Surgery - Breast Flashcards
US for breast best to detect masses of what size?
> 1cm in diameter
Acute mastitis
- causes
- description
- tx
Usually due to S. aureus. It is a cellulitis (vs breast abscess needing drainage)
Need to r/o breast cancer!
Dicloxacillin
Cephalosporins
Cont breast feeding as can dec progression of mastitis to breast abscess
Mammo guidelines
- Should start at age 40
- DO NOT DO before 20 (breast too dense) or lactation (all is milk)
Fibroadenoma
- description
- management
Young women (< 35 yo)
Firm, mobile, rubbery mass
Increase size/tenderness with menstruation
FNA
Sonogram
OPTIONAL removal
Giant juvenile fibroadenomas
- description
- management
Young adults
Rapid growth
YES remove
To avoid deformity and distortion of breast
Cystosarcoma phyllodes
- description
- management
30-50 yo
LARGE bulky mass that is mobile and arises from lobular tissue
Most benign, but can turn malignant
Core or incisional bx
YES remove
Fibrocystic disease
- description
- management
30s-40s Tender + grow w/ menstrual cycle Usually not increase risk of carcionma Diff histo types: - fibrosis - cystic - sclerosing adenosis (microcalcificatiosn on mammo) - epithelial hyperplasia
Mammo if no dominant or persistent mass
If persistent mass –> aspiration (not FNA)
If aspiration doesn’t disappear –> formal bx needed
Intraductal papilloma
- description
- management
Young women
Grows in lactiferous ducts
No increased cancer risk
Bloody nipple discharge
Mammogram to ID other lesions – will not show papilloma b/c too tiny
Galactogram (dx and for surgery resection)
Breast abscess
- description
- management
In lactating women
I & D
Bx of abscess wall
Treatment for breast cancer during pregnancy
No radiation
No chemo in 1st trimester
OK to keep pregnancy
DCIS
- description
- management
Can’t mets
Usually looks like microcalcifications on mammo
comedo has highest malignant potential
Diffuse lesions: Total simple mastectomy + Sentinel node bx
1 lesion: Lumpectomy + radiation
Breast cancer – resectable
- what do you do?
How about if not resectable?
Resectable:
Lumpectomy + axillary sampling + postop rad
Modified radical mastectomy + axillary sampling (sentinel lymph nodes)
Not resectable:
Chemo
Breast Cancer mets
- where does it go?
- dx?
- Tx?
Brain
<3 vertebral pedicles
Tx breast cancer in premenopausal? postmen?
Pre = tamoxifen
Post = anastrozole
Breast Cancer stage I
Tumor ≤ 2cm in diam
(-) mets
(-) nodes
Breast Cancer stage IIA
Tumor ≤ 2cm in diam + mobile axillary nodes
OR
Tumor 2-5 cm in diam, (-) nodes
Breast Cancer stage IIB
Tumor 2-5cm in diam + mobile axillary nodes
OR
Tumor > 5 cm, (-) nodes
Breast Cancer stage IIIA
Tumor > 5cm + mobile axillary nodes
OR
Any size + fixed axillary nodes, (-) mets
Breast Cancer stage IIIB
Peau d’orange OR Chest wall invasion/fixation OR Inflammatory cancer OR Breast skin ulceration OR Breast skin satellite mets OR Any tumor + ipsilateral internal mammary lymph nodes
Breast Cancer stage IIIC
Any size tumor, (-) mets
+ supraclavicular, infraclavicular, or internal mammary lymph nodes
Breast Cancer stage IV
Distant mets (including ipsilateral supraclavicular nodes) - Loves: lymph nodes, lung/pleura, liver, bones, brain
Metastatic breast cancer to bone - test to dx?
MRI
Mammo results w/ strong correlation with breast cancer
(1) breast calcifications that are
(a) smaller than 2 mm,
(b) punctate, microlinear, or branching,
(c) clustered along ducts or concentrated in clusters >5 calcifications per square centimeter;
(2) stellate-shaped lesions;
(3) masses with ill-defined borders or nodular contours;
(4) solitary dominant masses that are significantly larger than any other mass in either breast; and
(5) areas of increased noneffacing tissue density or distorted breast architecture.
What do breast cysts look like on mammo?
How do you confirm the nature of theses cysts?
Round, well-circumscribed densities
Confirm w/ breast US
