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Breast Disorders
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96
Medical
Professional
08/25/2011

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Cards

Term
mastalgia
Definition
pain in the breast
Term
What causes peau d'orange appearance?
Definition
lymphedema
Term
BI-RADS
Definition
Breast Imaging Reporting and Data System
Term
quality assurance tool designed to standardize mammography reporting, reduce confusion in breast imaging interpretations, and facilitate outcome monitoring
Definition
BI-RADS
Term
The younger the patient, the more ________ her breast tissue.
Definition
dense
Term
mammographic breast composition if the breast is almost entirely fat
Definition
<25% glandular
Term
mammographic breast composition if scattered fibroglandular densities
Definition
25-50% glandular
Term
mammographic breast composition if heterogeneously dense breast tissue
Definition
51-75% glandular
Term
mammographic breast composition if extremely dense
Definition
>75% glanular
Term
What is the difference between a mass and a density?
Definition
mass is a space occupying lesion seen in two different projections

density is a potential mass seen in only a single projection
Term
circumscribed margins
Definition
margins are sharply demarcated with an abrupt transition between the lesion and the surrounding tissue

without additional modifiers, there is nothing to suggest infiltration
Term
indistinct margins
Definition
poor definition of the margins raises concern that there may be infiltration by the lesion

not likely due to superimposed normal breast tissue
Term
spiculated margins
Definition
lesions in characterized by lines radiating from the margins of a mass

NEVER normal!
Term
architectural distortion
Definition
normal architecture is distorted with no definite mass visible

includes spiculations, focal retraction, or distortion of the edge of the parenchyma
Term
focal asymmetry
Definition
density that cannot be accurately described using the other shapes

visible as asymmetry of tissue density with similar shape on two views, but completely lacks borders and the conspicuity of a true mass
Term
What is the ideal BI-RADS classification?
Definition
1
Term
What BI-RADS classification means additional imaging is needed because something is unclear?
Definition
Term
BI-RADS classification for benign finding
Definition
2
Term
BI-RADS classification for probably benign finding (initial short-interval follow up suggested)
Definition
3
Term
BI-RADS classification for suspicious abnormality (biopsy should be considered)
Definition
4
Term
BI-RADS classification for highly suggestive of malignancy (appropriate action should be taken)
Definition
5
Term
BI-RADS classification for known biopsy-proven malignancy
Definition
6
Term
What action should be taken in a pt. with a BI-RADS of 0?
Definition
more imaging or prior mammograms for comparison
Term
What action should be taken for a pt. with a BI-RADS of 1?
Definition
nothing
Term
What action should be taken in a pt. with a BI-RADS of 2?
Definition
nothing
Term
What action should be taken in a pt. with a BI-RADS of 3?
Definition
initial short interval follow up
Term
What action should be taken in a pt. with a BI-RADS of 4?
Definition
biopsy
Term
What action should be taken in a pt. with a BI-RADS of 5?
Definition
appropriate action for possible malignancy
Term
What percent of masses are malignant in a BI-RADS 3 report?
Definition
<2%
Term
What percent of masses are malignant in a BI-RADS 4 report?
Definition
2-95%
Term
What percent of masses are malignant in a BI-RADS 5 report?
Definition
>95%
Term
What causes the calcifications seen in breast lesions?
Definition
calcium from milk production
Term
How many microcalcifications signify cancer?
Definition
7 or more
Term
What source of trauma is common in the breasts?
Definition
seat belt trauma
Term
What conditions cause bilateral breast pain?
Definition
cyclical mastalgia
fibrocystic breast changes
pregnancy
post-partum engorgement
Term
What conditions cause unilateral breast pain?
Definition
non-cyclical mastodynia
mastitis/abscess
trauma
inflammatory breast CA
Term
What symptoms are associated with cyclical mastalgia?
Definition
bilateral soreness/heaviness
may radiate to axilla and arms
poorly localized (diffuse)
Term
When is the incidence of fibrocystic breast disease highest?
Definition
30-50 years old
rare in postmenopausal women
Term
What are common components of the history in a pt. with fibrocystic breast disease?
Definition
-if tender, same as cyclical, plus may report multiple breast "lumps"
-rapid fluctuation in size of masses common
-premenstrual increase in discomfort and size of masses
Term
What physical exam findings are consistent with fibrocystic breast disease?
Definition
-single or multiple, non-discrete breast masses
-may or may not be tender
-be alert for discrete masses "masked" by FBD
Term
When in doubt about whether or not a palpated mass is due to fibrocystic breast disease or not, what should you do?
Definition
send for diagnostic mammogram
Term
What is the prognosis for fibrocystic breast disease?
Definition
benign, chronic, recurring, intermittent
Term
What is the treatment for fibrocystic breast disease?
Definition
-NSAIDs
-re-evaluate at different time of cycle (soon after menses)
-caffeine avoidance
-vitamin E 400-800 IU daily
Term
Why should a pt. with fibrocystic breast disease avoid caffeine?
Definition
increases the cystic component of fibrocystic breast changes
Term
When should a pt. with fibrocystic breast changes with lumps get a mammogram?
Definition
35 years old
Term
What test is helpful in differentiating solid from cystic masses in a pt. with lumps due to fibrocystic breast disease?
Definition
breast ultrasound
Term
What age group has the highest incidence of non-cyclical mastodynia?
Definition
40-50 year olds
Term
What components of the history are common in women with non-cyclical mastodynia?
Definition
no particular pattern of pain
unilateral
localized
sharp/burning pain
Term
What diagnostic tool should be used for postmenopausal women if non-cyclical mastodynia is suspected?
Definition
bilateral mammograms
Term
What diagnostic tool should be used in young women if non-cyclical mastodynia is suspected and their symptoms persist?
Definition
ultrasonography
Term
What is the prognosis for non-cyclical mastodynia?
Definition
resolves spontaneously
Term
What is the treatment for non-cyclical mastodynia?
Definition
same as cyclical mastodynia

NSAIDs
caffeine avoidance
vitamin E 400-800 IU daily
Term
What are the risk factors associated with breast abscesses?
Definition
puerperal mastitis
diabetes
rheumatoid arthritis
steroids
silicone/paraffin implants
lumpectomy with radiation
heavy cigarette smoking
nipple retraction
Term
What causes a puerperal abscess?
Definition
blocked lactiferous duct
Term
What causes a subareolar abscess?
Definition
squamous epithelial neoplasm with keratin plugs or ductal extension with associated inflammation
Term
What causes a peripheral abscess?
Definition
stasis of the duct
Term
What signs and symptoms are associated with a breast abscess?
Definition
tender breast lump, fluctuant, usually unilateral

erythema
draining pus
local edema
systemic malaise
fever
nipple and skin retraction
proximal LAD
Term
What diagnostic tool can you use for a breast abscess?
Definition
ultrasound
Term
What is the treatment for a breast abscess?
Definition
I&D
packed open with iodoform or plain gauze
C&S
antibiotics
Term
What antibiotic options do you have for a breast abscess?
Definition
erythromycin 250-500 mg qid

cephalexin 500 mg qid

cefaclor 250 mg tid

amoxicillin-clavulanate (augmentin) 250 mg tid
Term
What antibiotic should you give if an anaerobic infection is suspected in a breast abscess?
Definition
clindamycin 300 mg tid
Term
What type of wound commonly produces anaerobic infections?
Definition
puncture wound
Term
What is mastitis predominantly associated with?
Definition
lactation
Term
What demographic is mastitis more common in?
Definition
primagravidas (due to lack of experience)
Term
What is the most common organism that causes mastitis?
Definition
Staph aureus
Term
When does mastitis typically occur?
Definition
usually 2-4 weeks post-partum
Term
What are associated manifestations of mastitis?
Definition
engorgement
erythema
fever/chills
anorexia
headache
malaise
Term
What physical exam findings are consistent with mastitis?
Definition
-erythema usually confined to area of single breast lobule
-breast engorgement with edema, calor, tenderness, tenseness
-may or may not have fever
-axillary nodes may be enlarged or tender
Term
When should a mammogram be done in a pt. suspected to have mastitis?
Definition
only in lactating women who fial to respond to appropriate antibiotic treatment within 7-10 days
Term
What antibiotic options do you have for mastitis?
Definition
dicloxacillin 500 mg qid x 7-10 days

clindamycin 300 mg qid x 7-10 days

cephalosporins
Term
What is the treatment for infectious mastitis?
Definition
-anti-staphylococcal antibiotics
-pump and dump on infected side
-may continue nursing on unaffected side
-re-evaluate in 3 days after initiation of antibiotic therapy
Term
What patients is non-lactational mastitis usually seen in?
Definition
immunocompromised women
autoimmune disorders
history of radiation therapy
Term
What is the treatment for non-lactational mastitis?
Definition
clindamycin 300 mg qid
augmentin 500 mg bid
cephalexin 500 mg bid
Term
What should you suspect in older non-lactating women with mastitis?
Definition
inflammatory carcinoma
Term
What should you do if an older non-lactating woman with mastitis is non-responsive to antibiotic treatment?
Definition
immediate referral
Term
What signs and symptoms are associated with inflammatory breast cancer?
Definition
pain and erythema of entire breast
increased size and firmness of breast
peau d'orange skin changes
Term
How do you diagnose inflammatory breast cancer?
Definition
skin biopsy
Term
diffuse, brawny edema of the skin of the breast with an erysipeloid border, usually without an underlying palpable mass
Definition
inflammatory breast cancer
Term
What is the most aggressive form of breast cancer?
Definition
inflammatory breast cancer
Term
At presentation, nearly ___% of patients with inflammatory breast cancer have evidence of metastases.
Definition
35%
Term
Inflammatory breast cancer is generally a clinical diagnosis with pathologic confirmation of ______ ___________ in the dermal ________ by biopsy of the overlying skin.
Definition
tumor embolization; lymphatics
Term
What causes the inflammatory process associated with inflammatory breast cancer?
Definition
blockage of dermal lymphatics by tumor emboli, which results in edema and hyperemia
Term
What is the treatment for inflammatory breast cancer?
Definition
several cycles of neoadjuvant polychemotherapy followed by surgery or radiation depending on tumor response
Term
What percentage of nipple discharge is due to benign breast disease?
Definition
10-15%
Term
What percentage of nipple discharge is due to cancer?
Definition
2.5-3%
Term
What is the most common cause of galactorrhea?
Definition
increased prolactin
Term
What physiologic processes can cause nipple discharge?
Definition
pregnancy
post-lactational
cyclical hormone variations
nipple stimulation
stress
Term
What are the possible pathologic causes of nipple discharge?
Definition
duct ectasia
non-puerperal mastitis
intraductal papilloma
endocrine disorders
breast cancer
Term
What characteristics are common with physiologic nipple discharge?
Definition
usually bilateral
need compression
multiple ducts
Term
What characteristics are common with pathologic nipple discharge?
Definition
spontaneous
bloody
associated mass
usually unilateral
usually single duct
Term
What is a benign neoplastic growth within a major duct that causes nipple discharge?
Definition
intraductal papilloma
Term
What features are characteristic of nipple discharge associated with an intraductal papilloma?
Definition
single duct involvement
unilateral
spontaneous
secretions are serous or bloody
Term
What is the treatment for intraductal papillomas?
Definition
excision to exclude carcinoma
Term
What endocrine conditions can cause galactorrhea?
Definition
pituitary lesions
CNS lesions
primary hypothyroidism

any conditions that cause increased prolactin
Term
What medications can cause galactorrhea?
Definition
OCPs
Term
What is surgical referral indicated?
Definition
-persistent symptoms of mastitis, despite antibiotic therapy (no improvement in 7 days)
-unilateral, spontaneous nipple discharge
-dominant palpable mass
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