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Reproductive > Breast Lectures > Flashcards

Breast Lectures Flashcards

1
Q

Describe the location and relations of breasts

A
  • 2nd/3rd rib to 6th rib
  • Sternal edge to midaxillary line
  • Lies on the deep pectoral fascia
  • A small part (axillary tail) may extend towards the axillary fossa
  • Retromammary space - helps some degree of movement
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2
Q

Describe the structure of the breast

A
  • Nipple
  • Areola
  • 15-20 lobules of glandular tissue (parenchyma)
  • Each lobule is drained by a lactiferous duct
  • Each duct has a dilated portion (lactiferous sinus)
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3
Q

Describe the structure of the nipple

A
  • No fat or hair
  • Contains collagenous dense connective tissue, elastic fibres and bands of smooth muscle
  • The tips of the nipples are fissured with lactiferous ducts opening into them
  • Position: 4th intercostal space (roughly)
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4
Q

Describe the structure of the areola

A
  • Skin covering the nipple and areola contains numerous sweat and sebaceous glands
  • Oily secretion lubricates the nipple and areola
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5
Q

Name the four quadrants of the breast

A
  • Superolateral
  • Superomedial
  • Interolateral
  • Inferomedial
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6
Q

Describe the development of the breast

A
  • Mammary crests or ridges appear during the 4th week
  • These crests extend from the axillary region to inguinal region
  • The crests usually disappear (except in the pectoral region)
  • Primary mammary buds > secondary mammary buds > lactiferous ducts and their branches
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7
Q

What is the blood supply to the breasts?

A
  • Branches of axillary, internal thoracic and some intercostal arteries
  • Thoraco acromial a.
  • Lateral thoracic a.
  • Internal mammary a.
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8
Q

What is the innervation of the breasts?

A
  • Anterior and lateral cutaneous branches of 4-6th intercostal nerves
  • Sensory fibres and sumpathetic fibres to the blood vessels and smooth muscle
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9
Q

Which lymph nodes drain lymph from the breasts?

A

-Axillary lymph nodes
-Supraclavicular nodes
-Inferior cervical nodes
-Parasternal
(can drain to the opposite breast)

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10
Q

What is the function of the terminal duct lobular unit?

A

Milk secretory component of the breast

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11
Q

Describe the features of breast tissue prepuberty

A
  • Neonatal breast contains lactiferous ducts but no alveoli
  • Until puberty, little branching of the ducts occurs
  • Slight breast enlargement reflects the growth of fibrous stroma and fat
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12
Q

Describe the features of breast tissue at puberty

A
  • Branching of lactiferous ducts
  • Solid, spheroidal masses of granular polyhedral cells
  • Accumulation of lipids in the adipocytes
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13
Q

Describe the features of breast tissue post menopausal

A
  • Progressive atrophy of lobules and ducts

- Fatty replacement of glandular tissue

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14
Q

Name the signs of breast cancer

A
  • Skin dimpling
  • Abnormal contours
  • Oedema of the skin
  • Nipple retraction or deviation
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15
Q

Name some of the benign breast tumours

A
  • Fibroadenoma
  • Duct papillomas
  • Adenomas
  • Corrective tissue tumours
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16
Q

What is cytology and how can samples be obtained?

A
  • Miscroscopic examination of a thin layer of cells on a slide
  • FNA
  • Direct smear from nipple discharge
  • Scrape of nipple with scalpel
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17
Q

Which groups of patients should get cytology?

A
  • Symptomatic patients (discrete mass, diffuse thickening and nipple lesion)
  • Breast screening
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18
Q

What would you see on a benign cytology?

A
  • Low/moderate cellularity
  • Cohesive groups of cells
  • Flat sheets of cells
  • Bipolar nuclei in the background
  • Cells of uniform size
  • Uniform chromatin pattern
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19
Q

What would be seen on a malignant cytology?

A
  • High cellularity
  • Loss of cohesion
  • Crowding/ overlapping of cells
  • Nuclear pleomorphism
  • Hyperchromasia
  • Absence of bipolar nuclei
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20
Q

Which features on a cytology would suggest a specific type of cancer?

A
  • Cytoplasmic vacuoles: lobular carcinoma

- Cells arranged in tubes: tubular carcinoma

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21
Q

Describe the cytology scoring system

A
  • C1: unsatisfactory
  • C2: benign
  • C3: atypia (probably benign)
  • C4: suspicious
  • C5: malignant
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22
Q

What is the treatment for cysts?

A

Aspiration: fluid is then discarded unless blood stained or there is residual mass

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23
Q

What are the advantages of cytology?

A
  • Simple procedure
  • Well tolerated
  • Inexpensive
  • Immediate results
24
Q

What are the limitations of cytology?

A
  • Accuracy not 100%
  • False positives and false negatives
  • Invasion cannot be assessed
  • Grading cannot be done
  • Sampling: lesion can be missed
  • Suboptimal smears
  • Interpretation: features are similar
25
Q

What are the complications of FNA?

A
  • Pain
  • Haematoma
  • Fainting
  • Infection
  • Pneumothorax (rare)
26
Q

Which nipple lesions can be diagnosed from cytology of nipple discharge?

A
  • Duct ectasia: macrophages only
  • Intraduct papilloma: benign cells in papillary groups
  • Intraduct carcinoma: malignant cells
27
Q

What can cytology of a nipple scrape determine?

A

Whether there is Paget’s disease or eczema

28
Q

What is an axillary lymph node FNA used for?

A

Pre-operative planning

29
Q

When is a core biopsy performed?

A
  • All cases with clinical/ radiological/ cytological suspicion
  • Breast screening
  • Pre-operative classification
30
Q

What can a core biopsy do?

A
  • Confirms invasion
  • Tumour typing and grading
  • Immuno histochemistry - receptor status
31
Q

Which imaging techniques can be used for imaging breast tissue?

A
  • Mammography
  • USS
  • MRI
  • Nuclear medicine
  • Image guided techniques
  • CT
32
Q

When should a mammography be used?

A
  • Over age 40

- Under 40: if strong suspicion of cancer or FH risk > 40%

33
Q

When should an USS be used?

A
  • To differentiate solid from cystic and benign from malignant
  • First line for under 40yrs
34
Q

What is involved in a triple assessment?

A
  • Clinical examination
  • Imaging
  • FNA cytology
35
Q

What are the indications for an MRI of the breast?

A
  • Recurrent disease
  • Implants
  • Indeterminate lesion following triple assessment
  • Screening for high risk women
36
Q

Describe how the breast screening programme works

A
  • Women aged 50-70 invited every 3 yrs for a mammography
  • Detects 5 cancers for every 100 screened
  • Aims to detects cancers at DCIS stage or less than 15mm in size
  • Additional views: clinical exam, USS, FNA or core biopsy
37
Q

Give examples of benign breast conditions

A
  • Fibrocystic change: fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia
  • Fibroadenoma: circumscribed mobile nodule
  • Intraduct papilloma: lactiferous ducts and nipple discharge
  • Fat necrosis: traumatic
  • Duct ectasia: nipple discharge
38
Q

Describe the features of a fibroadenoma

A
  • Proliferation of epithelial and stromal elements
  • Most common breast tumour in adolescent and young adult women
  • Well circumscribed, freely mobile and non painful mass
  • May regress with age if left untreated
39
Q

Describe the features of a tubular adenoma

A
  • Far less common
  • Young women
  • Discrete, freely movable masses
  • Uniform sized ducts
40
Q

Describe the features of a lactating adenoma

A
  • Enlarging masses during lactation or pregnancy

- Prominent secretory changes

41
Q

Describe the features of a phyllodes tumour

A
  • Fleshy tumour: leaf like pattern and cysts on cut surface
  • Benign, borderline or malignant
  • Metastases are haematogenous
42
Q

Describe the features of breast carcinoma

A
  • Hard, fixed mass which is tethered to the skin
  • Peau d’ orange dimpling of the skin
  • Soft tissue opacity and microcalcification on a mammogram
43
Q

What are the risk factors for breast cancer?

A
  • Gender
  • Age
  • Menstrual history
  • Age at first pregnancy
  • Radiation
  • FH
  • Hormonal treatment
  • Genetic factors (BRCA1 and 2)
  • Obesity and lack of physical activity
  • Alcohol
44
Q

Name the histological classification of breast cancer

A
  • Non Invasive: ductal carcinoma in situ and lobular carcinoma in situ
  • Invasive: invasive ductal carcinoma and invasive lobular carcinoma
45
Q

Describe the features of in situ carcinoma

A
  • Preinvasive (not a palpable tumour)
  • Not detected clinically
  • Multicentricity and bilaterality
  • No metastatic spread
  • Risk of invasion depends on the grade
46
Q

How can breast cancer be diagnosed?

A
  • Clinical examination
  • Radiology: mammogram, USS and MRI
  • FNA cytology
  • Needle core biopsy
  • Wide local excision
47
Q

What are microcalcifications and what is their significance?

A
  • Tiny deposits of calcium
  • Majority are harmless
  • Minority may be in precancerous or cancerous tissue
48
Q

What is included in the histology report?

A
  • Invasive vs non invasive
  • Histological type
  • Grade
  • Size
  • Margins
  • Lymph nodes
  • Oestrogen/progesterone receptor
  • HER-2
49
Q

How does breast cancer spread?

A
  • Local: skin and pectoral muscles
  • Lymphatic: axillary and internal mammary nodes
  • Blood: bone, lungs, liver and brain
50
Q

Which factors affect the prognosis of breast cancer/

A
  • Node status
  • Tumour size
  • Type and grade
  • Age
  • Lymphovascular space invasion
  • Oestrogen and progesterone receptors
  • HER-2
  • Proliferation rate of tumour
  • Gene expression profiling
  • Nottingham prognostic index
51
Q

What do ER ad PR receptors show?

A

Presence is strong predictor of response to hormonal therapies

52
Q

How is breast cancer managed?

A
  • Staging
  • Surgery
  • Radiotherapy
  • Antihormonal therapy (Tamoxifen)
  • Chemotherapy
53
Q

Describe the features of Paget’s disease of the nipple

A
  • Result of intraepithelial spread of intraductal carcinoma
  • Large pale staining cells within the epidermis of the nipple
  • Limited to the nipple or extend to the areola
  • Pain or itching, scaling and redness
  • Ulceration, crusting and serous or bloody discharge
54
Q

Which investigations are used to assess the severity of the breast cancer?

A
  • FBC, U&Es, LFTs, calcium and PO2

- CXR

55
Q

What are the two main types of surgery to the breast?

A
  • Breast conservation surgery

- Mastectomy

56
Q

Which patients are suitable for breast conservation surgery?

A
  • Breast/tumour size ratio
  • Suitable for radiotherapy
  • Single tumours < 4cm (in olden days)
57
Q

What are the complications of axillary treatment?

A
  • Lymphoedema
  • Sensory disturbance
  • Decreased ROM of the shoulder joint
  • Nerve damage
  • Vascular damage
  • Radiation induced sarcoma

Reproductive (26 decks)

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