Breast Disorders and Breast Cancer Review

Comprehensive practice flashcards covering breast anatomy, diagnostic pathways (Triple Assessment, BIRADS), malignancy staging (TNM, IHC), surgical management (BCS, MRM), and benign vs. malignant conditions.

What are the three components of the Triple Assessment for breast diagnostics?

1. Clinical (History + clinical examination), 2. Imaging (Radiological Ix: USG or Mammogram), 3. Pathology (Histopathological Ix: Core biopsy).

According to the evaluation pathway for a palpable breast mass, what is the preferred initial imaging for patients aged $< 30$ years?

USG (Ultrasonography).

What anatomical structure is involved in the clinical sign of skin dimpling in breast cancer?

Ligaments of Cooper.

What is the clinical significance of Peau d'orange (PDO) in breast cancer?

It indicates involvement of the subdermal lymphatics ($T4b$ disease).

In the BIRADS scoring system, what does a score of $3$ signify and what is the recommended management?

Inference: Probably benign; Management: Follow up after $6$ months.

What does a BIRADS score of $4c$ indicate regarding the risk of malignancy?

High suspicion ($50 - 95\%$ risk).

According to ASBRS guidelines, what is the screening recommendation for a patient with a known $BRCA$ mutation?

Annual mammography from $25$ years of age.

What are the two standard views used in mammography?

Craniocaudal and medio-lateral oblique (MLO).

Which breast imaging modality is most sensitive for Ductal Carcinoma In Situ (DCIS)?

MRI (Magnetic Resonance Imaging).

What is the characteristic USG finding for an extracapsular breast implant rupture?

Snowstorm appearance.

Why is FNAC generally not preferred for the diagnostic evaluation of an primary breast mass lesion?

It destroys tissue architecture, cannot differentiate between in-situ and invasive cancers, and has a risk of false negatives.

What is the most common type of breast cancer and its most common location?

Type: Invasive ductal carcinoma (m/c); Location: Upper outer quadrant.

Which genetic mutation is most commonly associated with male breast cancer?

$BRCA2$ ($Chr 13q$).

In IHC, how is the HER2 neu result of $2+$ (Equivocal) further investigated?

Fluorescence In Situ Hybridization (FISH).

Which molecular subtype of breast cancer is seen in young patients and has the best response to chemotherapy but the worst prognosis?

Basal-like (TNBC - Triple Negative Breast Cancer).

In TNM staging, how is the $T2$ stage characterized?

Tumor size is $> 2\,cm$ but $\le 5\,cm$.

What is the most common site for distant metastasis in breast cancer and why?

Bones (specifically Lumbar vertebrae) due to Batson's plexus.

What is a mandatory follow-up treatment after Breast Conservative Surgery (BCS)?

Radiotherapy (to reduce local recurrence rate).

Which specific modified radical mastectomy (MRM) technique involves removing the pectoralis minor?

Patey (Scanlon & Patey).

What are the boundaries defined by the pectoralis minor for Level $1, 2, \text{ and } 3$ axillary lymph nodes?

Level 1: Lateral to lateral border; Level 2: Behind; Level 3: Medial to medial border.

What is the most common complication following a modified radical mastectomy (MRM)?

Seroma (Fluid accumulation).

Injury to which nerve causes 'winging of scapula' during breast surgery?

Long thoracic nerve (Nerve of Bell).

What is Stewart-Treves syndrome?

Angiosarcoma arising in the setting of long-standing ($7-8$ years) lymphedema, presenting as reddish or bluish nodules.

What is the most common complication of the blue dye technique used in Sentinel Lymph Node Biopsy (SLNB)?

Skin tattooing.

When is the drug Tamoxifen indicated, and what is its most common side effect?

Indicated for $ER(+)$ breast cancer (premenopausal); most common side effect is hot flashes.

What is the clinical definition of locally advanced breast cancer (LABC)?

Any $T3, T4$, or any $N2, N3$ with $M0$.

How is Lobular carcinoma In-situ (LCIS) currently characterized pathologically?

It is no longer considered an in-situ cancer but a benign disease with a risk of future malignancy (often bilateral and multicentric).

What is the 'breast mouse' and what is its characteristic mammographical finding?

Fibroadenoma; it shows popcorn calcification.

What is the characteristic presentation and management for Phyllodes Tumour?

Presentation: Rapidly enlarging breast lump with dilated veins over the chest wall; Management: Wide local excision (Lumpectomy) or simple mastectomy if malignant/recurrent.

What is the most common pathological cause of nipple discharge and how is it managed?

Duct ectasia (multiple ducts, greenish discharge); managed with antibiotics and, if persistent, Hadfield procedure (excision of all ducts).