lumps in breast

1. LUMPS&&&BUMPS&IN&THE&BREAST&
Indore&
465th&August&2018&

2. Current&imaging&modaliFes&&
- Mammography
Digital-CRbased
-FullFieldDigitalMammography
(FFDM)
-Ultrasound
Elastography
- MRI/PETMRI
- PETCT–NOROLE

3. • ?Mammogram
• ?Ultrasound
• ?MRI
Guidelinesfor
breastimaging

4. GeneralProtocol
• USG<30yrs
• USG+Mammogram:30–
50Yrs
• Mammogram>50yrs/and
USGifindicated
• MRI–Unequivocal
Mammogram/USGfindings

5. Breast&lumps&in&the&adolescent&

6. &&&&&&&&&&&&&&&&&&&CASE&1&
• 26#year#old#single#girl.#
• Presented#with#a#hard#painful#rapidly#
growing#lump#in#her#breast,#for#the#past#
3#months.##
• On&ExaminaFon:#A##hard,#tender,#
mobile#lump#in#the#supero<lateral#
quadrant#of#the#le>#breast.#
• Right#breast#normal#
• No#nipple#discharge##

7. Generalprotocol
• USG<30yrs
• USG+Mammogram:30–50Yrs.
• Mammogram>50yrs/andUSGifindicated.
• MRI–UnequivocalMammogram/USGfindings

8. FIBRO&
ADENOMA&

9. Simplecyst
Anechoic&
Wellcircumscribed
Thinechogenicwall
Enhancedthrough
transmission
Thinedgeshadow

10. #############Complicated&&cysts&
• Masses#with#homogenous#low#
level#internal#echoes#which#
otherwise#meet#the#criteria#for#
a#simple#cyst.#
• May#shi>#slowly#with#changes#
in#the#paDent’s#posiDon.#

11. • Misnomer:Shouldbe
calledcomplexcystic
andsolid.
• Itischaracterisedbya
solidfixedimmobile
muralnodule.
• Itshouldbeassigned
BIRADScategory4A.
• FNACisamust.
Complexcysts

12. &&&&&&&&&CASE&&2#
27#year#old#married#girl#presented#with#a#lump#of#6#
months#duraDon,#increasing#gradually#in#size.#
APRIL&2017&AUGUST&2017&
METAPLASTIC&CARCINOMA&

13. &&&&&&&&&&&&&&&&&&&&&CASE&3&
• 35#year#old#nulliparous#lady.##
• NoDced#a#lump#in#her#right#breast#3#
weeks#ago.#
• On&ExaminaFon:&&
• The#lump#was#non#tender#&#had#a#vague#
outline.##
• It#had#a#so>#feel#but#had#irregular#
margins.#
• The#le>#breast#was#normal.#
• No#nipple#discharge.#
• No#family#history#of#breast#cancer.#

14. FNAC-Medullarycarcinoma

15. #######################CASE&4&
• 30#year#old#lactaDng#woman#presented#with#a#painful#lump#
in#the#breast.#There#was#not##red#nor#hot#/##no#fever##

16. #########LactaFonal&changes&
• ProliferaDon#in#size#and#
number#of#TDLUs!glandular#
predominance#
• Acini#secrete!#Lumen#filled#
with#secreDons.#
#
• Asymmetry#of#secreDons!#
Adenoma#
• Lobular#obstrucDon#!#
Galactocoele#

17. • Anechoic#
• Hyperechoic###
• FaWy#milk#degradaDon##
#products#
• Layering#
• Mobility#of#contents+/<#
#
GALACTOCOELE&

18. CASE&5&
35#year#old#lady#28#weeks#pregnant#
presented#with#bloody#nipple#discharge#le>##
breast.#

19. &&&Management&recommendaFons&
#1.Simple&cyst<Leave#it#alone#unless#it#is#extremely#painful.#
In#that#case#it#can#be#aspirated#under&USS&&
• 2.Solitary&fibroadenomas#<#5cm<FNAC#/Biopsy##
• ############################################>5cm<Excision.#
• 3.MulFple&fibroadenomas#<6#monthly#follow#up#USG#
• 4.Galactocoele#–Non<infected#<AspiraDon#
#############################<Infected<Incision#and#drainage.#

20. &&&&Management&recommendaFons#
• 5.Nipple&discharge:#
• Single#duct,#spontaneous,#serous#/bloody<cytology#/#
USG#guided#FNAC.#In#case#of#intraductal#mass<
microdochectomy.#
• MulDple#ducts,#milky#/#dirty#brown<Only#follow#up.#

21. USS&GUIDANCE&IS&A&MUST&FOR&ALL&
FNAC&/&CORE&BIOPSY&
EVEN&THE&VERY&LARGE&MASSES&

22. SONO&MAMMOGRAM&
11614&MHZ&PROBE&&
ELASTOGRAPHY&

23. REPRODUCTIVE&&AGE&GROUP&

24. Generalprotocol

25. ACRCategory-Normalparenchymalpattern&
ACRPATTERND(4)&ACRPATTERNC(3)&
Extremely#Dense(>75%fibroglandular#Dssue)#
ACRPATTERNB(2)&ACRPATTERNA(1)&
#
#
##########Heterogeneously#Dense#Breast#(50<75%)#
#
###ScaWered#fibro<faWy#(##25<50%)#
##
#############
#
##########Predominantly#faWy#(<25#%)##

26. ##
Extremely#Dense##
Breast#
##
Predominantly#
faWy##breast#
#
Micro#calcificaDon#
#

27. #
#
#
#
#
#
CASE6&
&
44#year#old#lady#who#came#for#a#screening#
mammogram#with#strong#family#history#of#breast#
cancer#(mother#and#sister).##

28. STAGE&2&MALIGNANCY&

29. Breastimagingreportinganddata
system(BIRADS)
• Category&&&&0##<#Needs#addiDonal#imaging##evaluaDon#
• Category####1&#<#NegaDve##
• #########
• Category&&&&2&#<#Benign#findings#
• Category&&&&3##<#Probably#benign#–#needs#follow#up#
• Category&&&&4##<#Suspicious<needs#confirmaDon#:#FNAC#/#biopsy####
• ########
• Category&&&&5&&6##Malignant#
• Category&&&&6&&6##Biopsy#proven#malignancy#
######################

30. BIRADScategory########
Category<1#Normal#Category<2##Benign#Finding#
#################################Category<3###Probably#benign#finding#<needs#follow#up#

31. BIRADS&Category&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&CATEGORY&64&&6SUSPICIOUS&
&&&&&&CATEGORY656&MALIGNANT&
Pleomorphic&/&
Fine&Linear&
Branching&&
Micro6
calcificaFon&
IndisFnct&&margins&&
&Spiculated&margins&

32. GeneralProtocol
• USG<30yrs
• USG+Mammogram:30–50
Yrs
• Mammogram>50yrs/andUSG
ifindicated
• MRI–Unequivocal
Mammogram/USGfindings

33. LimitationsofBreastUltrasound

34. Case6
&
• 60&year&old&female&presented&with&the&C/O&
nodularity&in&the&le[&breast.&
&
• No&family&H/O&breast&cancer.&
&
• &No&previous&mammogram&available.&
&
&

36. IntracysDc#carcinoma#

37. &
54&year&old&lady&presented&with&a&rapid&increase&in&&the&size&of&the&breast&over&a&few&
weeks&with&discolouraFon&of&&the&overlying&skin.&Clinically&?&MasFFs&??&Inflammatory&&
carcinoma.&
&
On&examinaFon&the&breast&felt&rock&hard&with&diffusely&indurated&&skin&and&marked&
Peau&d’Orange&appearance.&
&
&&&
&&&Case&8&

38. Inflammatory#carcinoma#

39. Earlydetectioniscrucialto
reducethemortalityrate.

40. Acriticalmessage:Earlydetectionthroughscreening
Millions&of&precious&lives&can&be&saved&if&women&
follow&this&simple&plan:&
&
• Breast&self6examinaFon&once&a&month&a[er&the&age&
of&20.&
&&&&
• Clinical&examinaFon&once&a&year&a[er&the&age&of&30.&
&
• Mammogram&once&in&two&years&a[er&the&age&of&50.&
&
• Mammogram&once&a&year&a[er&the&age&of&60670&
YEARS&
&

41. MAMMOGRAPHY&EVERY&YEAR&FROM&40675&
YEARS&&INDIAN&GUIDELINES&STILL&EVOLVING&
6&6&
IMAGING&IS&A&MUST&FOR&ALL&LUMPS&
&
USG&GUIDANCE&IS&A&MUST&FOR&ALL&
FNAC&/&BIOPSY&
&

42. BREAST&IS&A&KNOTTY&STRUCTURE&!&