breast lump

Question 1

the triple test refers to

Answer 1

medical history and clinical breast examination
mammography and/or ultrasound
non-excisional biopsy - core biopsy and/or FNA

Question 2

presenting symtpoms of breast cancer

Answer 2

thickening or ridge
breast or nipple assymetry
skin changes such as dimpling/reddness
nipple changes
nipple discahrge
unilateral breast pain

Question 3

clinical breast examination important points

Answer 3

perform inspection with arms by their side, arms above their head, and pressing on hips
detail size, shape, consistancy, mobility, tenderness, fixation and exact position

Question 4

if you find suspicious or malignant breast or nipple change

Answer 4

refer to breast surgeon and request urgent diagnostic imaging

Question 5

first step to work up a lesion

Answer 5

mammography and/or US

Question 6

if there is a solid lesion or suspicious or malignaant lesion on mammography/US

Answer 6

refer to breast surgeon and
core biopsy

Question 7

benign nipple changes

Answer 7

slit like retraaction
retraction that is able to be easily everted

Question 8

clinically abnormal or suspicious nipple changes

Answer 8

colour change
fixed whole nipple inversion
ulceration and eczematous-like changes

Question 9

nipple discharge

Answer 9

unilateral, spontaneous, bloody or serous discharge from a single duct raises the possibility of cancer
malignant cells on cytology of discharge fluid are indicative of cancer, but negative discharge cytology cannot be used to rule out cancer due to low sensitivity
imaging for nipple discharge should include mammography and ulstrasound

Question 10

imaging for under 35

Answer 10

ultrasound is recommended as first-line imaging
mammography should be used in addition to ultrasound if
- the clinical findings are suspicious or malignant
- the US findings ar indeterminant
- the US findings are not consistant with clincial findings

Question 11

imaging for 35 years and older

Answer 11

mammography and ultrasound should both be performed

Question 12

imaging in pregnancy or lactation

Answer 12

ultrasound is the most useful modality
mammography should be used if the clinical or US findings re indeterminate or if there is inconsistncy

Question 13

imaging of the axilla

Answer 13

if mammography or US findings are suspicious of malignant the ipsilateral axilla should also b imaged with ultrasound

Question 14

whats the difference between cor biopsy and FNA cytology

Answer 14

core biopsy can differentiate between in situ and invasive cancer
FNA can be used to confirm the diagnosis of certain benign lesions
fluid aspirated from a cyst for diagnostic purposes should be sent for pathological examination

Question 15

surgical referral

Answer 15

should be made to a specialist breast surgeon or specialist multidisciplinary breast clinic service
discuss public vs. private insurance options

Question 16

when is surgical referral recommended

Answer 16

any one component of the triple test is positive
a cyst aspiration is incomplete, results in non-traumatic bloody aspirate or a lump remains post aspiration
spontaneous unilateral bloody or serous discharge from a single duct especially in a woman 60 years and over
eczematoid changes of the nipple-areolar skin which persist 1-2 weeks or do not respond to topical treatment
inflammatory breast conditions not resolving with 1-2 weeks of treatment
if any teest results is inconsistent with other results and requires additional investigation