Breast Investigation and Examination

Question 1

What do you do if breast abnormality in >40

Answer 1

Mammogram

Question 2

What do you do if focal lesion (pin point / discharge / dimpling)

Answer 2

USS

Question 3

Who gets screening

Answer 3

Women 
50-70
3 yearly mammogram
Annual if high risk gene / RT
Previous malignancy for follow up

Question 4

What do you do once >70

Answer 4

Have to invite themselves

Question 5

What do you want screening to detect

Answer 5

DCIS

<15mm impalpable

Question 6

What do you get if known BRCA1/2 mutation

Answer 6

Annual MRI up till 50
Annual mammogram after
Might opt for mastectomy + oophorectomy

Question 7

What do you do if <35

Answer 7

USS

Breast is too dense so won’t pick up malignant

Question 8

What happens as you get older

Answer 8

Breast replaced with adipose

Question 9

What do you do if mammogram +ve

Answer 9

Assessment clinic
Examination
Mammogram + USS
Further Rx e.g. biopsy

Question 10

USS

Answer 10

Cyst = black

Question 11

USS

Answer 11

Cyst = black (U2)
If solid = U3 further Ix
Irregular / shadow = behind
Tall / thin / acoustic enhancement = benign

Question 12

What normal can you see

Answer 12

Rib and lung behind pec major

Skin on top

Question 13

When do you do MRI

Answer 13

Recurrent
Implants
High risk <50

Question 14

When do you do USS

Answer 14

Axilla

Cystic

Question 15

What do you do if cyst

Answer 15

Aspirate

Question 16

What do you do if U3

Answer 16

USG biopsy

Question 17

What do you do if U4/5

Answer 17

Biopsy

Axillary USS

Question 18

What do you do if can’t see lesion on USS

Answer 18

Sterocore biopsy

USS axilla

Question 19

When is FNAC used

Answer 19

After mammography
If cystic lesion
Most get biopsy

Question 20

What are complications of FNAC

Answer 20

Pain / faint
Haematoma
Infection
Pneumothorax

Question 21

When do you do core biopsy

Answer 21

Following FNAC or if symptomatic or hard lump

Investigation of choice for all cases with clinical or radiological suspicion

Question 22

How do you do it

Answer 22

USS guied

Stereotatic (mammography)

Question 23

What does biopsy do

Answer 23

Confirm invasion
Tumour type and grade
Immunohistochemistry report for receptor status

Question 24

What do you do if DCIS

Answer 24

Much larger biopsy as don’t want to miss invasion

Question 25

What does histological report show

Answer 25

``` Invasive vs in-situ Ductal vs lobular Grade 1-3 Size of tumour Margins LN invovlenet ER / PR HER-2 ```

Question 26

What are other options

Answer 26

Punch biopsy if skin lesion Nipple smear of discharge Urine dip of smear for blood

Question 27

What does SNB involve

Answer 27

Inject dye Goes to lymphatics Remove node with highest frequency or blue or any malignant Max = 4

Question 28

What is SNB +VE

Answer 28

Risk of spread to other nodes | Need clearance

Question 29

If SNB -ve

Answer 29

Aall nodes -ve

Question 30

What suggests DCIS on mammogram

Answer 30

Microcalcification

Question 31

What does glandular tissue show as

Answer 31

White and dense

Question 32

What does fat show as

Answer 32

Grey

Question 33

What does HRT do

Answer 33

Makes breast more dense

Question 34

What views for mammogram

Answer 34

Medial + Lateral oblique - axilla / pec | Craniocaudal

Question 35

Benign mammogram

Answer 35

``` Smooth Lobulated Normal density Halo Round calcifications ```

Question 36

Malignant mammogram

Answer 36

``` Irregular Illdefined Speculated Dense - much whiter Enlarged LN on MLO Tension sign as cancer pulls in ```

Question 37

What is any well defined white lesion

Answer 37

M3 | Need USS to differentiate cyst from solid

Question 38

What do you look for on mamogram

Answer 38

``` Microclacification Soft tissue opacity Distortion Asyymetry Axila for enlarged node on MLO ```

Question 39

How do you describe

Answer 39

``` MLO and CC views Background Brest tissue - dense / radiolucent Describe abnormality Asymmetric density Speculate mass Well defined mas Archiectural distortion Microcalcification ```

Question 40

What is adult breast divided into

Answer 40

Nipple Axilla tail - project upper quadrant 4 quadrant

Question 41

Where does breast extend

Answer 41

Midline to lat dorsi | Clavicle to upper abdo

Question 42

How do you document lump

Answer 42

4 students 3 teachers at CAMPFIRE

Question 43

Lump

Answer 43

``` Site Size Shape Surface Tender Temp Transilumination Consistency Appearance - colour? Mobility Pulsation Fluctuation Irregualrity Regional LN Edge ```

Question 44

What should breast be

Answer 44

``` Smooth Uninterrupted Same colour Veins enlarged in pregnacy Can be asymmetric ```

Question 45

What should nipple be

Answer 45

Areola - pink to brown Smooth Can get sebaceous cyst / Montgomery tubule

Question 46

Anatomy of breast

Answer 46

Pec major and minor in front Serratus anterior Lat dorsi

Question 47

What supplies pec

Answer 47

C5,6,7

Question 48

What supplies serrates anterior

Answer 48

Long thoracic | Wing if damaged

Question 49

What supplies lat dorsi

Answer 49

Thoracodorsal

Question 50

If aspirate and clear fluid

Answer 50

Discard and reassure

Question 51

If bloody

Answer 51

Cytology

Question 52

If residual mass

Answer 52

Core biopsy

Question 53

If solid lump

Answer 53

Core biopsy

Question 54

Limitations of screening

Answer 54

``` OverDx False +ve leading to unnecessary further investigation False -ve leading to reassurance Pain and discomfort Exposure to radiation Psychologicla ```

Question 55

Benefits

Answer 55

Reduced mortality | Early detection so can do breast conserving treatment