1. Investigations of Breast Cancer -by preetam goswami 8th semester,unit-1

2. Contents INVESTIGATIONS FOR DETECTION. INVESTIGATIONS FOR STAGING. INVESTIGATIONS FOR TREATMENT.

3. INVESTIGATIONS FOR DETECTION MODALITIES:  Mammography.  Ultrasound of Breast  MRI of Breast  FNAC (Fine Needle Aspiration Cytology)  Biopsy  Other Investigations

4. Mammography It is a non invasive procedure for detection of breast cancer by using low energy x-rays. Principle : It identifies the areas of microcalcifications and tissue densities. Procedure:Compression X-rays of superior and medial aspects. Detection:  Malignant Lesions show irregular densities and intraductal calcifications  Benign Lesions show well defined borders and peripheral calcifications. It is a part of triple assessment therapy which also includes clinical assessment and cytological diagnosis by FNAC

5. NORMAL BREAST BENIGN LESION MALIGNANT LESION

6. USG of Breasts Benign Cyst It is a Non Invasive technique that uses sonic energy in the frequency range of 1 – 10 MHz. Appearance 1. Cysts : Fluid Filled Lesions – No internal echo. 2. Benign : Solid Lesions – Smooth and Well defined border 3. Malignant : Jagged Borders. Malignant Cyst

7. MRI of Breast Contrast : Gadolinium Chelate. Dose : 0.1mmol/Kg i.v Characteristics of Tumor : o Hypervascularity o Increased Capillary Permeability. o Increased Interstitial Space Advantages : o High Sensitivity o Distinguish Scar from Recurrence o Image Breasts with Implants. o Choice of Imaging in Pregnancy o Management of Axillary Infiltration Disadvantage : Costly, Non Available, Not Sensitive to Premalignant lesions

8. FNAC Done in case of cystic lumps of breast. Criteria for malignancy 1. Blood stained aspirate. 2. Mass does not completely. disappear after aspiration. FNAC Scoring C o : No epithelial cells. C 1 : Scanty epithelial cells, Benign. C 2 : Benign Cells. C 3 : Atypical Cells. C 4 : Suspicious Cells. C 5 : Malignant Cells. BIOPSY  TYPES Frozen Section Biopsy. Corecut/Trucut Biopsy. Excision Biopsy. Edge Biopsy.  It is used for definitive diagnosis of malignancy.

9. Other Investigations Oestrogen Receptor Study Progesterone Receptor Study Ductal Lavage Tumor Markers – CA 15/3, CEA, CA 27-29 Ductography Breast Ductal Endoscopy Thermography Newer Investigation Modalities : o Stereotactic Core Biopsy using computer mammography o Vacuum Assisted Biopsy o Needle Localised Biopsy under mammographic guidence. o I 125 – Seed Localisation Biopsy

10. INVESTIGATIONS FOR STAGING MODALITIES  For Tumor Size - MRI Scan  For Nodal involvement – Lympho Scintigraphy - CT Scan  For Metastatic Involvement – Bone X-Ray - Bone Scan (PET) - Chest X-Ray - USG/CT Abdomen - X-Ray/CT Spine - Biochemical Studies :- ALP (Bone and Liver) :- GGT (Liver) :- Urinary Steroids :- Urinary Hydroxy Proline

11. Bone Scan showing metastasis due to advance Carcinoma Breast. Liver Scan showing Metastatic mass. CT Scan of Chest and Abdomen showing mediastinal and retroperitoneal lymphadenopathy

12. INVESTIGATIONS FOR TREATMENT MODALITIES Routine Blood Investigations – Complete Blood Haemogram (TC, DC, Hb%, ESR) For Anaesthesia Fitness – Chest X-Ray - ECG Sentinel Lymph Node Biopsy Lymphoscintigraphy Axillary Sampling

13. Sentinel Lymph Node Biopsy  Sentinel Node indicates first node encountered by the tumor cells and its histological status predicts the status of distant Lymph Nodes.  Merits:  It is not done in clinically palpable axillary node as there is already distortion of lymphatic flow due to tumor.  If there is no involvement of sentinel node further axillary dissection is not required.  Demerits:There is high chance of false negative results.  Contraindications – Allergy to vital blue dye or radio colloid, pregnancy, inflammatory carcinoma of breast.  Complications – Blue Tattooing of skin, Bluish green urine and stool, anaphylaxis, seroma-formation.

16. To conclude with…  Mammography is highly reliable for evaluation of breast cancer as it has a sensitivity of over 90%.  Core needle biopsy has to be done wherever the FNAC is inconclusive.  USG may not detect lesions less than 1cm size.  USG is the Investigation of choice in young women less than 30 years of age.  ER and PR status are important for treatment by hormonal therapy.  Senitnel Lymph node Biopsy has to be done all in cases of node negative patients in clinical grounds.  Most of the deaths due to breast cancer is due to distant metastasis,hence early diagnosis of metastasis has to be done whenever suspected.