Breast Surgery Flashcards
MOST lymph of breast tissue drains into _______________ while the rest goes to ___________________.
Lymph from skin drains into: (3)
axillary lymph nodes
parasternal lymph nodes
axillary
deep cervical infraclavicular
parasternal nodes
What are diagnostic studies of the breast?
mammogram: mass, calcification, architectural distortion
Ultrasound: cystic or solid
breast MRI
biopsy
What is the BI-RADS Classification?
0-6
0: Incomplete study and needs more information
1: normal study
2: benign findings
3: PROBABLY benign: short term follow up suggested
4: suspicious abnormality
5: HIGHLY likely for malignancy
6: known biopsy proven malignancy
Mammogram uses xrays to image breasts. Imaging may detect small tumors and increase detection of small abnormal tissue growth.
There IS a risk for false positive and false negatives
It may not differentiate between ________ and ______ masses
FU with ________ and or ______ may be needed.
No clear data that it improves survival in women over 70-75 years old.
solid, cycstic masses
ultrasound, biopsy
What is the impact of screening and early detection?
24% reduction in cancer mortality
lower stages at diagnosis
increased likelihood of breast conversion therapy
Improved cosmesis with smaller tumors
SAVES LIVESSSSSSSS
Ultrasound uses sound waves to produce images. It can detect solid vs cystic. Under what circumstance may this be an initial study?
in a young woman with a mass and dense breasts
What are the indications for a breast MRI?
- evaluate women with silicone implants for rupture
- evaluate women diagnosed with breast CA
- assess the patient with the problem mammogram ***
- screen women at high risk for breast CA
What are the benefits of the MRI?
- MORE SENSITIVE
- useful for women at HIGH RISK of breast CA
- finds invasive breast CA well
- excellent at imaging around breast implants
- accurately images implant rupture and leaked material
- no compression of breast tissue
- good for dense breasts
- helps determine if lumpetomy or mastectomy will be best treatment
- images BOTH breasts simultaneously
What are the disadvantages to an MRI?
- not good at detecting DCIS
- leads to many false positive findings
- additional follow up exams and biopsies
- may cause claustrophobia
- requires use of IV contrast-gadolinium
- more expensive than mammorgram, needs approval
- may not be widely available
- slower than a mammogram (30-60 min)
What are the 3 different types of breast biopsies?
- fine needle aspirate (FNA) > cells
- Core needle biopsy > tissue mass
-ultrasound guided, (xray guided) biopsy - surgical biopsy
-excisional biopsy
-needle localization biopsy
Fine needle =
Core=
CYTOLOGY, small needle, cells or clumps of cells
PATHOLOGY
larger needle, thin piece of tissue
What are the advantages to image guided biopsy?
high incidence of benign pathology
less invasive procedure
guided decision making, plan surgical intervention
avoids multiple surgical procedures
What are indications for surgical excision?
known cancer
inability to diagnose from needle pathology
atypical findings on path
patient preference
you dont trust your specimen
Fibrocystic disease is the most frequent and common ____________ lesion. it is RARE in ___________ women. It presents as cyclic _________ and a _______ may be transiet. The imaging you want to do is a _________________. Suspicious lesions should be _____________
BENIGN
postmenopausal
breast pain, mass
Mammo/US
biopsied
A fibroadenoma is a common _______________. It is a nontender, ____________ mass. MUST ______________ but does not need treatment unless ____________
benign neoplasm
discrete
biopsy
it enlarges
