Case D Karmi Margaret G. Marcial

How will you approach the 35-year old, with a 2 x 2 x 2cm, firm, mobile, well-circumscribed non-tender mass on her R breast? Salient Features: –35 y/o –mass on R breast 2x2x2cm Firm Mobile Well circumscribed non-tender Points to evaluate in breast mass –Site –Shape –Size –Borders Benign = well-defined Malignancy = ill-defined –Consistency B = rubbery, like balls of hand M = hard, like knuckles of hand –Mobility B = mobile M = fixed –Tenderness – not a sign of CA

Role of imaging modality? Choice? Imaging methods are complements to, not substitutes for a thorough Hx and PE Proven Breast imaging methods –Mammography –UTZ –Ductography Promising methods –MRI –PET

Mammography –To screen the normal surrounding breast tissue and the opposite breast for non-palpable cancers Ultrasound –to differentiate solid from cystic masses –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

A mammogram was taken as seen in the picture. Is this benign or malignant? Benign

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 Cancer Screening Tests Breast MRI –For extremely dense breast tissue that make mammograms difficult to interpret

Radiologic difference between a benign and malignant mass BENIGN –Smooth contour –Well-circumscribed –Encapsulated –With “halo sign” –Will not change much in shape or size MALIGNANT Grow significantly Stellate or star-bust shaped that extends in all directions Calcifications