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Breast Lump Management

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Breast Lump Management

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

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