Flashcards in CM: Eval of Breast Dz Deck (14):
What are the indications for breast ultrasound?
eval palpable mass not seen on mammography
pregnant or lactating
cystic vs. solid
young women w dense glandular tissue
What are the indications for breast MRI?
eval inflammatory lesions
dense breast w no cancer
eval for implant rupture
characterize soft tissue mass
What is the clinical presentation of fat necrosis of the breast?
maybe hx of trauma, superficial masses w skin retraction
need surgical biopsy to confirm
What are the 3 options for management of a lesion found on mammography?
early mammographic follow-up and physical exam in 4-6 mos
needle localized surgical excisional breast biopsy
stereotactic or sonographic guided core needle biopsy or FNA
What are the indications for a stereotactic breast biopsy?
BIRADS 4 or 5 or lesion not seen on ultrasound (microcalcifications)
lesion identified in one view only on mammogram
What are the indications for referral to a surgeon w a lesion discovered on mammogram?
malignant diagnosis by biopsy
BIRADS 4 and 5
Which symptoms of nipple discharge suggest in increased likelihood of cancer?
serous, serosanguinous, sanguinous or watery
associated w mass
originating from single duct
associated w abnormal cytology or mammogram
pt over 50
How can you recognized when nipple discharge is due to fibrocystic dz?
multi ductal, bilateral, multi-colored, elicited w manual compression
What is the ddx of galactorrhea (milky discharge)?
OCPs, thyroid dz, chest wall trauma or stimulation, pit adenomas, meds
What is the appropriate evaluation of nipple discharge?
non lactational galactorrhea - get prolactin and thyroid fxn tests
characterize discharge, hemoccult test, cytologic examination on bloody
ductogram to delineate intraductal pathology
excision of duct and adjacent breast tissue if worrisome
What are the 6 most common etiologies of breast pain and what symptoms suggest each?
diffuse fibrocystic changes - can wax and wane w cycle
sudden enlargement of gross cyst
physiologic hormone cycling of exogenous hormone therapy
cancer - older, no hormone therapy, new onset
What is the further evaluation for breast pain?
physical exam, mammography if >40, withdrawal of hormone replacement can improve fibrocystic symptoms
aspirate gross cyst, confirm no inf or solid mass, symptomatic therapy
What are the six most common etiologies of breast inflammation?
recurring subareolar abscess - spontaneous drainage of pus around nipple areolar complex
skin inf (folliculitis or infected sebaceous cyst)
cancer - erythematous, edematous firm breast but no other signs of inf, fail to respond to antibiotics