Transcript How will you approach the 35 year old, with a 2 x 2 x 2cm, firm

How will you approach the 35 year
old, with a 2 x 2 x 2cm, firm, mobile,
well circumscribed non tender mass
on the right breast?
Role of imaging modality
• Mammography
– plays a central part in early detection of breast cancers
because it can show changes in the breast up to two years
before a patient or physician can feel them.
– Research has shown that annual mammograms lead to
early detection of breast cancers, when they are most
curable and breast-conservation therapies are available.
• Digital and conventional mammography
– both use x-rays to produce an image of the breast
• Conventional mammography: image is stored directly on film
• Digital mammography: images stored as a computer file
• full-field digital mammography (FFDM); mammography system in
which the x-ray film is replaced by solid-state detectors that
convert x-rays into electrical signals used to produce images
• can be enhanced, magnified, or manipulated for further evaluation
more easily
• Digital mammography advantages over conventional mammography:
– Health care providers can share image files electronically, making longdistance consultations between radiologists and breast surgeons
easier.
– Subtle differences between normal and abnormal tissues may be more
easily noted.
– Fewer follow-up procedures may be needed.
– Fewer repeat images may be needed, reducing the exposure to
radiation.
http://www.radiologyinfo.org/en/info.cfm?pg=mammo
• Ultrasound
– to differentiate solid from cystic masses; looks for shape and
texture
– to provide guidance for interventional breast procedures such as
cyst aspiration or core biopsy
– useful when a palpable mass is partially or poorly seen on a
mammogram, especially in young women
– When added to mammography= improved breast cancer
detection in high-risk women (Journal of the American Medical Association, 2008)
A mammogram was taken as seen in the
picture. Is this benign or malignant?
Dx:
BENIGN
CYST
Differentiate radiologically a benign
lesion from a malignant one.
BENIGN
MALIGNANT
Smooth contour
Grow significantly
Well-circumscribed
Stellate or star-bust shaped that extends in
all directions
Encapsulated
Calcifications
With “halo sign”
Will not change much in shape or size
Difference in ultrasound findings.
BENIGN
MALIGNANT
intense uniform hyperechogenicity
Irregular/spiculated borders (“Silhouette sign”)
ellipsoid or wider-than-tall (parallel) orientation taller-than-wide orientation
along with a thin, echogenic capsule
2 or 3 gentle lobulations and a thin, echogenic
capsule
angular margins
marked hypoechogenicity
posterior acoustic shadowing
punctuate calcifications
duct extension
branch pattern
microlobulation.
Should the patient have a mother who is a
breast cancer survivor, how would
that information change your
management?
Breast Cancer Screening Tests
• Mammogram
– is the best tool available for early breast cancer detection
– can often identify cancer before symptoms appear and can
reveal calcium deposits in the breast, which may be an
early sign of cancer
– HIGH RISK: annual mammogram beginning at an
age that is 5 to 10 years younger than the
youngest member of the family with breast cancer
Breast Cancer Screening Tests
• Clinical breast exam
– thorough physical examination of the breasts done by
a physician or nurse practitioner
– HIGH RISK: recommended every 6 to 12 months
• Self breast exam
– identify breast abnormalities and should be
performed monthly, about one week after the end of
your period
• Breast MRI
– For extremely dense breast tissue that make
mammograms difficult to interpret
Self breast Exam
National Cancer Institute