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Breast Lump Management
 

Breast Lump Management

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    Breast Lump Management Breast Lump Management Presentation Transcript

    • BREAST LUMP-MANAGEMENT
    • Differential Diagnosis
      • CYSTS
      • FIBROADENOMA
      • FIBROADENOSIS
      • FAT NECROSIS
      • CHRONIC INFLAMMATION
      • MALIGNANCY
    • TRIPLE TEST
      • CLINICAL BREAST EXAMINATION (CBE)
      • DIAGNOSTIC MAMMOGRAHPY
      • FINE NEEDLE ASPIRATION BIOPSY
      • (FNAB)
    • CBE
      • VISUAL INSPECTION
      • SITTING, LYING, ARMS BY SIDE
      • ABOVE HEAD, ON HIPS.
      • DIMPLING,
      • BREAST DISTORTION,
      • NIPPLE RETRACTION, PEAU D’ORANGE, INFLAMMATION
    • CBE
      • PALPATION TECHNIQUE
      • INCLUDE ALL QUADRANTS, BEHIND NIPPLES & AXILLARY AND SUPRACLAVICULAR FOSSAE
      • VERTICAL STRIP,
      • CONCENTRIC CIRCLES,
      • RADIAL SPOKE
    • MAMMOGRAPHY
      • INDICATIONS
      • SCREENING ASY.>50
      • “ “ >35 WITH HIGH RISK
      • INV. OF SYM.>35 WITH A LUMP
      • FOLLOWING LOCAL EXCISION OF CA
      • AUGMENTATION MAMMOPLASTY
      • BREAST LUMP IN MAN
    • MAMMOGRAPHY
      • SENSITIVITY
      • Age 31-40 41-50 51-60 61-70 71+
      • Sensitivity 70% 75% 85% 92% 89.5%
    • MAMMOGRAPHY
      • Younger women <35
      • *Clinical /US -- susp. of malignancy
      • *US findings are indeterminate
      • *US findings are inconsistent with clinical
      • *Strong family history of Ca
    • MAMMOGRAPHY
      • Main signs malgnancy
      • High density spiculated mass
      • Clustered microcalcifications with variable shape
      • and size.
      • * Well defined solid masses are sometimes malignant
    • Mammography
      • Secondary signs
      • Architectural distortion
      • Skin thickening
      • Nipple retraction
      • Focally dilated duct
    • FNAB
      • Most accurate
      • 15% false negative
      • Us/ mammo. localisation
    • FNAB
      • Benign
      • Atypical/indeterminate
      • Suspicious/probably malignant
      • Malignant
    • DIAGNOSTIC ULTRASOUND
      • Not a part of triple test
      • <35yrs
      • Cyst from solid
      • Cannot detect microcalcification
      • No role in screening
    • ULTRASOUND
      • INDICATIONS
      • * Dif. Cyst & Solid
      • *palpable mass not visible by X-ray
      • *location of mass
      • *young patient
      • *infected breast or an abscess
      • *interventional procedures.
    • CORE NEEDLE BIOPSY(CNB)
      • Advantage
      • 1.large tissue size
      • 2. distinguish invasive and intraductal ca.
      • 3.distinguish –low grade ductal ca and lobular ca
      • 4.dif. Non-comedo DCIS from fibrocystic dis.
      • 5.any pathologist can interpret
    • CNB
      • DISADVANTAGE
      • * Risk of seeding the needle tract
    • EXCISION BIOPSY
      • Most reliable
      • Small breast lump
      • Definitive therapy for a benign breast mass
    • INCISIONAL BIOPSY
      • 4cms or greater
      • palpable mass
      • aspirate
      • Fluid obtained cytology +ve cytology-ve
      • No blood blood
      • Mass disappears residual mass
      • Mammo. Norm. mammo. Susp.
      • Re ex.4-8wk treat biopsy
    •