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Yr 3 - Reproduction > Breast Lecture 2 > Flashcards

Breast Lecture 2 Flashcards

1
Q

What techniques are used to gain samples for breast cytology?

A

Fine Needle Aspiration (FNAC)

Smear from nipple discharge

Scrape nipple with scalpel

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2
Q

When is breast cytology used?

A

Symptomatic assessment

Breast screening (mostly core biopsy)

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3
Q

What features may you find on breast palpation?

A

Discrete mass - solid, cystic

Diffuse thickening

Nipple lesion

Discharge

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4
Q

What equipment is needed for FNAC?

A

23G needle

10ml syringe

Alcohol swab

Cotton wool/plaster

Glass slides

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5
Q

Outline the technique for FNAC?

A

Swab lump area

Localise with fingers

Insert needle 45o

Aspirate using in/out action

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6
Q

What is this?

Describe it

A

Benign Breast Mass cytology

  • low/ moderate cellularity
  • cohesive groups of cells
  • flat sheets of cells
  • bipolar nuclei in background
  • cells of uniform size
  • uniform chromatin pattern
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7
Q

What is this?

Describe it

A

Malignant breast mass cytology

  • high cellularity
  • loss of cohesion
  • crowding/overlapping of cells
  • nuclear pleomorphism
  • hyperchromasia
  • absence of bipolar nuclei
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8
Q

What does malignant cytology tell us?

A

Diagnosis not specific

May suggest type

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9
Q

Cytoplasmic vacuoles on breast cytology suggest what?

A

Lobular carcinoma

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10
Q

Tubular cell arrangement in breast cytology tell you what?

A

Tubular carcinoma

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11
Q

What is the cytology scoring system?

A

C1 Unsatisfactory

C2 Benign

C3 Atypia (probably benign)

C4 Suspicious (probably malignant)

C5 Malignant

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12
Q

What is the use of aspiration for cysts?

A

Aspiration is curative

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13
Q

What are the advantages of FNAC?

A

Simple

Well tolerated

Inexpensive

Immediate results

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14
Q

What are the disadvantages of FNAC?

A

False +ves/-ves

Invasion cannot be assessed

Cannot be graded

Sampling may miss lesion

Operator dependent for cell examination

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15
Q

Complications of FNA?

A

Pain

Haematoma

Fainting

Infection, pneumothorax

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16
Q

Nipple scraping can be used to differentiate what? How?

A

Paget’s Disease and Eczema

Paget’s - Squamous cells + malignant cells

Eczema - Squamous cells only

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17
Q

Macrophages alone on nipple discharge cytology suggests what?

A

Duct ectasia

18
Q

Benign cells in papillary groups alone on nipple discharge cytology suggests what?

A

Intraduct papilloma

19
Q

Malignant cells alone on nipple discharge cytology suggests what?

A

Intraduct carcinoma (DCIS)

20
Q

When is core biopsy indicated for breast mass?

A

All cases of clinical/radiological/cytological suspicion

Breast screening for microcalcification

Pre-operative classification

Rarely open biopsy

21
Q

What is the use of breast mass core biopsy?

A

Confirm invasion

Tumour typing and grading

Immunohistochemistry - receptor status

22
Q

What equipment is needed for a core biopsy?

A

14G needle

Intact tissue strand

Formalin (for fixation)

23
Q

What are the most common breast imaging modalities?

A

Mammogramography

USS

MRI

Nuclear medicine

CT

24
Q

What are the standard views used in mammography?

A

Mediolateral Oblique (MLO)

Craniocaudal (CC)

25
Q

What are the less common views used in mammography?

A

Coned

Magnification

True lateral

Extended CC

Eclund views

26
Q

When is mammography indicated in patients?

A

Over 40

Under 40 if:

  • Strong suspicion of cancer
  • FH risk >40%
27
Q

What radiation dose is given in mammography?

A

1mSv

28
Q

How is cancer seen on mammography?

A

Mass

Assymetry

Architectural distortion

Calcifications

Skin changes

29
Q

How does a malignant soft tissue mass appear on mammography?

A

Irregular, ill-defined

Spiculated

Dense

Distorted architecture

30
Q

How does a benign soft tissue mass appear on mammography?

A

Smooth

Lobulated

Normal density

Halo

31
Q

What is shown here?

A

Mammogram - Calcified fibroadenomas

32
Q

What is shown here?

A

Mammogram - Cyst

33
Q

Why is USS used in breast imaging?

A

Differentiate solid from cystic

First line for under 40s

No radiation

Less informative than mammography

34
Q

How does a solid benign mass present on breast USS?

A

Smooth outline

Oval shape

Acoustic enhancement

Orientation

35
Q

How does a malignant mass present on breast USS?

A

Irregular outline

Interrupting breast architecture

Acoustic shadowing

Anterior halo

36
Q

What is the triple assessment used for breast mass?

A

Clinical Examination

Imaging

FNA Cytology

37
Q

What are the main types of image guided needle biopsy?

A

Stereotactic (upright or prone)

Ultrasound (guided or freehand)

FNA/Core biopsy

38
Q

What are the indications for MRI of breast?

A

Recurrent disease

Implants

Indeterminate lesion following triple assessment

Screening high-risk women

39
Q

What are the adv/disadvantages of breast MRI?

A

Advantages

  • 94-98% sensitivity
  • Great for problem solving

Disadvantages

  • Poor specificity
  • Claustraphobic, noisy, IV contrast
  • Expensive
40
Q

How is sentinel node sampling performed?

A

Peritumoral injection of 99m Tc sulphur colloid + isosulphan blue dye

Lymphoscintigraphy

Intraoperative gamma probe

Single lymph node removal

Yr 3 - Reproduction (37 decks)

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