Breast Disease

Question 1

what are the main cytological investigations in regards to breast disease?

Answer 1

• fine needle aspiration
• US guided fine needle aspiration
• nipple scrape
• nipple discharge (straight onto slides)
• core biopsy

Question 2

what is the cytology score given to breast tissue after a FNA?

Answer 2

C1 - unsatisfactory
C2 - benign
C3 - atypia (likely benign)
C4 - suspicious (likely malignant)
C5 - malignant

Question 3

what is the main advantage of a core biopsy over a FNA for breast cancer?

Answer 3

core biopsy shows tissue structure and allows typing/staging of tumour

Question 4

what are some of the benefits of carrying out a FNA in breast lesions?

Answer 4

• curative if there is a cyst
• can identify malignancy (but not type)
• is quick, cheap and well tolerated

Question 5

what are some of the disadvantages of carrying out a FNA in breast lesions?

Answer 5

• not 100% accurate
• can miss lesions
• can’t identify type or stage of malignancy
• can be difficult to interpret
• can cause pain, bleeding

Question 6

when is a core biopsy of the breast tissue carried out?

Answer 6

• when there is a suspicion of malignancy
• when there are structural changes in the breast
• to classify a tumour prior to surgery

Question 7

what are the most important signs in the breast that point to breast cancer?

Answer 7

mass in breast on examination

microcalcifications on mammography

Question 8

name a few benign conditions that may present in the breast

Answer 8

fibroadenoma
duct ectasia
fat necrosis
intraduct papilloma

Question 9

what are the features of a benign lump in the breast?

Answer 9

soft
mobile
well circumscribed
encapsulated

Question 10

which cell type in the breast is most likely to become cancerous?

Answer 10

luminal epithelium of the lactiferous ducts

Question 11

define non-invasive and invasive in the context of breast cancer

Answer 11

non-invasive - myoepithelium intact

invasive - myothelium affected

Question 12

what is the classification of breast cancer, based on structure affected and their invasiveness?

Answer 12

lobular carcinoma in situ
ductal carcinoma in situ
invasive lobular carcinoma
invasive ductal carcinoma

Question 13

name a few risk factors for developing breast cancer

Answer 13

• older age
• female
• early menarche
• late menopause
• late pregnancy
• HRT/COCP
• radiotherapy
• family history
• previous history
• genetic (BRCA 1 and 2)
• lifestyle (obesity, smoking)

Question 14

histologically, which type of breast cancer is the most common?

Answer 14

ductal carcinoma

Question 15

which organs is breast cancer most likely to spread via the blood?

Answer 15

bone
lungs
liver
brain

Question 16

how are findings on mammography graded for malignancy?

Answer 16

M1 - unsatisfactory
M2 - benign
M3 - atypia (probably benign)
M4 - suspicious (probably malignant)
M5a - malignant non invasive
M5b - malignant invasive

Question 17

how do Her2 positive breast tumours tend to behave?

Answer 17

they are often more aggressive, but react well to Herceptin treatment

Question 18

how do ER/PR negative breast tumours tend to behave?

Answer 18

they do not respond well to hormonal treatment

Question 19

why do estrogen receptor positive and progesterone receptor positive breast cancers have a better prognosis?

Answer 19

because they respond to hormonal therapies

Question 20

what are the 5 molecular subtypes of breast cancer?

Answer 20

• luminal A
• luminal B
• triple negative/basal
• Her2 positive
• normal breast like

Question 21

what is the management of breast cancer?

Answer 21

staging
surgery (mastectomy, WLE +/- lymph nodes)
radiotherapy
hormonal therapy
chemotherapy

Question 22

what do the molecular subtypes of breast cancer reflect?

Answer 22

estrogen receptor status
progesterone receptor status
Her2 status
Ki67 protein levels

Question 23

what is Paget’s disease of the nipple?

Answer 23

intraductal carcinoma affecting the epidermis of the nipple and areola

Question 24

what skin condition can Paget’s disease of the nipple be mistaken for?

Answer 24

eczema

Question 25

what is the incidence of breast cancer?

Answer 25

breast cancer affects 1 in 8 women

Question 26

what is the main aim of FNA and core biopsy in breast cancer?

Answer 26

FNA - looks at cells

core biopsy - looks at tissue

Question 27

name a few signs/symptoms of breast cancer

Answer 27

• painless lump
• thickening of skin of breast
• nipple inversion
• nipple discharge
• abnormal shape/size of breast
• peau d’orange
• crusting of nipple (Paget’s disease)

Question 28

what are the less common types of invasive breast cancer?

Answer 28

medullary
tubular
mucinous
papillary

Question 29

when is a sentinel lymph node biopsy taken in breast cancer?

Answer 29

when ultrasound of sentinel lymph node is normal

Question 30

how is the axilla managed in breast cancer, depending on sentinel lymph node biopsy result?

Answer 30

biopsy negative (no tumour in sentinel lymph node) - no treatment to axilla
biopsy positive (tumour in sentinel lymph node) - surgery/radiotherapy to remove all axillary lymph nodes

Question 31

what is the action of tamoxifen in breast cancer?

Answer 31

blocks cell growth stimulation by oestrogen

Question 32

what is the action of herceptin in breast cancer?

Answer 32

monoclonal antibody - blocks Her2 receptor

Question 33

what are the first line imaging techniques to carry out in women who present with a lump/mass?

Answer 33

mammography (over 40 unless strong suspicion/FH)

ultrasound (under 40)

Question 34

what is the benefit of doing an ultrasound for a breast lump?

Answer 34

helps identify whether it’s solid or cystic

Question 35

what does the triple assessment involve in breast disease?

Answer 35

• clinical examination
• imaging (mammography/US)
• FNA cytology/core biopsy

Question 36

what are the commonest angles mammography pictures are taken at?

Answer 36

mediolateral oblique (MLO)
craniocaudal (CC)

Question 37

when is an MRI carried out for breast problems?

Answer 37

for recurrent disease
if lesion not identified by triple assessment
problems with breast implants
screening for high risk women

Question 38

how is the sentinel lymph node identified for breast cancer metastasis assessment?

Answer 38

through lymphoscintigraphy (nuclear scan)

Question 39

who is invited to take part in breast cancer screening? what does it involve?

Answer 39

women between 50-70

mammography every 3 years