Breast Disease

Tripple assessement
 General
MOU/ Surgery
Genetic Ward Radiology
Research

Community Palliative
Advocacy Care

Plastic
Surgery MHBC Pathology

Nuclear
Medicine Med
( bone Oncology
scans)

Anesthesia/ Radiation
ICU/ ITU
MDM oncology
Prof. Mah-Jabeen
Wire
localization

US Guided
MRI trucuts/
core
biopsies
Radiology
Clipping
CT SCAN
per- NACT

Mammo
Prof. M. Abbas Khokhar
NACT

US Guided
MDT trucuts/
core
biopsies

Oncology
LINEAR Clippling per-
ACCELERAT NACT
OR
MAMMO
GRAM
Prof. Rahat
FNAC

Diagnostic Imprint
s cytology

Pathology
Frozen
Immuno Section
Histopat
hology
 Fellowship

Dedicated
Oncoplastics
Bays
West
Surgical
Workshops / Ward Dedicated
Seminars Breast Clinic

Breast
registry
Prof. Ahmad Uzair Qureshi
 Breast Clinic Attendance 2022
( Data upto 22.7.22)
282

118 123

59 71
23
38
January February March April May June July
Ave Age : 48 YEARS
Laterality Grade
40
Number
35
Grade I Grade II Grade
30
25 20%
20
15 29 34 46%

10
5 3
0 34%
Right sided Left Sided Bilateral

Number of Cases
Stage of tumor
30

25 24
20 19
15
Axis Title
10 8 9
6
5
2 2 3
0
I s
ge II A IIB III
A
I II B
I IIC IV d e
St
a ge ge ge ge ge age l o
a St
a a a a St yl
St St St St Ph
 14

12
RECEPTO
10

6
Axis Title
4
RS

0
R2- V E V E
E R- R+
E R-
E T I TI ,H
E
,H
,H GA S - -,H
R+
R+ NE PO ,P
R
,- P
R P
,P E E + ,
+ IPL I PL ER ER E R-
ER T R TR
MRM vs BCS

MRM
32%

BCS
68%
Procedures
30

25

20

15

10

0
MRM WLE Palliative Mastectomy Recurrent surgeries
TUMOR TYPES Total admission

1%
3%
TOTAL DEATHS
5% TOTAL 42
DIS- 1%
CHARGES TOTAL AD-
IDC 1187 MISSION IN
PHYLLODES 37% WSW(M&F)
ILC 1945
INTRA-CYSTIC 61%
PAPILLARY

91%
TOTAL ADMISSION IN WSW(M&F) TOTAL DISCHARGES
TOTAL DEATHS
• Lattissimus dorsi flaps
 Donut
Mastectomy
• ALND
• SLND
• AX Sampling
Grissoti Flaps
Batwing
Mammoplasty
Inferior Pedicle based Crescent
flap Mammoplasty
Early results
Anatomy
Clinical Features

Radiological
Investigations

Tissue Diagnosis
 Common Presentation

• Breast Mass • Fibroadenoma

• Nipple Discharge • Phyllodes Tumor
• Breast Pain • Cysts
• Skin Changes • Fibrocystic Changes
• Abscess formation
• Infections
• Mastalgia
Histopathologic subtypesInvasive carcinoma

• In situ carcinomas
Common subtypes accounting for most cases • Ductal carcinoma in situ

Ductal (about 75%)

Noninvasive neoplasm of ductal origin that can
progress to invasive cancer
• Variable histopathology and malignant potential
Lobular (about 8%) • Paget disease of breast
• Lobular carcinoma in situ Now considered a benign
entity and removed from TNM staging; however, it
may beassociated with high risk for invasive cancer
• Estrogen receptor expression
• Progesterone receptor expression
• HER2 overexpression (about 15%-20% of cases )
• Androgen receptor expression
• Triple-negative (ie, estrogen receptor–negative, progesterone
receptor–negative, HER2-negative; about 15%-20% of cases)
Tumour ( T)
• Tumor (T)TX: primary tumor cannot be assessed
• T0: no evidence of primary tumor
• Tis: tumor in situ (ductal carcinoma in situ)
• Tis (Paget): Paget disease of nipple not associated with ductal
carcinoma in situ and/orinvasive carcinoma in breast parenchyma
• T1: tumor up to 20 mm in greatest dimension
• T2: tumor larger than 20 mm, up to 50 mm in greatest dimension
• T3: tumor larger than 50 mm in greatest dimension
• T4: tumor of any size with regional invasion
• cNX: cannot be assessed
• cN0: no regional node metastases by imaging or
clinical examination
• cN1: movable ipsilateral axillary nodes
• cN2: fixed ipsilateral axillary nodes or ipsilateral
internal mammary nodes
• cN3: ipsilateral nodes in addition to axillary nodes
Pathological Lymph node staging
• pNX: regional nodes cannot be assessed
• pN0: no regional node metastases on histologic
examination
• pN1: micrometastases or metastases in 1 to 3
nodes
• pN2: 4 to 9; or internal mammary nodes
clinically detected
• pN3: any of the following:10 or more axillary nodes
• Ipsilateral infraclavicular nodes
• Clinically detected internal mammary nodes with
axillary nodes
• Internal mammary nodes not clinically detected with
more than 3 axillary nodes
• Ipsilateral supraclavicular nodes
DISTANT
METASTASIS
 Stage 0: TisN0M0 Stage IIA: T0N1M0,
Stage IA: T1N0M0 T1N1M0, or T2N0M0
Stage IB: T0N1M0 or Stage IIB: T2N1M0 or
T1N1M0 T3N0M0

Stage IIIA: T0N2M0,

T1N2M0, T2N2M0, Stage IIIC: any T, N3, M0
T3N1M0, or T3N2M0 Stage IV: any T, any N,
Stage IIIB: T4N0M0, M1
T4N1M0, or T4N2M0
Clinical Features

Radiological
Investigations

Tissue Diagnosis
Risk increases with age

• Lifetime risk: 1 in 8
• Birth to age 49 years: 1 in 49
• Age 50 to 59 years: 1 in 42
• Age 60 to 69 years: 1 in 28
• Age 70 years or older: 1 in 14
10 COMPONENTS
OF
Examination of Breast
Swelling
• Patient position : Sitting / Recline / supine

• Exposure : uptil umbilicus

 Quadrants &

5 Nipple Areola
Complex
SWELLING
1. Nipple Areola Complex
2
3
4
5
 6
BREAST TAIL
AXILLA
7
7
7
7
7
 7
Supra & Infra-Clavicular fossae
 8
Infra-Mammary fold
ARM –
FOR
LYMPHEDEMA

9
 INSPECTION PALPATION
IN CASE OF
SWELLING

AUSCULTATION PURCUSSION
 INSPECTION PALPATION
IN CASE OF
SWELLING

AUSCULTATION PURCUSSION
Inspection

5S
Inspection

SITE

5S
Inspection

SITE

5S SIZE
Inspection

SITE

5S SIZE
SHAPE
Inspection

SITE

SURFACE
5S SIZE
SHAPE
Inspection

SURROUNDING
STRUCTURES
SITE

SURFACE
5S SIZE
SHAPE
Palpation

SURROUNDING
STRUCTURES
SITE

SURFACE
5S SIZE
SHAPE
 Palpation
CONSISTENCY
SURROUNDING
STRUCTURES
SITE

SURFACE
5S SIZE
SHAPE
 Palpation
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE

SURFACE
5S SIZE
SHAPE
 Palpation
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE
MARGINS

SURFACE
5S SIZE
SHAPE
 Palpation
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE
MARGINS

MOBILITY SURFACE
5S SIZE
SHAPE
 Palpation
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE
MARGINS

MOBILITY SURFACE
5S SIZE
SHAPE
 Palpation
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE FIXITY

MARGINS

MOBILITY SURFACE
5S SIZE
SHAPE
 Palpation
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE FIXITY

5S
MARGINS REDUCIBILITY
SIZE
MOBILITY SURFACE

SHAPE
 Palpation
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE FIXITY

5S
MARGINS REDUCIBILITY
SIZE PULSALITY
MOBILITY SURFACE

SHAPE
 INSPECTION PALPATION
IN CASE OF
SWELLING

AUSCULTATION PURCUSSION
 INSPECTION PALPATION
IN CASE OF
ULCER

AUSCULTATION PURCUSSION
Inspection & Palpation of Ulcer

SURROUNDING
STRUCTURES
SITE

SURFACE
5S SIZE
SHAPE
 INSPECTION
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE FIXITY

5S
MARGINS REDUCIBILITY
SIZE PULSALITY
MOBILITY SURFACE

SHAPE
 Inspection
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE FIXITY

5S
REDUCIBILITY
EDGES
SIZE PULSALITY
MOBILITY SURFACE

SHAPE FLOOR
 Palpation
FLUCTUATION
CONSISTENCY

COMPRESSIBILITY
SURROUNDING
STRUCTURES
SITE FIXITY

5S
REDUCIBILITY
EDGES
SIZE PULSALITY
MOBILITY SURFACE

SHAPE BASE
 DISTANT
METASTASIS

10
Clinical Features

Radiological
Investigations

Tissue Diagnosis
 TEN Common indications for breast
sonography

1. Evaluate a palpable mass in women younger than 30 years

or women who are pregnant or lactating
2. Evaluate questionable findings on a mammogram
3. Evaluate breast implants and associated problems
4. Evaluate the radiographically dense breast
5. Serial monitoring of a benign mass
 TEN Common indications for breast
sonography

6. Evaluate axillary lymph nodes

7. Provide localization during interventional procedures
8. Assist with treatment planning for radiation therapy
9. Evaluate the male breast
10. when mammography is compromised or contraindicated
Screening Mammography
POSSIBLE FINDINGS ON MAMMOGRAM

SPICULATED MASS CALCIFICATION, MASS

ARCHITECTURAL DISTORTION MASS

MASS
CT SCAN MRI
Clinical Features

Radiological
Investigations

Tissue Diagnosis
NEEDLE BIOPSY CORECUT BIOPSY

ULTRASOUND
GUIDED BIOPSY
• Preoperative Needle Wire Localization. Ultrasound offers a
• quick method for placement of a percutaneous needle wire
• assembly for preoperative localization of a nonpalpable breast
• lesion for surgical excision (Fig. 21.49) and offers a significant
• advantage in complicated cases, such as localization of a
• lesion adjacent to a breast implant, a lesion close to the chest
• wall, or a lesion in other areas not easily approached under
• mammographic guidance.
EXCISION BIOPSY
INCISION BIOPSY
Clinical Features

Radiological
Investigations

Tissue Diagnosis
Stage of tumor
30

25 24
20 19
15
Axis Title
10 8 9
6
5
2 2 3
0
I s
ge II A IIB III
A
I II B
I IIC IV d e
St
a ge ge ge ge ge age l o
a St
a a a a St yl
St St St St Ph