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Benign breast disease
- 1. Benign Breast Disease AlirezaMohammadzadeh, MD Thoracic Surgeon
- 2. Benign breast disorders& diseases encompass a wide range of clinical and pathologic entities
- 3. Understanding of thesefor : clear explanation to affected women appropriate treatment instituted unnecessary follow up
- 4. Fibroadenoma Predominantly in youngerwomen aged 15 to 25 years Usually grow to 1 or 2 cm and then are stable Small f. (<1cm) are considered normal Larger f.(<3cm) are disorders Giant f. (>3cm) are disease Multiple f. (more than 5 in one breast) are disease
- 5. Ultrasound Benign – Pure andintensely hyperechoic – Elliptical shape (wider than tall) – Lobulated – Complete tine capsule Malignant – Hypoechoic, spiculated – Taller than wide – Duct extension – microlobulation
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- 9. Sclerosing adenosis Prevalent duringchildbearing & perimenopausal years No malignant potential Occasionally presents as a palpable mass Benign calcification Lesions up to 1 cm are called radial scar Larger lesions are called complex sclerosing
- 10. Sclerosing adenosis Mimic ofcancer On physical examination, by mammography, at gross pathology Wire localized excisionl biopsy
- 11. Benign Breast Diseases Glandularbreast parenchyma – Mass – Asymmetric nodularity – Pain Nipple-Areolar Complex – Discharge – Rash – Retraction Surrounding breast skin – Dimpling
- 12. Management History Clinical Breast Exam Breastimaging Tissue sampling Therapy
- 13. History Age – Menarche – Pregnancy Breastfeeding – Menopause Family History Prior biopsies Hormone therapy
- 14. Clinical Exam Inspection – Skin –Symmetry – Masses Palpable – Gland – Axilla, Supraclavicular spaces – Nipple-areola complex
- 15. Breast Mass Breast Cysts –Fluid-filled – 1 out of every 14 women 50% multiple and recurrent – Hormonally influenced – Needle aspirated
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- 17. Breast Mass Phyllodes Tumor –Proliferation of connective tissue with ductal elements Whorled and cellular stroma – Firm, lobulated – 2 to 40 cm in size – 10% malignant – Treatment Wide excision
- 19. Fibrocystic Disease Clinical, mammographicand histologic findings Exaggerated response from hormones and growth factors – Cyclical pain – Nodularity – upper outer quadrants
- 20. Fibrocystic Disease Histology – Adenosis –Apocrine metaplasia – Fibrosis – Duct ectasia – Mild ductal hyperplasia
- 21. Fibrocystic Disease Risk Factors –Dense breast – Sclerosing adenosis – Atypical ductal, papillary, or lobular hyperplasia
- 22. Breast Pain Cyclical pain– hormonal – Dull, diffuse and bilateral – Luteal phase – Treatment Reassurance NSAIDS Evening primrose oil Non-cyclical pain – Non-breast vs breast – Imaging – Treatment Reassurance NSAIDS Evening primrose oil
- 23. Breast Infections Mastitis – Generalizedcellulitis of the breast – Ascending infection subareolar ducts commonly occurs during lactation – Staph. aureus – Erythema, pain, tenderness
- 24. Mastitis Treatment – Abx – Continueto breast feed – Close follow-up
- 25. Breast Abscess Abscess – Breasttissue – Treatment Abx Needle aspiration Incision and drainage
- 26. Nipple Discharge Physiologic – Bilateral –Involves multiple ducts – Heme (-) – Non-spontaneous
- 27. Nipple Discharge Pathologic – Unilateral –Spontaneous – Heme (+) Most common cause intraductal papilloma
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- 29. Intraductal Papilloma Single duct Benign 4%of intraductal ca
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- 31. Mammography Screening tool – Ageof 40 Estimated reduction in mortality 15-25% 10% false positive rate Densities & calcifications
- 34. Calcification Macrocalcifications – Large whitedots – Almost always noncancerous and require no further follow-up. Microcalcifications – Very fine white specks – Usually noncancerous but can sometimes be a sign of cancer. – Size, shape and pattern
- 38. BI-RADS BI-RADS Classification Features 0 Need additionalimaging 1 Negative – routine in 1 yr 2 Benign finding – routine in 1 yr 3 Probably benign, 6mo follow-up 4 Suspicious abnormality, biopsy recommended 5 Highly suggestive of malignancy; appropriate action should be taken
- 39. Ultrasound Not a screeningtool Palpable vs cystic Mammographic detected lesion
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- 44. MRI High risk patients –Personal history of breast ca – LCIS, atypia – 1st degree relative with breast cancer – Very dense breast High sensitivity (95-100%) – 10-20% will have a biopsy
- 45. MRI Pre Gad PostGad Color Overlay
- 46. Diagnosis Fine needle aspiration –Cytology Core biopsy – Image guided – Stereotactic Excisional biopsy – Needle localization
- 47. FNA Fast, inexpensive 96% accuracy Institutiondependent Unable to differentiate b/w in situ vs CA
- 48. Core Needle Biopsy 14-18gauge spring loaded needle Tissue Multiple
- 50. Large Core Biopsy 6-14gauge core Large samples Single insertion
- 51. Core biopsy VacuumAssisted
- 52. Excisional Biopsy Atypical lesions LCIS Radialscar Atypical papillary lesions Radiologic-pathologic discordance Phyllodes Inadequate tissue harvesting