Lecture 12: Breast Disorders Flashcards
When should the CBE be performed? (what phase)
Follicular phase
- one week after menses
3 causes of Cyclic breast pain (mastalgia)
- Hormonal changes w/menstrual cycle
- OCPs
- Fibrocystic breast Dz
What phase/days of the menstrual cycle is a/w Cyclic breast pain
Luteal phase
day 14-28
Large, pendulous breasts Mastitis BCA (inflammatory) Poorly-fitting bra Pregnancy Ductal ectasia
Causes of Non-cyclic breast pain
What does extramammary mean?
pain referred from source outside breast (chest wall)
Tx for mastalgia if exam is normal and pain is cyclic?
Meds for pain?
reassurance (+/- adjust OCP)
support/sports bra, wt loss
Pain meds: NSAIDs, acetaminophen
Med Tx for Severe Sxs of mastalgia?
Danazol, Tamoxifen, or Bromocriptine
When is mastitis MC,
normally d/t?
in lactating women
d/t nipple trauma (primigravida)
Main Sx of Mastitis?
Otehers?
Main = UNILATERAL BREAST PAIN (esp in 1 quad)
Others: breast swelling, warmth, tenderness; nipple d/c
MC pathogenic cause of mastitis
Staph Aureus
When should ABX tx for mastitis be started?
What is main ABX?
Pt edu for mothers while taking ABX?
Sxs lasting > 12-24hrs
Dicloxacillin
Mothers CAN continue to nurse/pump while on ABX
3 Nipple D/c Characteristics that are likely benign?
Nipple d/c that is:
- Bilateral
- Milky/clear
- Multiductal
Nipple D/c Characteristics: Spontaneous Unilateral Uniductal Bloody, straw colored, or clear Stains clothes Persistent
Malignant nipple d/c characteristics
Management for Physiologic nipple discharge w/no breast stimulation?
f/u in 2-3 mo
+/- endo referral
What is next step if find malignant nipple d/c, abn findings on US/mammo, or no resolution of Sxs after modifications in meds/lifestyle?
Refer to nipple specialist
are most breast masses/tumors benign or malig?
Benign
What is the MC presenting Sx in pts w/ BCA?
Breast mass
What type of Dx test/Bx used for breat cysts?
FNA w/Bx
also used for low probability CA
What is problem w/FNA Bx
Skill depedent–> High amt false negatives and non-Dx samples
Other Bx methods other than FNA
What type of Bx is specifically used for Paget’s Dz
- CNB (core needle Bx)
- Incisional Bx
- Excisional Bx
- Punch Bx (Paget’s dz)
What type of Bx is for a larger tissue specimen, uses only LA and is US guided
CNB
What can an US determine for breast masses
when is US 1st line Dx test?
whether mass is cystic or solid
1st line in women < 30 w/focal breast Sxs
What dx test used for SCREENING women w/no sxs?
Mammogram
When is SURVEILLANCE mammo used?
F/u in pts w/ Hx of BCA
When is MRI used to evaluate breast masses?
- screening for high risk women
- assess silicone implants
- eval suspicious findings
At what BIRADS categ is Bx recommended
Categ 4 or 5 –> Bx
At what BIRADS categ is the mass definitely malignant
Categ 6