BREAST LUMP-BREAST LUMP-MANAGEMENTMANAGEMENT

Differential DiagnosisDifferential Diagnosis

• CYSTSCYSTS• FIBROADENOMAFIBROADENOMA• FIBROADENOSISFIBROADENOSIS• FAT NECROSISFAT NECROSIS• CHRONIC INFLAMMATIONCHRONIC INFLAMMATION• MALIGNANCYMALIGNANCY

TRIPLE TESTTRIPLE TEST

• CLINICAL BREAST EXAMINATION CLINICAL BREAST EXAMINATION (CBE)(CBE)

• DIAGNOSTIC MAMMOGRAHPYDIAGNOSTIC MAMMOGRAHPY

• FINE NEEDLE ASPIRATION BIOPSYFINE NEEDLE ASPIRATION BIOPSY

(FNAB)(FNAB)

CBECBE

• VISUAL INSPECTIONVISUAL INSPECTION

SITTING, LYING, ARMS BY SIDESITTING, LYING, ARMS BY SIDE

ABOVE HEAD, ON HIPS.ABOVE HEAD, ON HIPS.

DIMPLING, DIMPLING,

BREAST DISTORTION,BREAST DISTORTION,

NIPPLE RETRACTION, PEAU NIPPLE RETRACTION, PEAU D’ORANGE, D’ORANGE, INFLAMMATION INFLAMMATION

CBECBE

• PALPATION TECHNIQUEPALPATION TECHNIQUE

INCLUDE ALL QUADRANTS, INCLUDE ALL QUADRANTS, BEHIND NIPPLES & AXILLARY BEHIND NIPPLES & AXILLARY AND SUPRACLAVICULAR FOSSAEAND SUPRACLAVICULAR FOSSAE

VERTICAL STRIP,VERTICAL STRIP,

CONCENTRIC CIRCLES,CONCENTRIC CIRCLES,

RADIAL SPOKERADIAL SPOKE

MAMMOGRAPHYMAMMOGRAPHY

• INDICATIONSINDICATIONS

1.1. SCREENING ASY.>50SCREENING ASY.>50

2.2. “ “ “ “ >35 WITH HIGH >35 WITH HIGH RISKRISK

3.3. INV. OF SYM.>35 WITH A LUMPINV. OF SYM.>35 WITH A LUMP

4.4. FOLLOWING LOCAL EXCISION OF CAFOLLOWING LOCAL EXCISION OF CA

5.5. AUGMENTATION MAMMOPLASTYAUGMENTATION MAMMOPLASTY

6.6. BREAST LUMP IN MANBREAST LUMP IN MAN

MAMMOGRAPHYMAMMOGRAPHY

SENSITIVITYSENSITIVITY

Age 31-40 41-50 51-60 Age 31-40 41-50 51-60 61-70 71+61-70 71+

Sensitivity 70% 75% 85% Sensitivity 70% 75% 85% 92% 89.5%92% 89.5%

MAMMOGRAPHYMAMMOGRAPHY

Younger women <35Younger women <35

*Clinical /US -- susp. of malignancy *Clinical /US -- susp. of malignancy

*US findings are indeterminate*US findings are indeterminate

*US findings are inconsistent with *US findings are inconsistent with clinicalclinical

*Strong family history of Ca*Strong family history of Ca

MAMMOGRAPHYMAMMOGRAPHY

Main signs malgnancyMain signs malgnancy• High density spiculated massHigh density spiculated mass• Clustered microcalcifications with Clustered microcalcifications with

variable shape variable shape

and size.and size.

* Well defined solid masses are * Well defined solid masses are sometimes malignantsometimes malignant

MammographyMammography

Secondary signs Secondary signs • Architectural distortionArchitectural distortion• Skin thickeningSkin thickening• Nipple retractionNipple retraction• Focally dilated ductFocally dilated duct

FNABFNAB

• Most accurateMost accurate• 15% false negative15% false negative• Us/ mammo. localisationUs/ mammo. localisation

FNABFNAB

• BenignBenign

• Atypical/indeterminateAtypical/indeterminate

• Suspicious/probably malignantSuspicious/probably malignant

• MalignantMalignant

DIAGNOSTIC DIAGNOSTIC ULTRASOUNDULTRASOUND

• Not a part of triple testNot a part of triple test• <35yrs<35yrs• Cyst from solidCyst from solid• Cannot detect microcalcificationCannot detect microcalcification• No role in screeningNo role in screening

ULTRASOUNDULTRASOUND

INDICATIONSINDICATIONS

* Dif. Cyst & Solid* Dif. Cyst & Solid

*palpable mass not visible by X-ray*palpable mass not visible by X-ray

*location of mass*location of mass

*young patient*young patient

*infected breast or an abscess*infected breast or an abscess

*interventional procedures.*interventional procedures.

CORE NEEDLE CORE NEEDLE BIOPSY(CNB)BIOPSY(CNB)

• AdvantageAdvantage

1.large tissue size1.large tissue size

2. distinguish invasive and intraductal ca.2. distinguish invasive and intraductal ca.

3.distinguish –low grade ductal ca and 3.distinguish –low grade ductal ca and lobular calobular ca

4.dif. Non-comedo DCIS from fibrocystic 4.dif. Non-comedo DCIS from fibrocystic dis.dis.

5.any pathologist can interpret5.any pathologist can interpret

CNBCNB

DISADVANTAGEDISADVANTAGE

* Risk of seeding the needle tract* Risk of seeding the needle tract

EXCISION BIOPSYEXCISION BIOPSY

• Most reliableMost reliable• Small breast lumpSmall breast lump• Definitive therapy for a benign Definitive therapy for a benign

breast massbreast mass

INCISIONAL BIOPSYINCISIONAL BIOPSY

• 4cms or greater4cms or greater

palpable masspalpable mass

aspirateaspirate

Fluid obtainedFluid obtained cytology +ve cytology +ve cytology-vecytology-ve

No blood bloodNo blood blood

Mass disappears Mass disappears residual massresidual mass

Mammo. Norm. mammo. Mammo. Norm. mammo. Susp. Susp.

Re ex.4-8wk Re ex.4-8wk treattreat biopsybiopsy