OBGYN: breast Flashcards
mc benign breast dz
second MC?
FIBROCYSTIC BREAST DISEASE
fibroadenoma is 2nd MC benign breast mass
MC benign brest tumor?
fibroadenoma
why is mamography not useful in adolescents
large amount of glandular tissue present in adolescents makes mammography difficult to interpret
too dense to create clear picture
main function of breast
secretion of milk
histologically breast is composed of
lobules/glands
milk ducts
CT
fat
breast sit atop?
intercostal muscles
pectoral muscles
BC commonly begins where
tail of spence
most benign and cancerous breast findings are
- felt on breast exam
2. seen on imaging
two MC types of imaging are
mammograms (x-rays)
sonograms/US
list benign breast conditions
- fibrocystic breasts
- cysts
- fibroadenomas
- abscess
Fibrocystic breast disease
- aka?
- define
- % of women who experience this
- MC in?
- etiology
- s/s
- tx
fibrocystic changes/chronic cystic mastitis
*general, all inclusive term for a variety of benign breast conditions
90% of women get this at some point in life
MC In younger, premenopausal women
etiology
*estradiol and progesterone secreted during luteal phase (first day) of menses–>stimulate breast glands to swell–>mastalgia
s/s
- breast pain and discomfort–MC during luteal phase
- bilateral tender nodules
TX
- NSAIDS
- avoid caffeine +/- helpful
- taking Combined contraceptives can help reduce severity
cysts
- influenced by ?
- diagnose
- classifications
influenced by hormonal fluctuations of menstrual cycle
diagnose:
* sonogram/US
classifications
- simple
- complicated–“debris”
- complex–>if solid component, it needs to be biopsied to R/O CA
Fibroadenoma
- define
- MC in
- etiology
- s/s
- diagnose
benign tumor
MC in 15-35YO
Etiology=hormones of menstrual cycle
S/s
- mass feels firm, smooth, rubbery
- freely mobile
- well defined margins
diagnose:
* sonogram
* if cannot determine cancerous or not, biopsy is needed
Abscess
- define
- MC assoc with
- s/s
- tx
infection that produces a collection of pus
pus has to be drained out for abscess to heal***
MC assoc with complication of mastitis (breast infection)
s/s:
*regular s/s of infection + induration and an area of fluctuation
TX
- I/D
- systemic s/s= ABX
BCA is affected by what hormone
estrogen
***why risk is higher the “more” estrogen you are exposed to
RF for BCA (top 4)
-others (6)
- young menarche (ovulation-more estrogen)
- –> before 12 - later menopause (ovulating for longer time=more estrogen)
- –>after 55 - last first birth/pregnancy (pregnancy is lower estrogen state)
- no births or pregnancies
__________________________ - breast tissue density–more dense
- female vs male
- incr age
- genetics
- fam hx
- DES exposure
family hx for BCA
- 1st degree relative?
- two 1st degree relatives
1st degree relative puts PT at 2 fold incr for BCA
2 1st degree puts PT at risk 3 fold for BCA
BCA protective factors
breastfeeding
list 2 things that are inconclusive regarding BCA risk
- estrogen and progesterone contraceptives
2. Post-menopausal hormone replacement therapy
things that do NOT influence BCA risk (6)
- abortion
- chemicals
- tubal ligation
- caffeine
- hair dye
- cosmetic breast implants
Gail model
risk-calculator model for PTs with RF for BCA
what needs to be done with a PTs lifetime risk is >20% or their 5 year risk is over 1.7%?
supplemental screening with MRI
how do we screen for BCA
- CBE
2. Mammos
when do we start doing CBEs and Mammos and how often
CBE: every 1-3 years starting at age 21
Mammo: every 1-2 years starting age 40
conflicting data regarding this exam and detection of BCA
SELF breast exams
-they can lead to unnecessary procedures
when are self breast exams best done?
after menses
findings that are suspicious for BCA (5)
- unilateral, spontaneous, nipple discharge–>bloody, clear or serous
- new onset nipple retraction or inversion
- asymmetric thickening/nodularity
- skin changes
- erythema
- scaling
- peau d’orange
- dominate mass that is painless, firm and non-mobile
why is a CBE always done before a mammogram
because if something is felt on CBE— you know to then order a DIAGNOSTIC mammo and not a SCREENING mammo
abnormal CBE, what do you order next
- diagnostic mammo
and
diagnostic sonogram
list 12 signs of BCA from the know your lemons ad
- thickened area
- bump
- dimple
- growing vein
- nipple crust
- sunken nipple
- red or hot
- new shape/size
- new fluid
- orange peel skin
- skin sores
- hard lump
list male BCA warning signs
- lump
- nipple discharge
- reddening
- inversion of nipple
- skin dimpling
two standard views on screening mammograms
- craniocaudal (CC)
2. Mediolateral (MLO)
pros/cons of mammograms
PROS
1. detect BCA two years before it is palpable
CONS
1. uses radiation–basic screening exposes patient to 0.5-1.0 rad
if something is “seen” on screening mammo, what is done next
diagnostic mammo and/or sonogram
**diagnostic mammos have more types of views vs the screening mammos
BI-RADS 0
not defined
needs additional evaluations
BI-RADS 1
negative
BI-RADS 2
benign
BI-RADS 3
prbaby benign
*need to return in 6 MO for follow up imaging
BI-RADS 4
suspicious abnormality
–need biopsy
BI-RADS 5
highly suggestive of malignnacy
—need biopsy
BI-RADS 6
known biopsy proven malignancy
3 basic types of breast biopsies
Fine needle aspiration/biopsy
core needle biopsy
Excisional biopsy
how to perform FNA
done by “feeling” the area and penetrating with the needle
- aspirate the fluid in the area
- fluid sent to lab
only works on fluid filled things like cyst*
*shows abnormal cells on pathology
how to perform core needle biopsy
guided by sonogram or mammogram (sterotactic)
- taking a piece of the core of the tumor
- shows abnormal cells on pathology
how to perform excisional biopsy
done to remove ALL the tissue and rule out any cancer cells
also called lumpectomy
- wire, hook or seed localization procedure with radiologist
- radiologist able to use imaging modality to insert wrie or seed into the area
