This woll helpful for student of medicine

1. Diagnosis of Breast Cancer
- Shubham aher
605

6. Breast profile:
A ducts, B lobules, C dilated section of
duct to hold milk
D nipple, E fat, F pectoralis major muscle,
G chest wall/rib cage
Enlargement:
A normal duct cells, B ductal cancer cells
breaking through the basement membrane
C basement membrane

7. .
Breast profile:
A ducts, B lobules, C dilated section of
duct to hold milk
D nipple, E fat, F pectoralis major muscle,
G chest wall/rib cage
Enlargement:
A normal duct cells, B ductal cancer cells
breaking through the basement membrane
C basement membrane

8. Breast Self Examination can pick up suspicious
lumps and nipple discharges
Start BSE at 20 years and
encourage self awareness

10. Who said size doesn’t matter?

11. Mammogram

14. Mammography can pick up clusters of micro-calcification

15. Ultrasound

17. MRI

18. Active cells, which often indicate rapid cancer growth, take up the radioactive
material. This helps radiologists identify areas where cells are suspiciously active,
which can indicate cancer

19. SENTINEL LYMPH NODE DISSECTION
remove only the one node that is most likely to have it. If this node is clean,
chances are the other nodes have not been affected. In reality, the surgeon
usually removes a cluster of two or three nodes—the sentinel node and those
closest to it.

21. Survival rates differ with Clinical Stage

22. Lymph Node Areas Adjacent
to Breast Area
A Pectoralis major muscle
B Axillary LN: levels I
C AxillaryLN: levels II
D Axillary LN: levels III
E Supraclavicular LN
F Internal mammary LN

23. Stage IIIA is defined as T0 - T3 N2 M0 or T3 N1 M0.
Stage IIIB is defined as T4 any N M0 or any T N3 M0.

24. Other Diagnostic Techniques
• Tumor markers
CA 15.3, CA125, CA 27.29 (early indicator of disease progression or
recurrence)
• Chest X-Ray
-Spread to lungs and heart
-Assess lungs before anaesthesia and chemotherapy
-Assess infections and radiation induced pneumonia
• Bone scintigraphy(bone scan)
-detect the presence of bone metastases
-evaluate persistent or progressive bone pain
-different from a bone density study (DEXA scan is the most popular type),
which evaluates bone strength and your risk of osteoporosis
-not necessary for DCIS

25. Ductal Lavage
- suction is applied to the nipple to bring out fluid
from the many little milk ducts that end in the
nipple.
- small canula, or tiny tube, is placed into the milk
duct, and then fluid is washed into the duct to
rinse out cells.
- This fluid is then pulled back out of the nipple
and sent to the laboratory for evaluation under
the microscope. Some call this technique a "Pap
smear" of the breast.

26. Sestamibi complements mammography—it
will not replace it.
• Sestamibi also called Miraluma are using to detect active
breast cancer cells, in the breast and in other parts of the
body
• Injection of a radioactive substance called technetium
99. This substance, which emits low levels of radiation,
gets picked up by tumors, so radiologists can see the
tumors on film
• Sestamibi does not detect calcification

31. 77.8% had histological grade 2 or 3

33. Assess mean nuclear area (mna),
mitotic index (smi), fraction of fields
with tubular differentiation (ftd) in BC
from
African-Americans (AA-166)
Caucasians (C-170)
Nigerians (N-148)

34. Mitotic index (smi) vs. Ki67 protein expression
ki-67(%)
80
70
60
50
40
30
20
10
0
SMI
120
100
80
60
40
20
0

35. Fine Needle Aspiration Biopsy

36. ER
HER2+
Ki67
P53
CD34
Biomarkers of human breast cancer

37. Upper panel. Breast tissue microarray containing representative samples of
the whole spectrum of breast pathology in a single slide. Lower Panel. A.
Tissue microarray sample of an invasive ductal carcinoma of the breast
stained with hematoxylin and eosin. B. Same tumor staining positive for RhoC
overexpression with a polyclonal anti-RhoC antibody

38. This is a diploid cell population This breast cancer is aneuploid .

39. 66.9% are premenopausal
mean age 43.8±11.2 years tumor size mean 4.2±1.3cm
73% are advanced (stages III and IV)

41. Breast Cancer in Nigeria categorized according to
"intrinsic gene expression"
Basal; 87; 59%
Luminal; 28;
19%
Her-2+; 33;
22%
Basal
Luminal
Her-2+

42. 0
20
40
60
80
SMI MNA FTD
Morphometric variables
Morphometric variables - mitotic index (smi), nuclear
area (mna), and degree of tubular differentiation (ftd)
show that molecular subsets are distinct (p<0.001)
Luminal
Basal
Her-2+

43. Protein expression of ER,HER-2, EGFR, P53,P63
(IHC) in Nigerian breast cancer (n=148)
22.3
18.9
27.7
12.8
41
77.7
81.1
72.8
87.2
59
0 20 40 60 80 100 120
ER
HER-2
p53
p63
EGFR
positive
negative

44. This wheel of tumor characteristics is used to prognosticate individual
patients' chances of recurrence

45. Patients’ Bill of Right
• A diagnosis within a week of a suspicious mammogram and biopsy.
You'll want a quick diagnosis to allay your anxiety.
• A prompt referral by your family doctor to a breast specialist or team
specializing in breast cancer
• A breast specialist with whom you feel comfortable
• A specific diagnosis. You know you have breast cancer, but you
need to know its attributes
• A second opinion
• A copy of medical records, including your pathology report

46. Patients’ Bill of Right
• Information about your condition and treatment options
in language you understand
• Know the scientific evidence behind your doctor's
treatment recommendation, and the strength of that
evidence
• Information about the benefits and risks of a particular
treatment in your case-including the benefits and risks of
not having the treatment.
• A referral to another breast specialist if you're having
trouble communicating with your doctor.

47. Pathologists In Medical
Malpractice Cases
• Pathologists are responsible for making or
confirming the diagnosis of cancer
• malpractice often involves cancer diagnosis
• Misdiagnosing a benign condition as cancer can
subject a patient to debilitating tx and the
emotional trauma of a death sentence
• Misdiagnosing cancer as a benign condition can
result in delay in diagnosis, allowing a curable
cancer to become incurable.

48. Medical Malpractice and Breast
Cancer
• Too many women have their breast cancer diagnosis
delayed when the physician and other health care
providers in whose hands such women entrust their well-
being fail to
• perform appropriate screening tests
• properly interpret test results
• take necessary steps when bc is suspected
• when this happens, the physician or other health care
provider are negligent.
• the tragic result of this negligence is too often the loss of
treatment options and/or the loss of chance of survival.

49. Failure to diagnose breast cancer
• 40 percent of all medical malpractice suits filed in 1999.
• Several of the top ten lawsuits settled (over 1 million dollars) in
Massachusetts involved medical malpractice where a physician failed to
identify, in a timely manner, a serious case of breast cancer.
• is a form of medical malpractice, which is the negligent or incorrect
performance of the professional duties of health care providers and
institutions.
• there are four prerequisites for a valid claim of medical malpractice:
1) A provider-patient relationship existed;
2) Negligent care was rendered;
3) the patient suffered damage or harm;
4) and the damage or harm done to the patient was a direct result of the
negligent care.

50. Reasons why doctors misdiagnose
breast cancer.
• relying too much on a woman's age as a
predicting factor for breast cancer.
• relying too heavily on negative
mammogram results, even if the woman
has felt a lump.
• don't take woman seriously when they
complain of symptoms.

51. Suggestions
• There is an epidemic of undiagnosed cancer in
this country. Much is due to doctor negligence.
• seek medical attention immediately if observed a
lump
• tests should be ordered to determine whether
there is a malignancy
• With doubt allow the second doctor to form an
opinion
• "Time is of the essence”