Malignant Breast cancer Surgery

distoriting the breast

inverted breast

edema peau d orange

breast workup?

H&P–Diagnostic imaging–Tissue acquisition

How to work up a patient with breast complaint

History and physical examination are very very important!!

History breast cancer?

3 important aspects:

–Local symptoms

–Systemic symptoms

–Personal risk factor

–Local symptoms

–Lump

–Pain

–Nipple discharge?
–Color

–Unilateral vs bilateral

–Spontaneous vs induced

–Skin or nipple areola changes

correct

–Local symptoms

–Local symptoms

–Lump

–Pain

–Nipple discharge?
–Color

–Unilateral vs bilateral

–Spontaneous vs induced

–Skin or nipple areola changes

Systematic symptoms:

–Weight loss

–Loss of appetite

–Bony pain

–Neurological symptoms (headache or visual changes

correct

Systematic symptoms:

Systematic symptoms:

–Weight loss

–Loss of appetite

–Bony pain

–Neurological symptoms (headache or visual changes

Paget disseae

skin tethering

mass

erythema inflammatory (breast cancer)

cancer metastasis
paget disease

fangating breast cancer

3 imaging for the breast?
US
MRI
mammogram

correct

3 imaging for the breast?

3 imaging for the breast?
US
MRI
mammogram

breast cancer mammogram is in which plane?
1- medial lateral oblique MLO ( pectoralis muscle and axillary vessels)
2- cranio-caudal

correct

breast cancer mammogram is in which plane?

breast cancer mammogram is in which plane?
1- medial lateral oblique MLO ( pectoralis muscle and axillary vessels)
2- cranio-caudal

medial lateral oblique MLO

CC
craniocaudal

round well defeined

irrigular shape mass

speculated margin

–  3% of pts have synchronous bilateral breast ca; ≥ 50% of them are non-palpable lesions.

correct

–MICROCALCIFICATION

DCIS

The typical high-risk finding will be a speculated mass with abnormal architecture & asymmetry, with clustered micro- calcification

correct

The typical high-risk finding will be a ___________ mass with _________ architecture & _________ , with clustered micro- calcification

The typical high-risk finding will be a speculated mass with abnormal architecture & asymmetry, with clustered micro- calcification

breast cancer means:

irregular margin
speculated mass

ultrasound in the breast used for whaT?

used to assess the vessels of the breasts
- deifferentiate between solid and cyst

ultrasound in the breast used for whaT?

used to assess the vessels of the breasts
- deifferentiate between solid and cyst

what is used for used to assess the vessels of the breasts
- deifferentiate between solid and cyst?

US

US

BIRADS →

0: Incomplete/Unable to evaluate· (US/MRI)

I: Negative·

II: Benign findings· → ROUTINE FOLLOW UP

III: Findings likely benign (~2% chance of ca; Repeat mammo in 6m+/- other radx investigation vs Bx)·

IV: Findings suspicious for malignancy (needs confirmatory tests & bx) TAKE BIOPSY

IV-A: mildly suspicious

IV-B: moderately suspicious

IV-C: highly suspicious

V: Highly suggestive of ca (>90% chance of ca)·

VI: known bx results of ca

CORRECT

BI-RADS stands for Breast Imaging Reporting and Data System, a classification system created by the American College of Radiology. It's designed to standardize mammogram reports and make it easier for nonradiologists to understand the findings.

COORECT

BI-RADS stands for Breast Imaging Reporting and Data System,

BI-RADS stands for Breast Imaging Reporting and Data System, a classification system created by the American College of Radiology. It's designed to standardize mammogram reports and make it easier for nonradiologists to understand the findings.

BIRADS →

0?

BIRADS →

0: Incomplete/Unable to evaluate· (US/MRI)

BIRADS →

I: ?

I: Negative·

BIRADS →

2

II: Benign findings· → ROUTINE FOLLOW UP

BIRADS →

3

BIRADS →

0: Incomplete/Unable to evaluate· (US/MRI)

I: Negative·

II: Benign findings· → ROUTINE FOLLOW UP

III: Findings likely benign (~2% chance of ca; Repeat mammo in 6m+/- other radx investigation vs Bx)·

IV: Findings suspicious for malignancy (needs confirmatory tests & bx) TAKE BIOPSY

IV-A: mildly suspicious

IV-B: moderately suspicious

IV-C: highly suspicious

V: Highly suggestive of ca (>90% chance of ca)·

VI: known bx results of ca

BIRADS →

4

BIRADS →

·

IV: Findings suspicious for malignancy (needs confirmatory tests & bx) TAKE BIOPSY

IV-A: mildly suspicious

IV-B: moderately suspicious

IV-C: highly suspicious

V: Highly suggestive of ca (>90% chance of ca)·

VI: known bx results of ca

BIRADS 4A

IV-A: mildly suspicious

BIRADS →

IV-B:

BIRADS →

IV-B: moderately suspicious

BIRADS →

IV-C:

BIRADS →

0: Incomplete/Unable to evaluate· (US/MRI)

I: Negative·

II: Benign findings· → ROUTINE FOLLOW UP

III: Findings likely benign (~2% chance of ca; Repeat mammo in 6m+/- other radx investigation vs Bx)·

IV: Findings suspicious for malignancy (needs confirmatory tests & bx) TAKE BIOPSY

IV-A: mildly suspicious

IV-B: moderately suspicious

IV-C: highly suspicious

V: Highly suggestive of ca (>90% chance of ca)·

VI: known bx results of ca

BIIRADS 5

BIRADS →

V: Highly suggestive of ca (>90% chance of ca)·

BIRADS 6?

VI: known bx results of ca

MOST COMMON TYPE OF BIOPSY IN breasts?

Core Biopsy

FNA fine needle aspiration:
- False negative rate of around 10%

–NEVER use it to diagnose BC

–Only for LN

correct

FNA fine needle aspiration:

FNA fine needle aspiration:
- False negative rate of around 10%

–NEVER use it to diagnose BC

–Only for LN

FNA can we use it to diagnose breast cancer?

FNA fine needle aspiration:
- False negative rate of around 10%

–NEVER use it to diagnose BC

–Only for LN

FNA used for?

LN

Core (Tru-Cut) Biopsy

rake real part of tumor

Core (Tru-Cut) Biopsy

most common mammary carcinoma?

invasive ductal

staging breast cancer by?

TNM

T1 < 20
T2 > 2 20 to 50
T3 > 50

T4a = attach to chest wall or breast skin

T4b = inflammatory BC

correct

T1 <
T2 >
T3 >

T4a =

T4b =

T1 < 20
T2 > 2 20 to 50
T3 > 50

T4a = attach to chest wall or breast skin

T4b = inflammatory BC

T4a =

T4a = attach to chest wall or breast skin

T4b =

T4b = inflammatory BC

N1 → Movable ipsilateral axillary
N2 → clinically fixed or matted or in clinically

detected ipsilateral internal mammary nodes

in the w/o axillary lymph node
N3 → Infraclavicular

Ipsilateral internal + Axillary

Supraclavicular lymph node

N1

Movable ipsilateral axillary

N1 →

N1 → Movable ipsilateral axillary
N2 → clinically fixed or matted or in clinically

detected ipsilateral internal mammary nodes

in the w/o axillary lymph node
N3 → Infraclavicular

Ipsilateral internal + Axillary

Supraclavicular lymph node

N2 →

N1 → Movable ipsilateral axillary
N2 → clinically fixed or matted or in clinically

detected ipsilateral internal mammary nodes

in the w/o axillary lymph node
N3 → Infraclavicular

Ipsilateral internal + Axillary

Supraclavicular lymph node

N3 →

N1 → Movable ipsilateral axillary
N2 → clinically fixed or matted or in clinically

detected ipsilateral internal mammary nodes

in the w/o axillary lymph node
N3 → Infraclavicular

Ipsilateral internal + Axillary

Supraclavicular lymph node

BREAST CANCER METASTASSI?

Lliver
Lungs
Bone
Bbrain

Tissue acquisistion: FNA
- False negative rate of around 10%

– NEVER use it to diagnose BC

corect

Tissue acquisistion: FNA

Tissue acquisistion: FNA
- False negative rate of around 10%

– NEVER use it to diagnose BC

BIRADIS score?

6

0 →Incomplete assessment-need additional

imaging evaluation or prior mammograms for

comparison

1→Negative-nothing to comment on; usually

recommend annual screening

2→ Benign finding -- usually recommend annual

corect

0 BIRADS?

0 →Incomplete assessment-need additional

imaging evaluation or prior mammograms for

comparison

1 BIRADS?

1→Negative-nothing to comment on; usually

recommend annual screening

2 BRAIDS?

2→ Benign finding -- usually recommend annual

BENIGN BRES?

2→ Benign finding -- usually recommend annual

Negative-nothing to comment on; usually

recommend annual screening

1

Prohably benign finding (<2% malignant)

initial short-interval follow-up suggested

flloow up in 6 months

3

BIRADS 3?

Prohably benign finding (<2% malignant)

initial short-interval follow-up suggested

flloow up in 6 months

Suspicious abnormality (2%-95% malignant)-

biopsy should be considered

4 BIRADS

4 BIRADS?

Suspicious abnormality (2%-95% malignant)-

biopsy should be considered

Highly suggestive of malignancy (>95%

malignant)-appropriate action should be taken

Known biopsy-proven malignancy

5

5

Highly suggestive of malignancy (>95%

malignant)-appropriate action should be taken

Known biopsy-proven malignancy

6

Known biopsy-proven malignancy

RIGHT

6

6

Known biopsy-proven malignancy

Core (Tru-Cut) Biopsy

solid tumorr

Axillary LN Dissectio

I Lateral to pectoralis minor

– II Behind

– III Medial

The younger female females have more lobules , ducts and less fatty tissue[that’s why it’s not recommended for young females to do mammogram]

correct

The younger female females have more lobules , ducts and less fatty tissue[that’s why it’s not recommended for young females to do mammogram]

The younger female females have more lobules , ducts and less fatty tissue[that’s why it’s not recommended for young females to do mammogram]

The younger female females have more lobules , ducts and less fatty tissue[that’s why it’s not recommended for young females to do mammogram]
we use ultrasound

corect

)In older females have more adipose tissues mammogram

correct

Fibro cystic changes:
- It's not a disease so never do surgery or give medications
- Patient complain of:pain+lumpy breast+menstrual change

In Ex:no palpable mass تحسي فيه كلاكيع بس, tenderness
- In Hx:

The pain is presented bilateral but usually

one more than the other,

In Ex : General Lumpiness but not well defined

masses
-

orrct

Fibro cystic changes:
- It's not a disease so never do surgery or give medications

right

Fibro cystic changes:

Fibro cystic changes:
- It's not a disease so never do surgery or give medications

Patient complain of:pain+lumpy breast+menstrual change

In Ex:no palpable mass تحسي فيه كلاكيع بس, tenderness
- In Hx:

The pain is presented bilateral but usually

one more than the other,

In Ex : General Lumpiness but not well defined

masses
-

fibrocystic changes

fibrocystic changeS:

The condition previously referred to as fibrocystic disease represents a

spectrum of clinical, mammographic, and histologic findings and is

common during the fourth and fifth decades of life.

An exaggerated response of breast stroma and epithelium to a variety of circulating and locally produced hormones and growth factors is frequently characterized by the constellation of breast pain, tenderness, and

nodularity.

Management: conservative

fibrocystic changes:
Osmosis: Key words in cases:

· Premenopausal women (20-50)

· Premenstrual breast pain (Hallmark)

· Multiple lumps in upper lateral quadrant

· Association with menstrual cycle.

· Not high risk with cancer.

correct

pain of the breast in what in fibrocytic changes? hallmark?

· Premenstrual breast pain (Hallmark)

fibrocytic changes:

in what place lumps?
risk cancer?
menstural cycle?

→ · Multiple lumps in upper lateral quadrant

· Association with menstrual cycle.

· Not high risk with cancer.
→ · Multiple lumps in upper lateral quadrant

· Association with menstrual cycle.

· Not high risk with cancer.

hallmark of fibrocystic chages?

Premenstrual breast pain (Hallmark)

Mammogram and US will show radiological features of

fibrocystic changes

And biopsy to confirm pathologically > Microscopic distribution

and it's the Gold standard in diagnosis fibrocystic changes

correct

what is gold standard of the fibrocystic changes to be confirmed?

Mammogram and US will show radiological features of

fibrocystic changes

And biopsy to confirm pathologically > Microscopic distribution

and it's the Gold standard in diagnosis fibrocystic changes

2

Sclerosing Adenosis

microcalcifications

No palpable mass only detected while screening

No surgery just follow up

Sclerosing adenosis is the most common pathologic diagnosis in patients

undergoing needle-directed biopsy of microcalcifications.

- Sclerosing adenosis is frequently listed as one of the component lesions of fibrocystic disease; it is common and has no significant malignant potential.

correct