cysts - influenced by ? - diagnose - classifications

influenced by hormonal fluctuations of menstrual cycle diagnose: sonogram/US classifications 1. simple 2. complicated--"debris" 3. 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

OBGYN: breast Flashcards by Caroline Bouillon

mc benign breast dz

second MC?

FIBROCYSTIC BREAST DISEASE

fibroadenoma is 2nd MC benign breast mass

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MC benign brest tumor?

fibroadenoma

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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

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main function of breast

secretion of milk

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histologically breast is composed of

lobules/glands
milk ducts
CT
fat

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breast sit atop?

intercostal muscles

pectoral muscles

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BC commonly begins where

tail of spence

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most benign and cancerous breast findings are

felt on breast exam

2. seen on imaging

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two MC types of imaging are

mammograms (x-rays)

sonograms/US

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list benign breast conditions

fibrocystic breasts
cysts
fibroadenomas
abscess

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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

NSAIDS
avoid caffeine +/- helpful
taking Combined contraceptives can help reduce severity

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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

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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

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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

I/D
systemic s/s= ABX

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BCA is affected by what hormone

estrogen

***why risk is higher the “more” estrogen you are exposed to

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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

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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

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BCA protective factors

breastfeeding

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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

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)

1. unilateral, spontaneous, nipple discharge-->bloody, clear or serous 2. new onset nipple retraction or inversion 3. asymmetric thickening/nodularity 4. 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

1. diagnostic mammo and diagnostic sonogram

list 12 signs of BCA from the know your lemons ad

1. thickened area 2. bump 3. dimple 4. growing vein 5. nipple crust 6. sunken nipple 7. red or hot 8. new shape/size 9. new fluid 10. orange peel skin 11. skin sores 12. hard lump

list male BCA warning signs

1. lump 2. nipple discharge 3. reddening 4. inversion of nipple 5. skin dimpling

two standard views on screening mammograms

1. 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 1. wire, hook or seed localization procedure with radiologist 2. radiologist able to use imaging modality to insert wrie or seed into the area