Breast Flashcards
What does a breast triple assessment consist of?
History taking + examination, imaging and histology
Decribe a breast examination
- Inspection
- Symmetry, scars, masses, skin changes (erythema, puckering), nipple changes
- With hand by side, on hips and behind head
- Palpation
- Lumps - position, size, shape, consistency, overlying skin changes, mobility
- Axilla - lymphadenopathy
What risk factors should be asked about when taking a breast history?
- Family history (first degree relative)
- Age at menarche
- Age at menopause
- How many children?
- Breastfeeding?
- At what age did they have their first child?
- Hormonal birth control or hormone replacement therapy?
What is the mainstay of imaging investigations used for triple assessment?
*
What does mammography involve?
Compression views of the breast across two views (oblique and craniocaudal), allowing for the detection mass lesions or microcalcifications.
What is ultrasound scanning used for?
Ultrasound scanning is more useful in women <35 years and in men, due to the density of the breast tissue in identifying anomalies.
This form of imaging is also routinely used during core biopsies.
A biopsy is required of any suspicious mass or lesion presenting to the clinic, how is this most commonly obtained?
What is the advantage of this compared to fine needle aspiration?
Core biopsy
A core biopsy provides full histology (FNA only provides cytology), allowing differentiation between invasive and in-situ carcinoma.
What is mastitis?
What is the most common cause?
Mastitis describes inflammation of the breast tissue, both acute or chronic.
By far the most common cause is from infection, typically through S. Aureus, but can occasionally be granulomatous.
How can mastitis be classed?
- Lactational mastitis (more common) is seen in up to a third of breastfeeding women; it usually presents during the first 3 months of breastfeeding or during weaning
It is associated with cracked nipples and milk stasis (often caused by poor feeding technique), and is more common with the first child
- Non-lactational mastitis (less common) can also occur, especially in women with other conditions such as duct ectasia, as a peri-ductal mastitis
Tobacco smoking is an important risk factor, causing damage to the sub-areolar duct walls and predisposing to bacterial infection
Clinical features of mastitis
Tenderness, swelling and erythema over the area of infection
Management of mastitis
Antibiotic therapy and simple analgesics
Continue milk drainage or feeding
Types of benign breast tumours
- Fibroadenoma
- Adenoma
- Papilloma
- Lipoma
Fibroadenoma is the most common benign growth in the breast. Who does it usually occur in?
Women of reproductive age
Fibroadenoma on examination:
- Highly mobile
- Well defined and rubbery
- Most less than 5cm
- Can be multiple and bilateral
Carcinomas in situ are malignancies that are contained within the basement membrane tissue. They are seen as pre-malignant condition, typically found on imaging and are rarely symptomatic at presentation.
What are the two main types of carcinoma in situ?
Ductal Carcinoma In Situ(DCIS) and Lobular Carcinoma In Situ (LCIS)
