Week 7 Flashcards
(53 cards)
US vs mammogram in breast lump assessment
US >40 years or targetted lump
Mammogram >40 years or screening 50-70
When would you offer excision in fibroadenoma?
Rapidly growing (consider phyllodes tumour - may be benign/borderline/malig)
Discomfort to patient
Where does fibroadenoma arise from?
Overgrowth of epithelium and stroma of breast
(overdevelopment of normal breast tissue)
Management of breast abscess
Continue breast feeding/expressing
Aspiration and Flucloxacillin
Prevent cracked nipples
What are you lookig for in mammogram?
Microcalcifications ≤100nm with high inherent contrast
Soft tissue abnormalities with lower intrinsic contrast
Two views of mammogram
Mediolateral oblique
Craniocaudal CC
Inidcations for mammography
Symptomatic assessment > 40 years
Screening (50 – 70yrs)
Higher risk ‘family history’ screening > 40 years
Benign calificiations on mammogram
Vascular calcification
Oil cyst eggshell calcification
Plasma cell mastitis (long, bilat, points to nipple)
Dystrophic calicification in scar
Features of DCIS on mammogram
Shape: Linear or branching
Distribution: Cluster or segmental
Pleomorphic (varying) size and density
Use of US in breast imaging
Targetted breast imaging
E.g. known lesion, suspicion on mamm.
Axilla lymphadenopathy
Tall mass on US suggests
Masss breaking through tissue layers, indicates malignancy
Anechoic mass on US?
Cyst
Features of concerning lymph nodes on US
Round shape
Absence of the fatty hilum
Increased concentric or focal cortical thickness
Imaging pathway in one stop breast clinic
Under 40 (or pregnant / breast-feeding)
- Ultrasound first
- Mammogram only if concerning finding requiring biopsy
40 years and over
- Mammogram first
- Targeted ultrasound
Types of image-guided biopsy in breast assessment
US or mammographic
Core 14G
- diagnostic, mass lesions, nodes
Vacuum assisted
- diagnostic, microcalcification
Vacuum assisted excision
- 2nd line, instead of surgery for B3
Function of radioopaque clips
Confirm position
Neoadjuvant chemotherapy
Localisation
Follow-up post surgery in breast cancer
5 year annual mammography
Most sensitive assessment of breast cancer
MRI
- IV gadolinium
- Lie prone with MRI scanner
- used for locoregional staging
- not highly specific
Indications for staging for distant mets
- T3 and T4 primary cancers (≥5cm or locally invasive)
- ≥4 abnormal nodes at axillary ultrasound or ≥4 macrometastatic nodes at axillary surgery
- If symptoms raise the suspicion of metastatic disease.
ANDIs include…
Fibroadenoma
Cysts (happens in run up to period, most common >40)
Papilloma (essentially skin tag inside cyst)
Pain (usually chest wall or hormonal)
When should nipple discharge be investgated?
Blood stained or associated with other red flag features
- Normal otherwise
Inflammatory conditions of breast
Mastitis
Fistula
Abscess
Why is HER2 status important in breast cancer?
ER vs PR positive
Triple neg is worst prognosis
PR is prognosticator and determines likelihood of chemo response
HER2 pos can determine type of hormonal/chemo needed
Types of chemo in breast cancer
Anthracyclines and Taxanes
- anti-HER2 as well
6-8 cycles, 3 weekly
