breast disorders Flashcards
(54 cards)
1
Q
inspection of breasts involves
A
- examines sitting upright and in the supine position
- both arms relaxed, raised, and body leaning forward, hands on hips
2
Q
list the concerning physical exam findings of breast mass
A
- hard, gritty texture of breast mass
- immobile
- irregular borders
- > 2 cm
- new or growing
3
Q
concerning finding on breast exam of nipple discharge
A
- unilateral
- bloody
- spontaneous discharge
4
Q
what imaging modalities are used to evaulate breast mass
A
- mammography -> most useful in women >35
-
ultrasound -> most useful in women < 35
- adjunct ot mammo
-
MRI
- adjunct to mammo and US
5
Q
What are the normal views taken with mammograms
A
- CC = cranial cadual view: top to bottom
- MLO = medial lateral oblique
6
Q
What are concerning findings on mammogram considering a mass
A
- increased density
- irregular border
- spiculation: lump of tissue with spikes or points on the surface
- clustered irregular microcalcifications
7
Q
if have clinically suspicious lump, does a negative MRI r/o cancer
A
No
8
Q
What is US used for in evaluation of breast cancer
A
- adjunct to mammogram
- mass cystic or solid
- guide core needle biopsies
9
Q
what are concerning findings of US for a breast mass
A
- hypoechoic lesion with ill-defined borders
- mass that is taller than wide
- spiculated margins
10
Q
what imaging modality is best at demonstrating ductal carcinoma in situ (DCIS)
A
MRI
11
Q
biopsies help to determine presence of malignant cells and determine if mass has what receptors
A
estrogen and progesterone
12
Q
Fine needle aspiration is ued to aspirate palpable mass/suspected cyst. Is follow up indicated after procedure?
A
- follow-up 4-6 weeks after aspiration
13
Q
concerning findings in Fine needle aspiration of breast mass
A
- recurrence of mass after aspiration
- bloody aspirate
- no fluid is obtained
14
Q
use of core needle biopsy
A
- obtain pathologic diagnosis of breast mass
- large 14-18 gauge needle
15
Q
concerning findings on core needle biopsy and/or sterotactic biopsy on breast mass
A
- carcinoma
- atypia: abnormal cells
- insufficient specimen
16
Q
what is a sterotactic biopsy
A
- provides 3 dimensional view
- evaluate
- microcalcifications, densities, masses
- multiple passes for tissue sampling
17
Q
differentiate between incisional and excisional biopsies
A
- incisional: portion of mass removed
- excisional: entire mass removed
18
Q
what is mastalgia
A
breast pain
19
Q
what is the common presentation of benign mastalgia
A
- cyclic
- mild
- bilat tenderness and swelling
- common few days preceeding menstrual cycle
20
Q
what is the concerning findings associated with mastalgia
A
- persistent
- unilateral pain
- tenderness
21
Q
What is a ductogram
A
- used in evaluation of nipple discharge
- cannulation of a single duct with catheter and injection of contrast solution
22
Q
What are concerning findings regarding nipple discharge
A
- unilateral
- spontaneous
- localized to single duct
- > 40 yo
- bloody
- associated with a mass
23
Q
managment of patient with concerning findings regarding nipple discharge
A
- excisional biopsy of offending duct and mass
- referral to breast specialist
24
Q
What is Duct Ectasia
A
- most common cause of nipple discharge
- benign
- multiple dilated ducts in the subareolar space
25
what nipple discharge would you expect with Duct Ectasia
* clear, milky or green-brown
26
tx of Duct Ectasia
duct exciosion if definitive histological diagnosis
27
What is Intraductal papilloma?
* Benign
* solitary lesion on the inside of the duct
28
what nipple discharge would you expect with Intraductal papilloma
* **reproducible, bloody** nipple discharge
29
what is the problem with Intraductal papilloma
* there is a malignant version: **invasive papillary carcinoma**
30
if patient presents with bilat milky nipple discharge and is not lactating, suspect what condition
* pituitary adenoma
* excess prolactin
31
Etiology of mastitis
* breast infection, usually bacterial
* S. aureus, S. epidermidis
32
when is mastitis most commonly seen
* after 3rd week of breastfeeding
* possibly due to inspissation of mild, obstruction and secondary infection
* progress to abscess in 5-10%
33
treatment of mastitis with abscess
* abx
* I&D (surgery consult)
* \*\*beware of "mastitis" that doesn't improve with tx -\> inflammatory carcinoma
34
breast cyst have highest incidence in what patient population
females 30-40 yo
35
what is most likely diagnosis
* firm, mobile, slightly tender mass
* well-defined border, smooth
* echo-free center on US
breast cyst
36
how is breast cyst diagnosed and treated
* **aspiration** : diagnostic and therapeutic
* re-image in 4-6 weeks
37
Fibroadenomas are most common in what age group? what causes them to enlarge
* females \< 30 yo
* pregnancy, OCP use, menses
* changes in size with menstrual cycle
38
what is most likely diagnosis
* discrete, smooth, firm, rubbery, mobile, non-tender mass
* well circumscribed borders
* weak internal echoes
Fibroadenomas
39
when is surgery indicated for Fibroadenomas
* mass increases in size
* \> 3 cm
* symptomatic
* planning a pregnancy
40
What are Phyllodes tumors ? benign?
* similar to fibroadenomas but **grow rapidly**
* 90% are benign
41
management of Phyllodes tumors
* wide local excision to tumor-free margins
* total mastectomy sometimes required
42
is there a risk of recurrence with Phyllodes tumors
* yes
* radiation on tumors \> 5 cm
* chemotherapy on tumors \> 5 cm and evidence of stromal overgrowth
43
What are some risk factors for breast cancer
* nulliparity
* late first pregnancy
* early menarche
* late menopause
* + FH
44
clinical presentation
* superficial irritation and itching sensation
* itching, burning, sticking pain in the nipple
* nipple appears erosive and thickened
* Paget's disease
45
What are the two types of noninvasive (in situ) breast carcinomas
* Lobular (LCIS)
* Ductal (LCIS)
46
What defines a Lobular (LCIS)
* a preinvasive lesion -\> not a cancer
* indicator for increased risk: 1% per year
47
What defines Ductal (DCIS)? What results are expected on mammography?
* treated as malignancy because can develop into invasive cancer
* on mammography -\> **clustered** pleomorphic **calcifications**
48
Differentiate between the two types of infiltrating (invasive) carcinomas
1. infiltrating ductal carcinoma
* 80%
2. infiltrating lobular carcinoma
* 10%
* higher incidence of **multicentricity**
* more likely to be **bilateral**
49
clinical presentation
* diffuse induration, erythema, warmth, edema, peau d'orange of the skin of the breast with/without palpable mass
* axillary lympadenopathy
* **inflammatory breast cancer**
* the most rapidly lethal malignancy of the breast
50
Where are the common locations of metastasis in breast cancer
* lung
* liver
* bone
* ovaries
* brain
51
What type of mastectomy is this: entire breast including pectoralis major fascia, nipple, and areola
simple (aka total)
52
What type of mastectomy is this: entire breast including nipple and areola + axillary lymph nodes
modified radical mastectomy
53
What type of mastectomy is this: entire breast, lymph nodes, pectoralis muscle
radical mastectomy
54
screening guidelines for mammography
* start age 40
* then every 1-2 years
