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Clinical Pathology > CP6-1 breast pathology > Flashcards

CP6-1 breast pathology Flashcards

1
Q

What is health screening?

A

The process of identifying people who appear health but may be at an increased risk of a disease

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2
Q

Who is eligible for breast screening?

A

Women aged 50-71

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3
Q

How often are eligible women invited to have their breasts screened?

A

3 years

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4
Q

What is the aim of breast screening?

A

To reduce mortality from breast cancer

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5
Q

Why might women be exempt from breast screening?

A

They have had bilateral mastectomies
Individually opt out of screening
Ceased under a best interests decision

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6
Q

What is the AgeX research trial?

A

A research trial to see if extending age range to 47-73 for breast screening will reduce breast cancer mortality - first report to be in 2026

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7
Q

What are the two types of breast screening?

A

Prevalent screening - first invitation to routine screening
Incident screening - routine invitations to those who have been screened before

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8
Q

In 90% of cases, when will results of breast screening be provided?

A

Within 2 weeks

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9
Q

What is the symptomatic presentation of breast cancer?

A

Lump or thickening in the breast
Change in nipple
Change in feel or look of the breast
Pain or discomfort in breast of armpit
Swelling or lump in the armpit

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10
Q

What is triple assessment?

A

Clinical, imaging and pathology

Clinical = age and examination
Imaging = ultrasound and mammogram
Pathology = fine needle aspiration cytology or core-cut biopsy

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11
Q

How is triple assessment scored?

A

Each section of the assessment is scored out of 5 based on how it looks clinically (P), radiologically (R) and pathologically (B).

1 = normal
2 = benign lesion
3 = atypical
4 = atypical probably malignant
5 = malignant

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12
Q

How is pathological staging further subdivided?

A

B3 split between uncertain malignant potential with and without epithelial atypia
B5 split into a (malignant in situ), b (malignant invasive) and c (malignant not assessable)

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13
Q

How does breast tissue differ between male and female breasts?

A

Unlike females, males have no lobules, no terminal duct lobular units (TDLUs) and no copper’s ligaments

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14
Q

What breast pathologies can only women have?

A

Fibroadenomas
Chests arising from breast stroma

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15
Q

What is a definition used to describe female breast tissue?

A

Modified sweat gland composed of lobes, lobules of glands within fibroadipose stroma and specialised epithelium and stroma.

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16
Q

What are 3 breast pathologies that can be picked up on breast screening?

A

Fibrocystic disease
Fibroadenoma
Breast cancer

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17
Q

Can you palpate calcification of breast tissue?

A

No - only seen on mammogram not felt under skin

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18
Q

Who is most likely to have fibrocystic change in breast tissue?

A

Women aged 20-45 years old

19
Q

What are characteristics of fibrocystic change?

A

Usually bilateral and multi focal
No increased risk for subsequent development of carcinoma

20
Q

What is fibrocystic disease?

A

Benign, hormonal mediated breast changes (usually due to menopause) including cyst formation, stromal fibrosis, mild epithelial hyperplasia WITHOUT atypia

21
Q

How do patients with firbocystic disease present?

A

Lumpy, premenstrually painful breasts

22
Q

What is a Fibroadenoma?

A

Benign well defined lesions showing proliferation of both epithelial and stromal components which presents as a mobile painless lump.

23
Q

Who is at risk of a Fibroadenoma?

A

Women aged 20-30
More common in Afro Caribbean women

24
Q

How do fibroadenomas appear on ultrasound?

A

As a well defined homogenous, hypoechoic mass

25
Q

If coarse calcification is seen on a mammogram, what biopsy should be taken of the breast tissue?

A

A stereotactic-guided core biopsy

26
Q

How may a ductule carcinoma in situ appear under a microscope?

A

With microcalcifications and comedonecrosis

27
Q

How can a DCIS (ductule carcinoma in situ) be treated?

A

With wide local excision with wire localisation or magseed localisation

28
Q

What margin is represented by which suture length in wire localisation?

A

Short = superior margin
Long = lateral
Medium = medial
Problems with hook wire = posterior

29
Q

What colour ink represents which surgical margin?

A

Black = superior
Green = lateral
Red = medial
Yellow = posterior
Orange = anterior
Blue = inferior

30
Q

What is used as margin markers in magseed localisation?

A

1x5mm single use metallic markers injected using US or X-ray up to 30 days before operation

31
Q

What is a precursor of invasive carcinoma in DCIS (ductal carcinoma in situ)?

A

Malignant clinal proliferation of cells within parenchymal structures.

32
Q

How do DCIS progress?

A

Can’t metastasise but can invade basement membrane

33
Q

What is the epidemiology of breast cancer?

A

1/9 women develop breast cancer in their lifetime

34
Q

What are risk factors for breast cancer?

A

linked to oestrogens which increase with early menarche, late menopause, obesity in postmenopausal women, oral contraceptive pills, hormonal therapy for menopause and alcohol.

35
Q

What are molecular markers taken from invasive tumours?

A

ER & PR
HER2

36
Q

How are tumours graded?

A

By tubule formation (T1-3)
By nuclear pleomorphism (N1-3)
By mitosis (M1-3)

Score 3-5 = grade 1
Score 6-7 = grade 2
Score 8-9 = grade 3

37
Q

If a patient has an invasive tumour, what should be biopsied in a wide local excision?

A

The sentinel lymph node to the tumour (SLNB)

38
Q

What are the subtypes of invasive ductal carcinomas?

A

Metaplastic
Lobular
Ductal
Tubular
Mutinous
Medullary

39
Q

What are the different types of breast carcinomas in situ?

A

Ductal carcinoma
Lobular carcinoma

40
Q

What are the main invasive breast cancers?

A

Stromal breast cancers = phyllodes tumour or sarcomas
Epithelium derives breast cancers = invasive ductal carcinomas, invasive lobular carcinomas, inflammatory recast carcinoma, Paget’s disease
Lymphoma
Metastases to the breast

41
Q

What is the Nottingham prognostic index (NPI) formed from?

A

The tumour grade, size and lymph node status

42
Q

What is the NPI used for?

A

Determining prognosis e.g. if NPI is 3.4 or less prognosis is good (80% have 16 year survival)

43
Q

What is oncotype DX used for?

A

Predicting the likelihood the patient would benefit from chemotherapy in addition to hormone therapy and provides a recurrence score.

Clinical Pathology (65 decks)

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