Breast

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Author:
Anonymous
ID:
57456
Filename:
Breast
Updated:
2010-12-29 20:39:53
Tags:
Absite Review
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Description:
Breast absite review
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  1. Benign Breast Disease
    Fibrocystic disease includes:
    • Papillomatosis
    • Sclerosing adenosis
    • Epithelial hyperplasia
    • Ductal hyperplasia
    • Lobular hyperplasia

    • *Risk of cancer with ATYPICAL ductal or lobular hyperplasia
    • *Tx: remove suspicious areas
  2. Sclerosing adenosis
    Cluster of calcifications on mammogam without mass or pain; can look like breast CA
  3. Intraductal papilloma
    • Most common cause of bloody discharge from nipple
    • Not premalignant
    • Dx: contrast ductogram
    • Tx: resection (subareolar resection can by curative)
  4. Fibroadenoma
    • Most common in adolescents and young women
    • 10% are multiple
    • Change with menstrual cycle/enlarge with pregnancy
    • Giant >5cm
    • Path: fibrous tissue compressing epithelial cells
    • Mamm: coarse calcifications

    • <30 yo
    • Exam: 'feel benign' (firm, rubbery, rolls, not fixed)
    • US or mamm
    • FNA or core needle bx

    • >30yo
    • Excisional biopsy
  5. Nipple discharge
    • Most is benign
    • Dx: BL mamm

    • Green: fibrocystic
    • Bloody: intraductal papilloma, ductal CA
    • Serous: CA
    • *tx: excisional biopsy
    • Spontaneous: CA
    • *dx: biopsy
    • Nonspontaneous: ...
    • *+/- excisional biopsy
  6. Diffuse papillomatosis
    • Multiple ducts of both breasts
    • Mamm: swiss cheese
    • Increase risk of CA with diffuse type (40%)
  7. DCIS
    • Malignant cells of ductal epithelium without invasion of basement membrane
    • 50-60% will get cancer in the ipsilateral breast if not removed
    • *5-10% get cancer in contralateral breast
    • Premalignant
    • Clinically not palpable
    • Mamm: cluster of calcifications
    • 2-3mm margin with excision
    • Solid
    • Cribiform
    • Papillary
    • Comedo
    • *most aggressive, likely to recur
    • *tx: simple mastectomy
    • Tx: lumpectomy and XRT, +/- tamoxifen
    • *Simple mastectomy: high grade (comedo, multicentric, multifocal), large tumor, unable to get good margins, no ALND
  8. LCIS
    • 40% get cancer of either breast
    • *likely ductal CA (70%)
    • *5% have synchronous breast CA
    • No calcifications, not palpable
    • Premenopausal
    • Do not need negative margins with excision
    • Tx: nothing, tamoxifen, or bilateral subcutaneous mastectomy without ALND
  9. Breast CA Risk
    • Risk 1/8 or 12%
    • 4-5% in women with no risk factors
  10. Symptomatic breast mass workup
    • <30 yo:
    • US
    • *If solid: FNA
    • *If FNA nondiagnostic: excisional biopsy

    • 30-50yo:
    • BL mamms
    • FNA
    • Excisional biopsy if FNA nondiagnostic

    • >50yo
    • BL mamms
    • Excisional or core needle biopsy
  11. Breast cyst fluid
    • Bloody: cyst excisional biopsy
    • Clear and recurs: excisional biopsy
    • Complex: excisional biopsy
  12. Mammogram
    • 90% sensitivity and specificity
    • Sensitivity increases with age
    • >5mm to be detected
    • Suspicious lesions need needle loc and excisional or core needle biopsy
  13. Screening
    • Mamm every 2-3 years after age 40, yearly after 50
    • High risk screen: mamm 10 years before youngest age of diagnosis of breast CA in first-degree relative
  14. BIRADS
    • 1: Negative: Routine screening
    • 2: Benign: Routine screening
    • 3: Probably benign: Short-interval follow-up
    • *6mo
    • 4: Suspicious abnormality: Definite probability of malignancy, consider biopsy
    • 5: Highly suggestive of malignancy: High probability of cancer, appropriate action needs to be taken
    • *Image guided core biopsy, needle loc and excision
  15. Node levels
    • I: lateral to pectoralis minor
    • II: beneath to pectoralis minor
    • III: medial to pectoralis minor

    Rotter's: between the pec major and minor
  16. Prognostic staging factors
    • Node status is the most important
    • Other: tumor size, grade, progesterone and estrogen receptor status

    • 30% of nonpalpable nodes are positive at surgery
    • 0+: 75% 5 yr survival
    • 1-3+: 60% "
    • 4-10+: 40% "

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