Post on 24-Dec-2015
ASSESSMENT OF BREASTSYMPTOMS/LUMPS
Professor P Grantley Gill
Specialists Without BordersSeminar in Surgery
Rwanda, September 2010
• SIGNS AND SYMPTOMS AT PRESENTATION
Palpable massThickening, Pain
Mass or pain in the axilla
Nipple discharge
Oedema or erythema of the skin
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• CAUSES OF BREAST LUMPS– Fibroadenoma– Cyst– Fibrocystic change– Cancer– Duct ectasia– Fat necrosis– Haematoma
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• BREAST CANCER RISK FACTORS– Age– History of breast cancer– Family history of breast cancer, especially in first degree
relatives– Specific genetic mutations e.g. BRCA-1, BRCA-2– Benign breast “cancer” atypical hyperplasia– Early menarche, late menopause– Late first pregnancy/no pregnancy– Exogenous oestrogens– Radiation– Diet, alcohol
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• EXAMINATION OF BREAST
– Inspection– Palpation– Lymph node basins (axilla, neck)– Contralateral breast
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• INSPECTION
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• NIPPLE RETRACTION
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• SKIN DIMPLING
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• PAGET’S DISEASE
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• PAGET’S DISEASE
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• TRIPLE ASSESSMENT OF A BREAST LUMP– Clinical– Imaging• Mammography• Ultrasound
– Pathology• Fine needle aspiration cytology (FNAC)• Core biopsy
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• PALPABLE LYMPH NODES
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• MAMMOGRAPHIC STAGING
– Masses– Asymmetry
• Architectural distortion
– Calcification– Skin changes
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• NORMAL FATTY REPLACEMENT
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• NORMAL INVOLUTION
• DENSE BREASTS
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• DENSE BREASTS – RETROAREOLAR TISSUE LEFT
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• DENSE BREASTS +++ ALL OF LIFE
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• ULTRASOUND
• A: Fibroadenoma
• B: Carcinoma
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• FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)
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• FNAC INTERPRETATION AND ACTION
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INTERPRETATON ACTIONUnsatisfactory for diagnosis Repeat or core
Cellular, benign Accept if consistent with imaging; repeat or core if not
Cellular, some atypia Core biopsyOpen biopsy
Suspicious Core biopsyOpen biopsy
Malignant Treatment
• TRIPLE ASSESSMENT OUTCOME
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ASSESSMENT CONCORDANT DISCORDANT
Clinical Accept results benign or malignant
Core biopsyOpen biopsyImaging
Cytology
• CONCLUSION
– Confirm malignancy in ≥90% by triple assessment
– Open biopsy if not possible
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