Breast Lump
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Surgery Essay
Describe the procedures you would adopt to reach a diagnosis in a fifty-year-old woman who presents with a lump in her breast.
In order to reach a diagnosis regarding the breast lump, the following procedures have to be undertaken: history taking, clinical examination, imaging and fine-needle aspiration cytology and/or core biopsy. The most important pointer to the diagnosis is the age of the patient: the older the woman, the likelier it is to have a malignant condition. In the process of history taking it is important to determine the duration of the breast lump: breast cancers usually grow slowly, but cysts may appear overnight. Family history, drug history and other risk factors can be assessed during the history taking. For the clinical examination the patient must undress till the waists and inspection should be done with the patient’s arms by her side, above her head, and then pressing on her hips. Skin dimpling is present in a high percentage of patients with breast cancer. With the patient lying down, arms under head, all breast tissue are examined, using the fingertips to detect any abnormalities. When the lump is felt, it should be assessed for texture, and outline. In order to see if the breast has a deep fixation, the patient is asked to press their hands on their hips, in this way tensing the pectoralis muscle, on which the breast lies. All palpable lesions should be measured with callipers and 1
Surgery Essay
the position (o’clock) is recorded. Next the nodal areas are palpated, in the axilla and above the clavicle for the supraclavicular nodes. Enlarged nodes are found in patients with no clinically significant breast disease, and at times people with breast cancer may have no palpable nodes. Since the patient is 50 years old, mammography is useful in this age group. This requires compression of the breast between two plates. It allows the detection of mass lesions, areas of parenchyma distortion and micro calcifications. Ultrasonography is another option, where high frequency waves are beamed to the breast and reflections are turned into pictures. It is easy to differentiate cysts and other benign lesions, which have well demarcated edges from cancers with an indistinct outline. Another option is MRI, which has a high sensitivity for breast cancer. Fine-needle aspiration cytology can be used to differentiate between solid and cystic leaisons. In core biopsy several cores are removed from a mass or an area of micro calcification by means of cutting needle technique. Palpation can be used to guide the biopsy but better to use with ultrasound. False-positive results occur with all diagnostic techniques. Image guided core biopsy is the most accurate of the various techniques used to diagnose breast masses. 19/01/09
2
Describe the procedures you would adopt to reach a diagnosis in a fifty-year-old woman who presents with a lump in her breast.
In order to reach a diagnosis regarding the breast lump, the following procedures have to be undertaken: history taking, clinical examination, imaging and fine-needle aspiration cytology and/or core biopsy. The most important pointer to the diagnosis is the age of the patient: the older the woman, the likelier it is to have a malignant condition. In the process of history taking it is important to determine the duration of the breast lump: breast cancers usually grow slowly, but cysts may appear overnight. Family history, drug history and other risk factors can be assessed during the history taking. For the clinical examination the patient must undress till the waists and inspection should be done with the patient’s arms by her side, above her head, and then pressing on her hips. Skin dimpling is present in a high percentage of patients with breast cancer. With the patient lying down, arms under head, all breast tissue are examined, using the fingertips to detect any abnormalities. When the lump is felt, it should be assessed for texture, and outline. In order to see if the breast has a deep fixation, the patient is asked to press their hands on their hips, in this way tensing the pectoralis muscle, on which the breast lies. All palpable lesions should be measured with callipers and 1
Surgery Essay
the position (o’clock) is recorded. Next the nodal areas are palpated, in the axilla and above the clavicle for the supraclavicular nodes. Enlarged nodes are found in patients with no clinically significant breast disease, and at times people with breast cancer may have no palpable nodes. Since the patient is 50 years old, mammography is useful in this age group. This requires compression of the breast between two plates. It allows the detection of mass lesions, areas of parenchyma distortion and micro calcifications. Ultrasonography is another option, where high frequency waves are beamed to the breast and reflections are turned into pictures. It is easy to differentiate cysts and other benign lesions, which have well demarcated edges from cancers with an indistinct outline. Another option is MRI, which has a high sensitivity for breast cancer. Fine-needle aspiration cytology can be used to differentiate between solid and cystic leaisons. In core biopsy several cores are removed from a mass or an area of micro calcification by means of cutting needle technique. Palpation can be used to guide the biopsy but better to use with ultrasound. False-positive results occur with all diagnostic techniques. Image guided core biopsy is the most accurate of the various techniques used to diagnose breast masses. 19/01/09
2
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