high grade breast carcinoma?

A

G3 ductal carcinoma

169
Q

How is an invasive breast carcinoma generally defined?

A

Malignant epithelial cells which have breached the basement membrane

170
Q

In terms of the UK population, how common is invasive breast carcinoma?

A

Most commonly diagnosed UK cancer

171
Q

What reproductive history features increase the risk of breast carcinoma?

A 
Early menarche (younger than 12 years)
Late pregnancy (First pregnancy at age >30)
Low/No parity
Not breastfeeding
Late menopause (Older than 55)
172
Q

What lifestyle features increase the risk of breast carcinoma?

A 
Overweight
Low physical activity
Alcohol
Poor diet
Smoking
173
Q

How do NSAIDs affect the risk of breast carcinoma?

A

Lower it

174
Q

In what populations is breast carcinoma more common?

A

White populations

Western Europe >

175
Q

How does a first degree relative of breast carcinoma affect the risk?

A

Doubles risk

176
Q

What syndrome is the TP53 gene associated with?

A

Li Fraumeni Syndrome

177
Q

What cancers does TP53 mutation predispose to?

A 
Childhood sarcoma
Brain
Leukaemia
Adrenocortical carcinoma
Early-onset breast
178
Q

What cancers does BRCA2 predispose to?

A

Breast (inc. male)
Ovarian
Prostate
Pancreatic

179
Q

What cancers does BRCA1 predispose to?

A

Breast
Ovarian
Bowel
Prostate

180
Q

What syndrome does PTEN mutation cause?

A

Cowden’s Syndrome

181
Q

What cancers does PTEN mutation predispose to?

A

Breast
GI
Thyroid (benign and malignant)

182
Q

What syndrome does STK11/LKB1 predispose to?

A

Peutz-Jeghers Syndrome

183
Q

What cancers does STK11/LKB1 mutation predispose to?

A

Breast
GI
Pancreatic
Ovarian

184
Q

What syndrome does ATM mutation predispose to?

A

Ataxia telangiectasia

185
Q

What cancers does ATM mutation predispose to?

A

NHL
Ovarian
Breast (in heterozygote carriers)

186
Q

Where do breast carcinomas invade locally?

A

Stroma of breast
Skin
Muscles of chest wall

187
Q

Where do breast carcinomas spread haematogenously?

A 
Bone
Liver
Brain
Lungs
Abdominal viscera
Female genital tract
188
Q

What percentage of breast carcinomas are ER+?

A

80%

189
Q

What percentage of breast carcinomas are progesterone receptors +?

A

67%

190
Q

What percentage of breast carcinomas are HER+?

A

14%

191
Q

What is the most common histopathological type of breast carcinoma?

A

Ductal

192
Q

What intrinsic breast cancer sub-type is ER-, HER2- and Basal CK+?

A

Basal-like

193
Q

What intrinsic breast cancer sub-type is ER- and HER2+?

A

HER2

194
Q

What intrinsic breast cancer sub-type is ER- and non-epithelial?

A

Normal breast-like

195
Q

What does ER receptor expression in breast cancer predict?

A

Response to anti-oestrogen therapy:

  • Oophorectomy
  • Tamoxifen
  • Aromatase inhibitors (Letrozole)
  • GnRH antagonists (Goserelin)
196
Q

What is HER2?

A

Human Epidermal GF Receptor 2

197
Q

What does HER2 expression in breast cancer predict?

A

Response to Trastuzumab (Herceptin)

198
Q

What is the Nottingham Prognostic Index?

A

A histopathological prognostic index:

  • 0.2 x tumour diameter (cm)
  • Tumour grade (1 - 3)
  • LN status (1 - 3)
199
Q

What factors does the Adjuvant! Online prognostic index take into account?

A

Histopathology
ER
Clinical features

200
Q

What factors does the PREDICT prognostic index take into account?

A 
Histopathology
ER
Clinical features
HER2
Mode of detection
201
Q

How is a breast mass imaged in women ages <40 years?

A

USS

202
Q

How is a breast mass imaged in women aged >40 years?

A

Mammography +/- USS

203
Q

What is mammography designed to do?

A

Maximise contrast between the breast tissues whilst minimising radiation dose

204
Q

What is the only method of breast imaging that reliably visualises microcalcifications (<0.5mm)?

A

Mammography

205
Q

When is digital mammography better?

A

Dense breasts

Younger women

206
Q

What are the advantages of digital mammography?

A 
Better contrast
Faster
Fewer technical repeats
Fewer films
Easier image storage and transfer
207
Q

How does glandular tissue appear on a normal mammogram?

A

Higher density

208
Q

How do trabeculae appear on a normal mammogram?

A

Thin

Sharply defined

209
Q

How do lymph nodes appear on a normal mammogram?

A

Oval/Horseshoe
Fatty hilum
25% have intramammary nodes (upper outer quadrant)

210
Q

How do calcifications appear on a normal mammogram?

A

Bright white:

  • Arterial
  • Sebaceous glands (polo mints)
  • Eggshell curvilinear (oil cysts)
211
Q

What views are taken in mammograms?

A

Mediolateral oblique
Craniocaudal
Extended craniocaudal

212
Q

What is the best single view in mammography?

A

Mediolateral oblique:

- Least foreshadowing

213
Q

What does a craniocaudal view allow visualisation of?

A

Retromammary fat

Medial and most of lateral tissue

214
Q

What do paddle view mammograms allow demonstration of?

A

Borders of mass

215
Q

What are the BIRADS parenchymal patterns on a normal mammogram?

A 
a = Nearly all fat
b = Scattered fibroglandular densities
c = Heterogeneously dense
d = Extremely dense
216
Q

If calcifications on a mammogram are in a cluster or segmental, what does this suggest?

A

Suspicious

217
Q

If calcifications on a mammogram are scattered or diffuse, what does this suggest?

A

Benign

218
Q

What MRI sequences help determine breast cancer morphology?

A

High resolution T1 and T2

219
Q

What MRI sequences help determine breast cancer vascularity?

A

Dynamic contrast enhancement kinetics

220
Q

What MRI sequences help determine breast cancer cellularity?

A

Diffusion-weighted imaging

221
Q

What MRI sequences help determine breast cancer metabolism?

A

Spectroscopy

222
Q

What MRI sequences help determine breast cancer oxygenation?

A

Intrinsic susceptibility-weighted MRI

223
Q

What can cause false negatives on MRI?

A

Invasive lobular carcinoma
DCIS
Mucinous carcinoma

224
Q

What can cause false positives on MRI?

A 
Normal
BBC
Fibroadenomas
Post-therapy changes
Fat necrosis
Intramammary nodes
225
Q

In breast conservation surgery, how big do the margins need to be for equivalent disease free and overall survival when compared to mastectomy?

A

Clear margins >=1mm

226
Q

What is the standard chemotherapy treatment following breast surgery?

A 
Standard FEC100:
- Fluorouracil, Epirubicin + Cyclophosphamide
AND
Taxane (eg. Docetaxel)
\+/- Herceptin
227
Q

What free-flap options are available for breast reconstruction?

A

Latissimus dorsi pedicled flap
Deep inferior epigastric artery perforator
Inferior gluteal artery perforator

Year 3 - Reproductive and Sexual Health (DP) (7 decks)

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