MANAGEMENT OF BREAST LUMP

DIFFERENTIAL DIAGNOSIS CYSTS FIBROADENOMA FIBROADENOSIS FAT NECROSIS CHRONIC INFLAMMATION MALIGNANCY TRIPLE TEST CLINICAL BREAST EXAMINATION (CBE) DIAGNOSTIC MAMMOGRAHPY FINE NEEDLE ASPIRATION BIOPSY (FNAB) CBE VISUAL INSPECTION SITTING, LYING, ARMS BY SIDE, ABOVE HEAD, ON HIPS.
DIMPLING, BREAST DISTORTION,NIPPLE RETRACTION, PEAU DORANGE, INFLAMMATION

PALPATION TECHNIQUE INCLUDE ALL QUADRANTS, BEHIND NIPPLES & AXILLARY AND SUPRACLAVICULAR FOSSAE VERTICAL STRIP, CONCENTRIC CIRCLES, RADIAL SPOKE

MAMMOGRAPHY INDICATIONS 1. SCREENING. ASY.>50 2. SCREENING WITH HIGH RISK >35 3. INVESTIGATION . .>35 WITH A LUMP 4. FOLLOWING LOCAL EXCISION OF CA 5. AUGMENTATION MAMMOPLASTY 6. BREAST LUMP IN MAN 7. YOUNGER WOMEN <35 a. CLINICAL /US -- SUSP. OF MALIGNANCY b. US FINDINGS ARE INDETERMINATE c. US FINDINGS ARE INCONSISTENT WITH CLINICAL d. STRONG FAMILY HISTORY OF CA SENSITIVITY AGE: SENSITIVITY 31-40 70% 41-50 75% 51-60 85% 61-70 92% 71+ 89.5%

MAIN SIGNS MALIGNANCY HIGH DENSITY SPICULATED MASS CLUSTERED MICROCALCIFICATIONS WITH VARIABLE SHAPE AND SIZE WELL DEFINED SOLID MASSES ARE SOMETIMES MALIGNANT SECONDARY SIGNS ARCHITECTURAL DISTORTION SKIN THICKENING NIPPLE RETRACTION FOCALLY DILATED DUCT

FNAB MOST ACCURATE 15% FALSE NEGATIVE

FINDINGS OF FNAB

BENIGN ATYPICAL/INDETERMINATE SUSPICIOUS/PROBABLY MALIGNANT MALIGNANT DIAGNOSTIC ULTRASOUND NOT A PART OF TRIPLE TEST <35YRS CYST FROM SOLID CANNOT DETECT MICROCALCIFICATION NO ROLE IN SCREENING INDICATIONS DIFFERENTIATE. CYST & SOLID PALPABLE MASS NOT VISIBLE BY X-RAY LOCATION OF MASS YOUNG PATIENT INFECTED BREAST OR AN ABSCESS INTERVENTIONAL PROCEDURES.

CORE NEEDLE BIOPSY(CNB) ADVANTAGES 1. 2. 3. 4. 5. LARGE TISSUE SIZE DISTINGUISH INVASIVE AND INTRADUCTAL CA. DISTINGUISH LOW GRADE DUCTAL CA AND LOBULAR CA DIFFERENTIATE. NON-COMEDO DCIS FROM FIBROCYSTIC DIS. ANY PATHOLOGIST CAN INTERPRET

DISADVANTAGES RISK OF SEEDING THE NEEDLE TRACT EXCISION BIOPSY MOST RELIABLE SMALL BREAST LUMP DEFINITIVE THERAPY FOR A BENIGN BREAST MASS INCISIONAL BIOPSY 4CMS OR GREATER PALPABLE MASS ASPIRATE FLUID OBTAINED NO BLOOD MASS DISAPPEARS MAMMO. NORM. RE EX.4-8WK TREAT CYTOLOGY +VE CYTOLOGY-VE RESIDUAL MASS MAMMO. SUSP. BIOPSY BLOOD