Breast Flashcards
differences between a discrete lump + localised nodularity
discrete lump
- stands out from adjoining tissue
- has definable borders
- is measurable
name 7 factors that make a patient more likely to warrant hospital referral
- lump
- pain
- nipple discharge
- nipple retraction or distortion
- nipple eczema
- change in skin contour
- family history
2 views on mammography
mediolateral oblique view + cranio-caudal
why are breasts compressed in mammography
spread out glandular tissue of the breast, reducing overlapping structures
first line imaging in women < 35 years
ultrasound imaging
what is ultrasonography?
high frequency sound waves beamed through breast; reflections are detected + turned into images
Ultrasound appearance of:
- cysts
- cancers
cysts = transparent objects
(other benign lesions have well demarcated edges)
cancers = indistinct outlines
what is colour flow doppler ultrasound used for
Images the blood flow to lesions
what is the blood flow to malignant lesions?
have greater blood flow than benign lesions
what is the value of MRIs in breast assessment
- assess extent of invasive lobular cancers; sometimes not well seen on mammography
- optimum method for imaging breast implants
- high risk women between 35 and 50 years
What is the role of FNAC or needle core biopsy?
establish diagnosis without need for surgical excision
1-5 scale for each component of tripple assessment
1 - normal 2 - benign 3 - intermediate/probs benign 4 - suspicious 5 - malignant
2 indications for breast imaging
1) symptomatic
2) breast screening
frequency of breast screening
every 3 years from 47 to 73 years of age
management of: breast mass + localised nodularity?
clinical + imaging assessment with biopsy
investigation for presentation of galactorrhea?
- associated with: pregnancy or breastfeeding
- check prolactin levels
- investigate for pituitary tumours
what is nipple retraction
slit like retraction: characteristic of benign disease
what is nipple inversion?
whole nipple is pulled inwards
occurs in association with both breast cancers + inflammatory conditions
incidence of breast cancer
1 in 8
cause of arm swelling following breast cancer?
axillary node clearance –> causes lymphoedema
breast changes in breastfeeding
- breasts feel firmer and larger
ultrasound changes in breastfeeding breast
- glandular enlargement
- engorgement of breast tissue
- duct dilatation
mammographic changes in breast feeding breasts
increases in breast size + density
what are the structures seen on a Mammogram
- axillary lymph nodes (in oblique view)
- pectoralis major (oblique view)
- fibroglandular tissue
- fatty tissue
what is Paget’s disease?
when bone interfers with bodys normal recycling process and new bone and tissue gradually replaces old bone tissue; over time the disease can cause bone to become fragile
most commonly affected areas by pagets disease
- pelvis
- skull
- spine
- legs
inspection on breast examination
- size
- symmetry
- lumps
- breast distortion
- tethering
- skin changes
- scars from previous surgery
- discharge from nipples
- change positions to accentuate any lumps
3 positions to ask patient to do in breast examination
1) raise arms above head
2) hands on hips + press downwards + forwards
3) lie flat on couch with one arm above head + only expose the breast on that side
how to palpate?
concentric movements of (flat of) hands around the breast, also: areolar
what is skin tethering
when the lump is attached to the skin; pulling the skin inwards producing a dimple
what is skin fixation
lump can not be moved without moving the skin
who is offered breast screening?
all women between 47 and 73, every 3 years
can you still have breast screening if above 70 years
yes but you need to ask your local breast screening unit
duration of breast screening appointment
< 30 mins
preparations to take for breast screening
do not wear talcum powder or deodorant as this can cause artefacts
contact breast screening unit prior to appointment if: (5)
- physical disability or find climbing stairs difficult
- pregnant
- had a mammogram recently
- breastfeeding
- have breast implants
when will i get results from breast screenigng
within 2 weeks
what % women asked to come back for further testing following breast screen
and
of these how many will have cancer
4 in 100
and
1 will have cancer
which additional women are now screened for breast cancer under NHS breast screening programme
BRCA1/2 mutation
Tp53 mutation
Previous supradiaphragmatic radiotherapy for Hodgkins lymphoma
who reads the mammogram?
independently by 2 trained film readers
