Clinical Presentation of Breast Disease, Mammography, and Biopsy Flashcards
How many women with cancer are symptomatic?
- About 45% with the remainder coming to attention through mammographic screening
What are some symptoms that a patient with breast cancer may present with?
- Pain (mastodynia)
- Discharge from nipple
- Mass
What are the two distribution patterns associated with pain in the breast?
- Cyclic (diffuse) = Normal
- Noncyclic (localized) = Ruptured cyst, trauma, infection
About how many breast cancers present with pain?
- 10%
What does milky discharge from the nipple indicate?
- Elevated prolactin, repeated stimulation
What does bloody discharge from the nipple indicate?
- Large duct papilloma
- Pregnancy
- DCIS
What is worrisome about spontaneous unilateral discharge?
- Cancer
- Increases with age especially >60
Is discharge from the nipple normal?
- May be normal when bilateral and small quantity
What can masses arise from in breasts?
- Proliferation of stromal cells or epithelial cells and are generally detected when 2 to 3 cm in size (depending on breast size)
What are most masses in the breast like?
- 95% are benign and tend to be round or oval in shape
- Rubbery and mobile
- Have circumscribed borders
What are the most common palpable benign lesions of the breast?
- Cysts and fibroademonas
How do malignant tumors invade and present upon palpation?
- Invade across tissue planes causing for a hard (scirrhous) consistency
- Usually have irregular borders
Where are a majority of malignant breast tumors located?
- Upper outer quadrant (50%)
What are the most common palpable malignant lesions?
- Invasive ductal carcinomas
Does breast exams/screening have a significant effect on reducing breast cancer mortality?
- No, has little effect
What is the best way to tell if breast cancer is presetn?
- Mammogram
When was mammographic screening introduced?
- 1980s
What is a mammogram used for?
- Used to detect breast cancer before metastatic spread
- Sensitivity and specificity increases with age
What are you looking for in a mammogram?
- Densities
- Calcifications (presence and pattern)
How many of invasive carcinomas are not detected by mammograms?
- 10%
Why are some invasive carcinomas not seen on mammorgrams?
- Breast tissue is too dense which obscures the tumor
- Small size of the tumor (need a higher magnification)
- Too close to the chest wall or in the peripheral breast
What are the differences between digital and conventional mammogram?
- Digital gives a clearer picture than the conventional/analog
After what stage of BI-RADS requires biopsy?
- After stage 4
What is the next step after you diagnose a mass?
- Any suspicious mass that is detected on PE, mammography, or ultrasonography should be biopsied
What is crucial for diagnosis of masses?
- Biopsy
