breast procedures Flashcards
max dose of 1% lidocaine with epinephrine used for deep local anesthesia is
7 mg/kg body weight, not to exceed 500 mg
indication for ductogram
single pore discharge that is bloody, clear/serous, or serosanginous
nipple discharge colors of benign etiology
white and green
How much contrast is used for a ductogram
0.2 to 0.3 mL, volume to not exceed 1 mL
The patient should be referred back to a breast surgeon. In these images, an intraductal filling defect/mass is identified at the 6:00 position retroareolar. Primary differential diagnosis is papilloma or DCIS. Localizing this mass for a surgical breast biopsy will increase the probability of removing the etiology of the discharge rather than a blind surgical duct excision. The intraductal mass can be localized for subsequent surgical biopsy, either with a biopsy marker at the time of diagnostic ductogram or with a repeat ductogram/wire localization on the day of surgical biopsy. (from Core Review Breast)
Stereotactic breast biopsy is not indicated in this instance. The standard mammogram is most likely negative, which will make the intraductal mass difficult to localize for stereotactic biopsy. Also, a percutaneous biopsy may not remove the entirety of the mass.
A stereotactic biopsy was performed on a 47-year-old patient. The pathology results are atypical ductal hyperplasia (ADH). What is the appropriate recommendation?
Surgical excision
The difference between atypical ductal hyperplasia (ADH) and ductal carcinoma is often determined by the number of ducts involved. Therefore, a larger sample may result in the diagnosis of DCIS when the core biopsy was ADH.
A 43-year-old female, with no known allergies or past medical condition, underwent an uneventful right breast stereotactic core needle biopsy in the morning. After needle biopsy, hemostasis was successfully achieved, and the patient was sent home. The patient returns to the radiology department complaining of right breast pain at the breast biopsy site. There is no oozing or unexpected bleeding or palpable lump at the biopsy site. Which of the following is the most appropriate initial management of the patient’s breast pain?
the first step in management of the patient’s breast pain is to have the patient take acetaminophen initially and then every 6 hours as needed, up to 4 g/d.
A 31-year-old pregnant patient is discovered during her first trimester to have a breast cancer. The treatment for her breast malignancy is
immediate surgical resection
Surgical procedures such as breast conservation surgery, mastectomy, and axillary lymph node sampling can be performed when the patient is pregnant. Radiation to the breast or chest wall is postponed until after delivery (but can be done in 3rd trimester). Chemotherapy is not given in the first trimester because there is a significant risk of spontaneous abortion.
