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Cameron Breast > Eval of Common Breast Problems > Flashcards

Eval of Common Breast Problems Flashcards

1
Q

What skin findings are significant in a breast exam?

A

Rash, retraction, erythema

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2
Q

What imaging is the best in evaluating a breast mass?

A

US

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3
Q

What are the most common causes of breast masses?

A

Fibrocystic changes, cysts, fibroadenomas, and lipomas

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4
Q

What group of women should always have biopsies of breast masses?

A

Postmenopausal women because their breasts are not changing as much (e.g. with the menstrual cycle) and they have an increased risk for breast CA.

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5
Q

What are the physical exam findings for fibrocystic change of the breast?

A

Vague thickening or rubbery, ill-defined mass or density

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6
Q

What are the physical exam findings for a breast cyst?

A

Discrete fluid-filled mass

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7
Q

What are the physical exam findings for a fibroadenoma?

A

Smooth-margined solid mass in a premenopausal woman

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8
Q

What are the physical exam findings of a breast lipoma?

A

Smooth, soft, mobile mass

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9
Q

What are the physical exam findings of breast cancer?

A

Discrete solid mass with irregular edges

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10
Q

What size mass can be evaluated by FNA?

A

At least 7 mm

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11
Q

What kind of biopsy can be done for masses not visualized by US, but seen on mammography?

A

Stereotactically guided core needle bx

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12
Q

Mastalgia is usually related to

A

Hormonal and fibrocystic changes of the breast

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13
Q

What are common benign causes of focal persistent breast pain?

A

Cysts, fibroadenomas, mastitis, and abscess

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14
Q

What classes of medications are associated with noncyclical mastalgia?

A

Antidepressants and antihypertensives

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15
Q

What are two chest wall syndromes that may manifest as breast pain?

A

Costochondritis and Tietze syndrome

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16
Q

What is Tietze syndrome?

A

SWELLING and inflammation of the costal cartilages

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17
Q

What is costochondritis?

A

Temporary inflammation (not swelling) of the costal cartilage - the cartilage that connects each rib to the sternum at the costosternal joint

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18
Q

How does one differentiate between costochondritis and Tietze syndrome

A

There is inflammation of the costal cartilage in both diseases, but Tietze syndrome has swelling as well

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19
Q

What is the treatment of Tietze syndrome and costochondritis?

A

NSAIDs and rest

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20
Q

What is the treatment for cyclical mastalgia?

A

Evening primrose oil, NSAIDs, caffeine/chocolate abstinence, low-fat diet or 3-to-6 month trial of tamoxifen.

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21
Q

What kind of nipple discharge warrents surgical evaluation?

A

Spontaneous, recurrent, unilateral and from a single duct

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22
Q

What is “normal” nipple discharge

A

Present in premenopausal women. A small amount of induced nonspontaneous discharge that can occur after a warm shower or mammogram. Can also be elicited with massage.

23
Q

Is testing for occult blood or cytology of nipple discharge recommended?

A

No - results are confusing and often misinterpreted.

24
Q

Evaluation of nipple discharge begins with

A

H&P, mammogram and sometimes an US

25
Q

If an abnormal targetable lesion is found on imaging obtained for nipple discharge is found, what should be done?

A

Core needle biopsy or needle-localized biopsy

26
Q

If no suspicious lesion is found on imaging to correlate with nipple discharge, what should be done?

A

Excisional biopsy of the offending duct for diagnosis and rule out cancer

27
Q

Is a ductogram needed for pre-op planning for nipple discharge?

A

Generally no. It is a painful procedure for the paitent and challenging for the radiologist. The results are often fraught with misinterpretation.

28
Q

Describe the steps of a duct excision

A
  1. Place lacrimal duct probe if possible
  2. Subareolar incision and dissect just under the nipple
  3. Follow dissection down to chest wall or terminal ducts
29
Q

What are the most common causes of nipple discharge?

A

Papillomas, duct ectasia and fibrocystic changes.

30
Q

Bloody nipple discharge is most commonly due to?

A

Benign papilloma

31
Q

What are the causes of true galactorrhea?

A

Hyperprolactinemia 2/2 pituitary tumor, hypothyroidism or druge side effect

32
Q

What are the two groups of acute mastitis?

A

Those associated with pregnancy w/lactation andthose associated with a bacterial infection of unknown origin

33
Q

Acute mastitis in a lactating patient is usually 2/2

A

Staphylococcus

34
Q

How is acute mastitis in lactating patient usually treated?

A

Oral abx, warm packs, and massage to decompress the plugged duct

35
Q

After an I&D for acute mastitis, should breast feeding cease on the affected side?

A

Yes, to allow the breast to heal.

36
Q

What is the treatment for acute mastitis in a non-lactating patient?

A

Early oral abx - may take several weeks. IV abx if necessary.

37
Q

If skin changes that accompany an underlying breast infection occur, when should a punch biopsy and core bx of underlying tissue be performed?

A

Within a month if the changes do not resolve with abx or steroids within 1 month

38
Q

If persistent scaling or iching of the nipple or areola do not resolve with steroid ointment, what should be done?

A

Skin punch bx to rule out Paget disease

39
Q

Can fibroadenomas fluctuate in size with menses or grow with oral contraceptives and pregnancy?

A

Yes

40
Q

When does a fibroadenoma require excision?

A

If it grows over time, is >2-3 cm at diagnosis, or if is painful

41
Q

Is there a risk of cancer with a fibroadenoma?

A

No

42
Q

When should breast cyst fluid be sent for cytopathology?

A

If it is bloody

43
Q

When should a breast cyst be biopsied?

A

A complex cyst on ultrasound or associated with a solid component

44
Q

In pregnancy, a complex cyst may be the result of

A

A lactating adenoma

45
Q

Do lactating adenomas resolve without treatment

A

Yes. However, follow-up imaging is warranted if there is a low-risk of CA

46
Q

Performing an open breast bx duirng lactation often leads to

A

A milk fistula. This may require cessation of breast feeding for resolution

47
Q

Does one need to excise a breast lipoma?

A

No

48
Q

A painful fatty tumor is likely the result of

A

An angiolipma. Excise to relieve pain.

49
Q

What benign breast abnormalities warrant a needle-localized excisional bx?

A

Atypical ductal hyperplasia, atypical lobular hyperplasia, LCIS, complex sclerosing lesion, or a radial scar.

50
Q

Gynecomastia is common in what two age groups?

A

20-30s and > 60 years of age

51
Q

Is unilateral breast enlargement directly behind the nipple common in gynecomastia?

A

Yes

52
Q

What work-up is needed to rule out breast cancer in males?

A

Same work-up as women: breast exam, mammogram, and bx if indicated

53
Q

What are the causes of gynecomastia?

A

Drug interactions, alcoholism, loss of testosterone, elevation of estrogen levels due to thyroid orliver problems, or hormone-secreting tumors

Cameron Breast (9 decks)

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