Breast Disease - Tieman Flashcards
most common breast mass in young women
fibroadenoma
<30yo
benign
firm, moveable, non-tender
fibroadenoma diagnosis
U/S
FNA helpful - but can’t distinguish from phyllodes
giant fibroadenoma
> 5cm
tx of fibroadenoma
may be watched, excised, or treated with cryoablation
phyllodes tumor
stroma grows rapidly and tumor becomes large
may be benign or malignant - depends on mitotic rate and histo
malignant - tx - wide local excision or mastectomy
fibrocystic breast disease
cyst may be painless - multiple painful are common
35-55yo
fluctuate with menstrual cycle
fluctuate with menstrual cycle
fibrocystic breast disease
areas of fibrosis in ducts with destruction and dilation of terminal ductules and lobules
fill with cystic fluid
tx fibrocystic breast disease
aspiration
if recur - may be reaspirated
bloody aspirate - examine it
bilateral diffuse cyclical breast pain
fibrocystic breast disease
U/S - multiple small cysts
mammography - dense tissue - without mass
increased risk of fibrocystic breast disease
caffeine
chocolate
alcohol
tx of fibrocystic breast disease
support bra analgesica avoid trauma danazol, tamoxifen - if severe primrose oil low fat diet vit E
sclerosing adenosis
proliferation of fibrous stroma and terminal ductules with deposition of calcium
mammogram - look like microcalcifications of breast ca
no malignant potential
radial scar
complex sclerosing lesion
microcyst, epithelial hyperplasia, adenosis, central sclerosis
need bx - to distinguish from breast cancer**
slight increased risk to develop breast cancer
expressed nipple discharge
goes away when manipulation stopped
spontaneous nipple discharge
needs evaluated if serous/blood discharge
evaluation of nipple discharge
mammogram, cytology, U/S
unilateral, spontaneous, bloody/serous nipple discharge
duct excision required
95% benign papilloma
5% papillary carcinoma
bilateral nipple discharge
fibrocystic disease with duct ectasia
if not lactating - hyperPRL, hypothyroid, drug induced
lactational mastitis
younger
breast feeding women with fever
breast erythema and tenderness
staph aureus - tx antibiotics
may form abscess
chronc sub-areolar mastitis with duct ectasia
older women
diabetics who smoke
mixed flora
tx - antibiotics
may form abscess
non-resolving mastitis
requires biopsy*
bc looks like inflammatory breast cancer
fat necrosis
scarring folowing trauma, surgery, radiation
scar tissue, chronic inflammatory cells, and macrophages
often with calcifications
no malignant potential
male gynecomastia
diffuse male hypertrophy
pubertal - adolescent boys - rarely requires tx
senescent - males >50, medication associated - digoxin, thiazide, estrogens, phenothiazines, theophylline
must rule out underlying medical condition (cirrhosis, renal failure, malnutrition)
male breast cancer
harder, non-tender, fixed to surrounding sructure
lobes of breast
15-20
estrogen
ducts
progesterone
lobules
nipple openings
15-20
age <30
fibroadenoma
age 30-50
fibrocystic mass
age >60
majority of breast cancers
but cancer can happen at any age
social hx for breast ca
smoking, ETOH, occupation
family hx for breast ca
first degree relative - 2-3x risk increase
BRCA1 and 2 - 80% lifetime risk
endocrine disease
estrogen window
menarche to menopause
age of 1st pregnancy >35yo
1.5-3x increase risk of breast cancer
GAIL model
risk assessment for breast cancer
age, menarche age, age 1st birth, 1st relative with breast cancer, number of biopsies, race
patient <40yo with benign breast mass desiring excision
surgical biopsy
benign breast mass >40yo
mammogram
ultrasound
FNA
excise if malignant - repeat 3 months if benign
MRI of breast
high sensitivity
low specificity
more false positive readings and bx expenses
screening for high risk BRCA patients, dense breasts, small lesions, implants
FNA
minimally invasive
can be done in office
requires skilled cytopathologist
core needle biopsy
obtain tissue
ER/PR analysis
doesn’t interrupt lymphatics
atypia on FNA or core needle bx
requires excision of entire lesion - to rule out malignancy
atypical hyperplasia on biopsy
3-6x increased risk of later invasive cancer
LCIS
tx as risk factor
15-20x increased risk of DCIS bilaterally**
excisional biopsy with clear margins
DCIS
tx with lumpectomy/radiation
most common invasive breast cancer
ductal
-favorable - medullary, tubular, mucinous, papillary
lobular carcinoma of breast
bilateral
slightly better prognosis than ductal
peau d’orange
inflammatory cancer of beast
breast cancer staging
T1 - 5cm
T4 - wall fixation or skin involved
N0 - no nodes
N1 - mets to ipsilateral nodes
N2 - mets to fixed or matted axillary nodes
stage 0 prognosis
Tis, N0, M0 - 95% 5 year
stage 1 prognosis
T1, N0, M0 - 85% 5 year
BI-RADS 0
requires additional studies
BI-RADS 1
no abnormal findings
-routine screening
BI-RADS 2
benign findings
-routine screening
BIRADS 3
probably benign
-6 month follow up
BIRADS 4
suspicious abnormality
-image guided bx
BIRADS 5
highly suggestive of malignancy
-image guided bx
mammotome biopsy
image guided
radical mastectomy
removal of breast, pec muscles, axillary nodes
rarely used - only if invades pectoralis muscles
modified radical mastectomy
remove breast, axillary nodes
partial mastectomy
remove part of breast
breast ca with negative axillary nodes
ALND
axillary lymph node dissection
-preferred tx if lymph node positive for cancer or patient doesn’t want to risk having two procedures
complications - numbness - lymphedema
neoadjuvant therapy
chemo/rad before surgery
to down size and down stage tumors
anastrazole
aromatase inhibitor
breast cancer follow up
6-12 months
look for recurrence/mets
mammograms - yearly bilateral
