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Pimp Session: Breast By James Lee, MD
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What muscle does the lateral thoracic artery supply?
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What muscle does the lateral thoracic artery supply?
Serratus anterior
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What muscle does the thoracodorsal artery supply?
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What muscle does the thoracodorsal artery supply?
Latissimus dorsi
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What percentage of lymphatic drainage of the breast is to the axillary nodes?
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What percentage of lymphatic drainage of the breast is to the axillary nodes?
97%
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What percentage of lymphatic drainage of the breast is to the internal mammary nodes?
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What percentage of lymphatic drainage of the breast is to the internal mammary nodes?
1-2%
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Describe what levels I, II and III nodes are in the breast?
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Describe what levels I, II and III nodes are in the breast?
Level I: Lateral to the pectoralis minor muscle Level II: Beneath the pectoralis minor muscle Level III: Medial to the pectoralis minor muscle
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What are the boundaries of an axillary lymph node dissection?
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What are the boundaries of an axillary lymph node dissection (ALND)?
Superior - axillary vein Posterior - long thoracic nerve Lateral - latissimus dorsi muscle Medial - pectoralis minor
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What nerves do you have to be aware of in an ALND?
.
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What nerves do you have to be aware of in an ALND?
Long thoracic nerve Thoracodorsal nerve Medial pectoral nerve Lateral pectoral nerve
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What is the most likely cause of sudden, painful, early postop swelling of the ipsilateral arm after an axillary dissection?
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What is the most likely cause of sudden, painful, early postop swelling of the ipsilateral arm after an axillary dissection? Axillary vein thrombosis
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What is the most likely cause of slow, painless, progressive swelling of the ipsilateral arm after an axillary dissection?
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What is the most likely cause of slow, painless, progressive swelling of the ipsilateral arm after an axillary dissection? Lymphatic fibrosis
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What is the most likely cause of hyperesthesia of the inner upper aspect of the ipsilateral arm after an axillary dissection?
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What is the most likely cause of hyperesthesia of the inner upper aspect of the ipsilateral arm after an axillary dissection? Injury to the second intercostobrachiocutaneous nerve
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What is the incidence of lymphedema after axillary node dissection?
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What is the incidence of lymphedema after axillary node dissection?
15-30%
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What is the indicence of lymphedema after sentinel node biopsy?
2-4%
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What is the most common breast abnormality?
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What is the most common breast abnormality?
Accessory nipple
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What is the most common cause of bloody nipple discharge?
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What is the most common cause of bloody nipple discharge?
Intraductal papilloma
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What is the dose of evening primrose oil to treat mastodynia?
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What is the dose of evening primrose oil to treat mastodynia?
3-4 grams daily
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What is the most aggressive subtype of ductal carcinoma in situ?
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What is the most aggressive subtype of ductal carcinoma in situ?
Comedo pattern
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What is the Risk of lymph node metastasis with DCIS?
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What is the Risk of lymph node metastasis with DCIS?
< 2%
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What is the surgical treatment for a < 1 cm low grade DCIS?
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What is the surgical treatment for a < 1 cm low grade DCIS?
Excision with 1 cm margins +/- radiation
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What is the surgical treatment for a > 1 cm DCIS?
Lumpectomy and radiation with 1 cm margins or total mastectomy without axillary dissection
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What are the indications to perform a simple mastectomy for DCIS?
Contraindications to radiation, DCIS > 1cm, and diffuse breast involvement
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Which breast does invasive cancer arise in the setting of DCIS?
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Which breast does invasive cancer arise in the setting of DCIS?
Usually the ipsilateral breast
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Which breast does invasive cancer arise in the setting of LCIS?
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Which breast does invasive cancer arise in the setting of LCIS?
Carcinoma can arise in either breast
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What is the assessment and recommendation for each BI-RADS category?
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What is the assessment and recommendation for each BI-RADS category?
BI-RADS 0: Incomplete; follow-up imaging necessary BI-RADS 1: Negative; routine screening BI-RADS 2: Definite benign finding; routine screening BI-RADS 3: Probably benign; 6 month short interval follow-up BI-RADS 4: Suspicious abnormality; biopsy should be considered BI-RADS 5: Highly suspicious of malignancy; appropriate action should be taken BI-RADS 6: Known biopsy proven malignancy; assure that treatment is completed
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How large must a mass be to be detected on mammography?
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How large must a mass be to be detected on mammography?
5 mm or greater
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What are the general population screening recommendations for breast cancer?
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What are the general population screening recommendations for breast cancer?
Initial screening mammogram at age 40 and annual mammograms after age 40
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What are the screening recommendations for a patient at high risk for breast cancer?
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What are the screening recommendations for a patient at high risk for breast cancer?
Mammogram 10 years before the youngest age of diagnosis of breast cancer in a first-degree relative
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What percentage of breast cancers have a negative mammogram and ultrasound?
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What percentage of breast cancers have a negative mammogram and ultrasound?
10%
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Which subtype of ductal carcinoma with the worse prognosis?
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Which subtype of ductal carcinoma with the worse prognosis?
Scirrhotic carcinoma
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How long does it take for a single malignant cell to become a 1-cm tumor?
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How long does it take for a single malignant cell to become a 1-cm tumor?
5-7 years
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What are indications for radiation after mastectomy?
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What are indications for radiation after mastectomy?
4 nodes, extracapsular nodal invasion, fixed axillary nodes (N2) or internal mammary nodes (N3), inflammatory cancer, positive margins, skin/chest wall involvement, tumor > 5 cm
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What is the treatment for male breast cancer?
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What is the treatment for male breast cancer?
Modified radical mastectomy
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What is removed with a modified radical mastectomy?
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What is removed with a modified radical mastectomy?
Breast, nipple-areolar complex, and axillary nodes (level I, II)
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What is the chance of local recurrence after mastectomy?
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What is the chance of local recurrence after mastectomy?
5% (4-8%)
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What is the standard dosage of Tamoxifen in regards to adjuvant treatment for breast cancer?
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What is the standard dosage of Tamoxifen in regards to adjuvant treatment for breast cancer?
20 mg daily for 5 years
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What percentage of cystosarcoma phyllodes are malignant based on > 5-10 mitoses/HPF?
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What percentage of cystosarcoma phyllodes are malignant based on > 5-10 mitoses/HPF?
10%
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What is the most common bacteria to cause mastitis?
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What is the most common bacteria to cause mastitis?
Staphylococcus aureus
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What are indications for neoadjuvant therapy in breast cancer?
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What are indications for neoadjuvant therapy in breast cancer?
Primary tumors >5 cm, fixed or matted axillary nodes, and inflammatory breast carcinoma.
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What are contraindications to radiation therapy?
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What are contraindications to radiation therapy?
Previous radiation therapy to breast, severe collagen vascular disease, pregnancy
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