1. WORK UPS

2. Ultrasound method of choice for the differentiation of cysts from solid masses and for guidance in interventional procedures. Benign: – solid lesions with smooth or lobulated margins that are sharply defined, with homogeneous hypoechoic contents and a horizontal orientation Malignant: – hypoechoic lesions with irregular and poorly defined margins the lesion is a fibroadenoma

3. CORE BIOPSY – Gold standard for diagnosing breast mass – procedure where a gauge needle ( 21 gauge) is passed through the skin to take a sample of tissue from a mass or lump. – more invasive procedure than FNAB, as it involves a local anaesthetic.

4. WORK UPS in the ward Dec’ 2010 – CORE BIOPSY RESULTS: Invasive Lobular Carcinoma Lobular neoplasia involving adenosis. Notice the black ink on perimeter of core indicating targeted calcifications. Microcalcification is present in acinus.

5. Works ups FNAB – percutaneous procedure that uses a fine gauge needle (22 or 25 gauge) and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass

6. FNAB This type of biopsy is performed for one of two reasons: - A biopsy is performed on a lump or a tissue- mass when its nature is in question. - For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies.

7. Chest X-ray to check and see whether the cancer has metastasize to the lungs During treatment for breast cancer: If a person has advanced breast cancer that has spread to the lungs, a chest x-ray is used to check on how the disease is responding to treatment. For people who develop a fever during chemotherapy, chest x-rays are used to check for the presence of pneumonia. If a person experiences new shortness of breath in the first few months after radiation therapy, with or without a cough, to see if the radiation caused any inflammation of the lungs.

8. Bone scan nuclear scanning test that identifies new areas of bone growth or breakdown It can be done to evaluate damage to the bones, find cancer that has metastasized to the bones monitor conditions that can affect the bones BONE SCAN FINDINGS Confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan

9. Work ups February 1’ 11 Chest Xray Normal results Lung fields clear February 7’11 Bone Scan No definite scintigraphic evidence of osseous metastasis

10. Mammography – process of using low-dose amplitude-X-rays to examine the human breast and is used as a diagnostic and a screening tool. – early detection of breast cancer Screening: 40y/o every 1-2years 50 y/o once a year – follow up exam of breast CA treatment – follow up exam of the contralateral breast

11. Mammography Malignant lesions tend to have irregular and (usually) spiculated margins Benign well-defined edges and a halo sign Normal Fatty breast

12. IN OUR PATIENT Assessment: Spiculated, high density mass, high suspicion of malignancy, left (s/p core biopsy – invasive lobular carcinoma) Assessment: Spiculated, high density mass, high suspicion of malignancy, left (s/p core biopsy – invasive lobular carcinoma)

13. CT scan may be used as an adjuvant for monitoring spread effective for the detection of intraductal extension of breast carcinoma and is thought to be useful in the preoperative assessment of indications of breast-conserving surgery.