Clinical Presentation of Breast Disease, Mammography, and Biopsy

Question 1

How many women with cancer are symptomatic?

Answer 1

• About 45% with the remainder coming to attention through mammographic screening

Question 2

What are some symptoms that a patient with breast cancer may present with?

Answer 2

• Pain (mastodynia)
• Discharge from nipple
• Mass

Question 3

What are the two distribution patterns associated with pain in the breast?

Answer 3

• Cyclic (diffuse) = Normal

- Noncyclic (localized) = Ruptured cyst, trauma, infection

Question 4

About how many breast cancers present with pain?

Answer 4

• 10%

Question 5

What does milky discharge from the nipple indicate?

Answer 5

• Elevated prolactin, repeated stimulation

Question 6

What does bloody discharge from the nipple indicate?

Answer 6

• Large duct papilloma
• Pregnancy
• DCIS

Question 7

What is worrisome about spontaneous unilateral discharge?

Answer 7

• Cancer

- Increases with age especially >60

Question 8

Is discharge from the nipple normal?

Answer 8

• May be normal when bilateral and small quantity

Question 9

What can masses arise from in breasts?

Answer 9

• Proliferation of stromal cells or epithelial cells and are generally detected when 2 to 3 cm in size (depending on breast size)

Question 10

What are most masses in the breast like?

Answer 10

• 95% are benign and tend to be round or oval in shape
• Rubbery and mobile
• Have circumscribed borders

Question 11

What are the most common palpable benign lesions of the breast?

Answer 11

• Cysts and fibroademonas

Question 12

How do malignant tumors invade and present upon palpation?

Answer 12

• Invade across tissue planes causing for a hard (scirrhous) consistency
• Usually have irregular borders

Question 13

Where are a majority of malignant breast tumors located?

Answer 13

• Upper outer quadrant (50%)

Question 14

What are the most common palpable malignant lesions?

Answer 14

• Invasive ductal carcinomas

Question 15

Does breast exams/screening have a significant effect on reducing breast cancer mortality?

Answer 15

• No, has little effect

Question 16

What is the best way to tell if breast cancer is presetn?

Answer 16

• Mammogram

Question 17

When was mammographic screening introduced?

Answer 17

• 1980s

Question 18

What is a mammogram used for?

Answer 18

• Used to detect breast cancer before metastatic spread

- Sensitivity and specificity increases with age

Question 19

What are you looking for in a mammogram?

Answer 19

• Densities

- Calcifications (presence and pattern)

Question 20

How many of invasive carcinomas are not detected by mammograms?

Answer 20

• 10%

Question 21

Why are some invasive carcinomas not seen on mammorgrams?

Answer 21

• 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

Question 22

What are the differences between digital and conventional mammogram?

Answer 22

• Digital gives a clearer picture than the conventional/analog

Question 23

After what stage of BI-RADS requires biopsy?

Answer 23

• After stage 4

Question 24

What is the next step after you diagnose a mass?

Answer 24

• Any suspicious mass that is detected on PE, mammography, or ultrasonography should be biopsied

Question 25

What is crucial for diagnosis of masses?

Answer 25

• Biopsy