SYMPTOMSLUMPS Professor P Grantley Gill Specialists Without Borders Seminar in Surgery Rwanda September 2010 SIGNS AND SYMPTOMS AT PRESENTATION Palpable mass Thickening Pain Mass or pain in the axilla ID: 335280
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ASSESSMENT OF BREAST
SYMPTOMS/LUMPS
Professor P Grantley Gill
Specialists Without Borders
Seminar in Surgery
Rwanda, September 2010Slide2
SIGNS AND SYMPTOMS AT PRESENTATION
Palpable mass
Thickening, Pain
Mass or pain in the axilla
Nipple discharge
Oedema or erythema of the skin
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CAUSES OF BREAST LUMPS
Fibroadenoma
CystFibrocystic change
CancerDuct ectasiaFat necrosisHaematoma
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BREAST CANCER RISK FACTORS
Age
History of breast cancer
Family history of breast cancer, especially in first degree relativesSpecific genetic mutations e.g. BRCA-1, BRCA-2
Benign breast “cancer” atypical hyperplasia
Early menarche, late menopause
Late first pregnancy/no pregnancy
Exogenous oestrogensRadiationDiet, alcoholwww.specialistswithoutborders.orgSlide5
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
ImagingMammography
UltrasoundPathologyFine needle aspiration cytology (FNAC)Core biopsy
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PALPABLE LYMPH NODES
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MAMMOGRAPHIC STAGING
Masses
Asymmetry
Architectural distortionCalcificationSkin changes
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NORMAL FATTY REPLACEMENTSlide15
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NORMAL INVOLUTION
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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
ACTION
Unsatisfactory for diagnosis
Repeat or core
Cellular, benign
Accept if consistent with imaging; repeat or core if not
Cellular, some atypia
Core biopsy
Open biopsy
Suspicious
Core biopsy
Open biopsy
Malignant
TreatmentSlide23
TRIPLE ASSESSMENT OUTCOME
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ASSESSMENT
CONCORDANT
DISCORDANT
Clinical
Accept results benign or malignant
Core biopsy
Open biopsy
Imaging
CytologySlide24
CONCLUSION
Confirm malignancy in ≥90% by triple assessment
Open biopsy if not possible
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