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Flashcards in Breast Deck (34)
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1
Q

Indications for resection of fibroadenoma (5)

A
Size >2cm
Increasing size
Pain associated with lesion
Increased cellularity of lesion
Anxiety caused by presence of mass
2
Q

Treatments for mastalgia (1 Rx, 3 OTC, 2 diet modifications)

A

Rx: NSAIDs
OTC: Vitamin E, fish oil, evening primrose oil
Diet: Low fat, low caffeine

3
Q

Treatment for nipple discharge that can be induced from several ducts with manipulation of the breast

A

Reassurance

4
Q

Treatment for nipple discharge that is spontaneous, unilateral, recurrent and involving a single duct

A

Dx mammography and ultrasound, possible biopsy and surgical excision. Suspicious nipple discharge is bloody or clear.

5
Q

Most common causes of nipple discharge (3)

A

Papillomas, duct ectasia and fibrocystic breast disease (all benign)

6
Q

When is there a high suspicion for inflammatory breast cancer in a patient presenting with “mastitis”?

A

Patient is postmenopausal and non-lactating, with no precipitating factors or systemic signs of infection

7
Q

What is the treatment for patients with needle biopsy results of atypical ductal hyperplasia?

A

Excisional biopsy, coexisting malignancy present in 15-20% of cases

8
Q

What is the treatment for patients with needle biopsy results of atypical lobular hyperplasia?

A

Excisional biopsy, coexisting malignancy present in 10-15% of cases

9
Q

What is the treatment for patients with needle biopsy results of sclerosing adenosis with radial scarring?

A

Excisional biopsy, coexisting malignancy present in 10-15% of cases

10
Q

What is the immediate treatment for patients with needle biopsy results of LCIS?

A

Excisional biopsy to decrease sampling error

11
Q

If excisional biopsy demonstrates only LCIS, what should be offered?

A

High-risk screening and antiestrogen therapy

High risk screening: annual mammogram, annual MRI, breast exam every 6mo

12
Q

Who are high risk patients? (6)

A
BRCA mutation
Family history
History of chest wall radiation
Past breast cancer
LCIS
Atypia
13
Q

BIRADS 0

A

Incomplete, need for additional imaging

14
Q

BIRADS 1

A

Negative, resume routine screening

15
Q

BIRADS 2

A

Benign, resume routine screening

16
Q

BIRADS 3

A

Probably benign, risk of malignancy <2%, 6mo follow up recommended

17
Q

BIRADS 4

A

Suspicious abnormality, intermediate risk of malignancy, biopsy recommended

18
Q

BIRADS 5

A

Highly suggestive of malignancy (>95% chance)

19
Q

BIRADS 6

A

Known biopsy-proven malignancy

20
Q

Treatment of BIRADS 5 lesion after benign needle biopsy

A

Excisional biopsy, risk is too high of false-negative

21
Q

Treatment of clinically suspicious palpable lesion, occult on mammogram and ultrasound, with benign needle biopsy

A

Excisional biopsy

22
Q

ACS criteria for annual breast MRI (5)

A

First-degree relative of BRCA carrier, untested
Lifetime risk >20% (models dependent on family history)
Radiation to chest between ages of 10-30y
Li-Fraumeni syndrome and first-degree relatives
Cowden and Bannayan-Riley-Ruvacaba syndromes and first-degree relatives

23
Q

Per ACS, can consider annual breast MRI (5)

A

Lifetime risk 15-20% (family history models)
LCIS or atypical lobular hyperplasia
Atypical ductal hyperplasia
Heterogeneously or extremely dense breast on mammography
Personal history of breast cancer or DCIS

24
Q

Incidence of breast cancer caused by genetic abnormalities

A

5-10%

25
Q

What is the treatment for patients with needle biopsy results of flat epithelial hyperplasia?

A

Excisional biopsy to rule out sampling error

26
Q

Indications for stereotactic biopsy (8)

A

Lesions that are highly-suggestive of malignancy (BIRADS 5)
Lesions that are suspicious for malignancy (BIRADS 4)
Lesions that are BIRADS 3 when there are other clinical reasons to suspect malignancy or when short-term follow up is not feasible
Multiple suspicious lesions
Mammographic lesions that correspond to suspicious lesions on MRI
A nonpalpable suspicious solid mass on mammography that is not seen on ultrasound
Suspicious microcalcifications that are new or at site of prior lumpectomy
Suspicious architectural distortion

27
Q

What is the presumptive diagnosis and treatment of a fibroepithelial lesion on core biopsy?

A

Phylloides tumor, wide local excision

28
Q

What breast cancer patient should have an Oncotype sent?

A

ER(+), node-negative cancers

Can consider in ER(+), node-positive, HER2(-) cancers as well

29
Q

Contraindications to breast-conserving therapy (5)

A
Multicentric disease
Locally-advanced cancer
Inflammatory breast cancer
Unfavorable breast-tumor ratio
Any contraindication to radiation therapy
30
Q

What are the patient criteria required to qualify for “Z11”? (5)

A

Tumor size <5cm (T1 or T2)
Fewer than 3 positive SLN
No evidence of extracapsular tumor extension in SLN
Planned whole breast RT
Planned standard of care adjuvant therapy

31
Q

If a patient qualifies for Z11, what does that mean?

A

She may avoid completion sentinel lymph node dissection even in the presence of a positive sentinel lymph node.

As a reminder, Z11 means:
Tumor size <5cm (T1 or T2)
Fewer than 3 positive SLN
No evidence of extracapsular tumor extension in SLN
Planned whole breast RT
Planned standard of care adjuvant therapy

32
Q

Why do SLNB for DCIS?

A

15-20% chance of upstaging when excisional biopsy complete

33
Q

What is the benefit of tamoxifen in high-risk patients?

A

Reduces cancer risk by 50%

Does increase risk of endometrial cancer and DVT.

34
Q

What patients are not eligible for a SLNB?

A

Patients with inflammatory breast cancer (tumor emboli cause lymphatics)
T4 lesions
Biopsy-proven positive nodes