ASSESSMENT OF BREAST SYMPTOMS/LUMPS

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


• 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


• EXAMINATION OF BREAST

– Inspection– Palpation– Lymph node basins (axilla, neck)– Contralateral breast


• INSPECTION


• NIPPLE RETRACTION


• SKIN DIMPLING


• PAGET’S DISEASE


• TRIPLE ASSESSMENT OF A BREAST LUMP– Clinical– Imaging• Mammography• Ultrasound

– Pathology• Fine needle aspiration cytology (FNAC)• Core biopsy


• PALPABLE LYMPH NODES


• MAMMOGRAPHIC STAGING

– Masses– Asymmetry

• Architectural distortion

– Calcification– Skin changes



• NORMAL FATTY REPLACEMENT


• NORMAL INVOLUTION

• DENSE BREASTS


• DENSE BREASTS – RETROAREOLAR TISSUE LEFT


• DENSE BREASTS +++ ALL OF LIFE


• ULTRASOUND

• A: Fibroadenoma

• B: Carcinoma


• FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)


• FNAC INTERPRETATION AND ACTION


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


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


ASSESSMENT OF BREAST SYMPTOMS/LUMPS

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