The Breast Flashcards
Breast lymph drains to…
axillary nodes
If Gail Model risk score is > _____%, consider ____ therapy to reduce estrogen and risk.
1.66
Tamoxifen
If you don’t feel a mass but feel something that is like a bag of peanuts, what do you do?
Check to see if it’s symmetric bilaterally. If not, evaluate further w/imaging.
Nipple discharge or Apiration–>What test?
Cytology (cells); 80% accurate
Core biopsy or Excisional biopsy—>what test?
pathology (tissue); More accurate
When are mammograms not useful? Then what would you do?
Not useful w/dense, small breasts.
US.
(this is more applicable for young patients; 30-35)
Negative US means that the mass is…
solid (aka not a cyst)
Negative mammogram means what?
Nothing. Some tumors are not radio opaque or may be too small.
Negative US and Mammogram means….
You need to do an excisional biopsy. (NOT FNA).
Birads 1 & 2… what do you do?
repeat mammogram in one year.
Birads 3…what does this mean? what do you do?
Benign appearing mass. 1% chance of becoming cancer. Repeat mammogram in 6 months.
Birads 4… what does this mean? what do you do?
Theses are clusters of calcifications. 10-50% chance of cancer. So biopsy.
Birads 5… what does this mean? what do you do?
Solid, spiculated mass.
BIOPSY (yesterday)! 90-97% chance of cancer.
Birads 6 means?
known malignancy
Galactogram/ductogram is used for what?
evaluate nipple discharge from a single duct
When might you use an MRI for breasts?
Looking at extent of breast CA
Lymph nodes
Screening for cancer in young patients w/extensive family hx
Evaluating breast implants
Evaluating lumpectomy sites for recurrence
Mass–> Positive Mammogram or US. DO what?
Core biopsy (with wire localization if you can’t feel it)
Painless, slow growing, well circumscribed, firm, rubbery nodule. What is it likely to be? What should you do?
Fibroadenoma most likely, espec if young.
NEED biopsy still. (core or excisional)
Symmetric or asymmetric enlargement of breast tissue before age 12.
Juvenile hypertrophy or prepubertal gynecomastia.
Hypoplasia of chest wall/no pec muscle
Poland syndrome
Accessory breast tissue (extra nipples, mass in axilla)
Polythelia/Polymastia
breast pain prior to menses
cyclical mastalgia
constant severe breast pain
mastodynia
mastitis and abscess are common in who?
nursing moms
If mastitis doesn’t get better w/abx…do what?
biopsy. be scared of inflammatory breast cancer.
milk filled cyst, tx w/I&D
galactocele
management of complex cysts
aspirated then US every 6 mos out to 2 years to document stability
do cysts need re-aspiration?
sometimes. once. then excise if it recurs. Also excise if bloody.
Nipple discharge— do what? what is the most common cause?
MC: Intraductal papilloma
Do cytology. If unilateral, do ductogram. Prolactin level. Rarely cancer
stellate densite on mammogram; need excising
radial scar
Small, round, benign fatty tumor. Needs biopsy.
Lipoma
benign lump following trauma.
Fat necrosis
superficial thrombophlebitis of breast. Cordlike. Following trauma or exercise. Tx w/NSAIDS and time.
Mondor’s dz
Since DCIS becomes invasive ductal carcinoma, what do you do?
lumpectomy + radiation or mastectcomy - radiation
LCIS is not premalignant, but is a RF for…
DUCTAL carcinoma
What do you do about LCIS
usually nothing. Could do tamoxifen, mastectomies, etc… but usually nothing.
MC breast cancer
invasive ductal carcinoma (need mastectomy)
what is special about inflammtory breast cancer tx
chemo or XRT first before mastectomy
MC types of metastatic carcinoma
squamous, pseudosarcomatous
Pagets dz means…
pts have DCIS or invasive ductal carcinoma. Need MRM (modified radical mastectomy
MRM means what?
mastectomy plus lymph nodes
