Term
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Definition
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Term
| What causes peau d'orange appearance? |
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Definition
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Term
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Definition
| Breast Imaging Reporting and Data System |
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Term
| quality assurance tool designed to standardize mammography reporting, reduce confusion in breast imaging interpretations, and facilitate outcome monitoring |
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Definition
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Term
| The younger the patient, the more ________ her breast tissue. |
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Definition
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Term
| mammographic breast composition if the breast is almost entirely fat |
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Definition
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Term
| mammographic breast composition if scattered fibroglandular densities |
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Definition
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Term
| mammographic breast composition if heterogeneously dense breast tissue |
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Definition
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Term
| mammographic breast composition if extremely dense |
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Definition
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Term
| What is the difference between a mass and a density? |
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Definition
mass is a space occupying lesion seen in two different projections
density is a potential mass seen in only a single projection |
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Term
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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 |
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Term
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Definition
poor definition of the margins raises concern that there may be infiltration by the lesion
not likely due to superimposed normal breast tissue |
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Term
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Definition
lesions in characterized by lines radiating from the margins of a mass
NEVER normal! |
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Term
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Definition
normal architecture is distorted with no definite mass visible
includes spiculations, focal retraction, or distortion of the edge of the parenchyma |
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Term
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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 |
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Term
| What is the ideal BI-RADS classification? |
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Definition
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Term
| What BI-RADS classification means additional imaging is needed because something is unclear? |
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Definition
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Term
| BI-RADS classification for benign finding |
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Definition
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Term
| BI-RADS classification for probably benign finding (initial short-interval follow up suggested) |
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Definition
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Term
| BI-RADS classification for suspicious abnormality (biopsy should be considered) |
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Definition
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Term
| BI-RADS classification for highly suggestive of malignancy (appropriate action should be taken) |
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Definition
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Term
| BI-RADS classification for known biopsy-proven malignancy |
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Definition
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Term
| What action should be taken in a pt. with a BI-RADS of 0? |
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Definition
| more imaging or prior mammograms for comparison |
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Term
| What action should be taken for a pt. with a BI-RADS of 1? |
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Definition
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Term
| What action should be taken in a pt. with a BI-RADS of 2? |
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Definition
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Term
| What action should be taken in a pt. with a BI-RADS of 3? |
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Definition
| initial short interval follow up |
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Term
| What action should be taken in a pt. with a BI-RADS of 4? |
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Definition
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Term
| What action should be taken in a pt. with a BI-RADS of 5? |
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Definition
| appropriate action for possible malignancy |
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Term
| What percent of masses are malignant in a BI-RADS 3 report? |
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Definition
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Term
| What percent of masses are malignant in a BI-RADS 4 report? |
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Definition
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Term
| What percent of masses are malignant in a BI-RADS 5 report? |
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Definition
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Term
| What causes the calcifications seen in breast lesions? |
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Definition
| calcium from milk production |
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Term
| How many microcalcifications signify cancer? |
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Definition
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Term
| What source of trauma is common in the breasts? |
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Definition
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Term
| What conditions cause bilateral breast pain? |
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Definition
cyclical mastalgia
fibrocystic breast changes
pregnancy
post-partum engorgement |
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Term
| What conditions cause unilateral breast pain? |
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Definition
non-cyclical mastodynia
mastitis/abscess
trauma
inflammatory breast CA |
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Term
| What symptoms are associated with cyclical mastalgia? |
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Definition
bilateral soreness/heaviness
may radiate to axilla and arms
poorly localized (diffuse) |
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Term
| When is the incidence of fibrocystic breast disease highest? |
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Definition
30-50 years old
rare in postmenopausal women |
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Term
| What are common components of the history in a pt. with fibrocystic breast disease? |
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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 |
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Term
| What physical exam findings are consistent with fibrocystic breast disease? |
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Definition
-single or multiple, non-discrete breast masses
-may or may not be tender
-be alert for discrete masses "masked" by FBD |
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Term
| When in doubt about whether or not a palpated mass is due to fibrocystic breast disease or not, what should you do? |
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Definition
| send for diagnostic mammogram |
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Term
| What is the prognosis for fibrocystic breast disease? |
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Definition
| benign, chronic, recurring, intermittent |
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Term
| What is the treatment for fibrocystic breast disease? |
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Definition
-NSAIDs
-re-evaluate at different time of cycle (soon after menses)
-caffeine avoidance
-vitamin E 400-800 IU daily |
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Term
| Why should a pt. with fibrocystic breast disease avoid caffeine? |
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Definition
| increases the cystic component of fibrocystic breast changes |
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Term
| When should a pt. with fibrocystic breast changes with lumps get a mammogram? |
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Definition
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Term
| What test is helpful in differentiating solid from cystic masses in a pt. with lumps due to fibrocystic breast disease? |
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Definition
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Term
| What age group has the highest incidence of non-cyclical mastodynia? |
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Definition
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Term
| What components of the history are common in women with non-cyclical mastodynia? |
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Definition
no particular pattern of pain
unilateral
localized
sharp/burning pain |
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Term
| What diagnostic tool should be used for postmenopausal women if non-cyclical mastodynia is suspected? |
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Definition
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Term
| What diagnostic tool should be used in young women if non-cyclical mastodynia is suspected and their symptoms persist? |
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Definition
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Term
| What is the prognosis for non-cyclical mastodynia? |
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Definition
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Term
| What is the treatment for non-cyclical mastodynia? |
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Definition
same as cyclical mastodynia
NSAIDs
caffeine avoidance
vitamin E 400-800 IU daily |
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Term
| What are the risk factors associated with breast abscesses? |
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Definition
puerperal mastitis
diabetes
rheumatoid arthritis
steroids
silicone/paraffin implants
lumpectomy with radiation
heavy cigarette smoking
nipple retraction |
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Term
| What causes a puerperal abscess? |
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Definition
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Term
| What causes a subareolar abscess? |
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Definition
| squamous epithelial neoplasm with keratin plugs or ductal extension with associated inflammation |
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Term
| What causes a peripheral abscess? |
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Definition
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Term
| What signs and symptoms are associated with a breast abscess? |
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Definition
tender breast lump, fluctuant, usually unilateral
erythema
draining pus
local edema
systemic malaise
fever
nipple and skin retraction
proximal LAD |
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Term
| What diagnostic tool can you use for a breast abscess? |
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Definition
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Term
| What is the treatment for a breast abscess? |
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Definition
I&D
packed open with iodoform or plain gauze
C&S
antibiotics |
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Term
| What antibiotic options do you have for a breast abscess? |
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Definition
erythromycin 250-500 mg qid
cephalexin 500 mg qid
cefaclor 250 mg tid
amoxicillin-clavulanate (augmentin) 250 mg tid |
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Term
| What antibiotic should you give if an anaerobic infection is suspected in a breast abscess? |
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Definition
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Term
| What type of wound commonly produces anaerobic infections? |
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Definition
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Term
| What is mastitis predominantly associated with? |
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Definition
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Term
| What demographic is mastitis more common in? |
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Definition
| primagravidas (due to lack of experience) |
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Term
| What is the most common organism that causes mastitis? |
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Definition
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Term
| When does mastitis typically occur? |
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Definition
| usually 2-4 weeks post-partum |
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Term
| What are associated manifestations of mastitis? |
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Definition
engorgement
erythema
fever/chills
anorexia
headache
malaise |
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Term
| What physical exam findings are consistent with mastitis? |
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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 |
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Term
| When should a mammogram be done in a pt. suspected to have mastitis? |
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Definition
| only in lactating women who fial to respond to appropriate antibiotic treatment within 7-10 days |
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Term
| What antibiotic options do you have for mastitis? |
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Definition
dicloxacillin 500 mg qid x 7-10 days
clindamycin 300 mg qid x 7-10 days
cephalosporins |
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Term
| What is the treatment for infectious mastitis? |
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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 |
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Term
| What patients is non-lactational mastitis usually seen in? |
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Definition
immunocompromised women
autoimmune disorders
history of radiation therapy |
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Term
| What is the treatment for non-lactational mastitis? |
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Definition
clindamycin 300 mg qid
augmentin 500 mg bid
cephalexin 500 mg bid |
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Term
| What should you suspect in older non-lactating women with mastitis? |
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Definition
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Term
| What should you do if an older non-lactating woman with mastitis is non-responsive to antibiotic treatment? |
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Definition
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Term
| What signs and symptoms are associated with inflammatory breast cancer? |
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Definition
pain and erythema of entire breast
increased size and firmness of breast
peau d'orange skin changes |
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Term
| How do you diagnose inflammatory breast cancer? |
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Definition
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Term
| diffuse, brawny edema of the skin of the breast with an erysipeloid border, usually without an underlying palpable mass |
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Definition
| inflammatory breast cancer |
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Term
| What is the most aggressive form of breast cancer? |
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Definition
| inflammatory breast cancer |
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Term
| At presentation, nearly ___% of patients with inflammatory breast cancer have evidence of metastases. |
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Definition
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Term
| Inflammatory breast cancer is generally a clinical diagnosis with pathologic confirmation of ______ ___________ in the dermal ________ by biopsy of the overlying skin. |
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Definition
| tumor embolization; lymphatics |
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Term
| What causes the inflammatory process associated with inflammatory breast cancer? |
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Definition
| blockage of dermal lymphatics by tumor emboli, which results in edema and hyperemia |
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Term
| What is the treatment for inflammatory breast cancer? |
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Definition
| several cycles of neoadjuvant polychemotherapy followed by surgery or radiation depending on tumor response |
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Term
| What percentage of nipple discharge is due to benign breast disease? |
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Definition
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Term
| What percentage of nipple discharge is due to cancer? |
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Definition
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Term
| What is the most common cause of galactorrhea? |
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Definition
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Term
| What physiologic processes can cause nipple discharge? |
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Definition
pregnancy
post-lactational
cyclical hormone variations
nipple stimulation
stress |
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Term
| What are the possible pathologic causes of nipple discharge? |
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Definition
duct ectasia
non-puerperal mastitis
intraductal papilloma
endocrine disorders
breast cancer |
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Term
| What characteristics are common with physiologic nipple discharge? |
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Definition
usually bilateral
need compression
multiple ducts |
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Term
| What characteristics are common with pathologic nipple discharge? |
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Definition
spontaneous
bloody
associated mass
usually unilateral
usually single duct |
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Term
| What is a benign neoplastic growth within a major duct that causes nipple discharge? |
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Definition
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Term
| What features are characteristic of nipple discharge associated with an intraductal papilloma? |
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Definition
single duct involvement
unilateral
spontaneous
secretions are serous or bloody |
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Term
| What is the treatment for intraductal papillomas? |
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Definition
| excision to exclude carcinoma |
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Term
| What endocrine conditions can cause galactorrhea? |
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Definition
pituitary lesions
CNS lesions
primary hypothyroidism
any conditions that cause increased prolactin |
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Term
| What medications can cause galactorrhea? |
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Definition
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Term
| What is surgical referral indicated? |
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Definition
-persistent symptoms of mastitis, despite antibiotic therapy (no improvement in 7 days)
-unilateral, spontaneous nipple discharge
-dominant palpable mass |
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