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 breast mass work up  



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Author7 Posts
  #1

If 25 yr old female with a mobile breast mass in upper and outer quadrand.

What is the next step?? and further workup
a Excisional biopsy
b Ultrasonography
c FNAC
d mammogram
e observe


If the same problem in 45 yr old female what would we do next?? and further workup.
If 45 yr old patient has microcalcifications seen on mammography. next step?
If patient has fixicity of skin and a underlying mass next step??
If patient has fibrocystic diseae which reoccured after aspiration what would you do??
Can someone tell the staging of breast cancer?? the amount we need to know for the boards.




  #2

Well, I see you have too many questions....not so many people have time to answer those...at one shot. Next time if you have any doubt I would suggest frame it in a MCQ format. Guys on forum really like that way.

Okay...breast masses are real time issues, in the 1st case I would go by doing a FNAB...as ultimately you have to rule out Ca anyways...this is what UW says. I dont see anything wrong in that.

2nd-if this thing is with a women > 45 yr of age...I would like to go for a mammogram, which I dont feel is right as mammogram is useful in cases where no mass is palpable in older women and we screen them by mammogram rather than breast palpation for feeling the mass. But FNAB will be required later in any case so can run away from that either.

3rd- Microcalcification with age>35.....high chance of Ca breast....go for a core biopsy, rather than FNAB. will yield better result.

4th- fixity is stong indication of breast Ca and is also a poor prognostic sign....do the same thing and later as skin inv is there do a MRM.

5th- fibrocystic Ds if diagnosed needs not much work but if reoccurs I think the management depends on what type of disease it is...and treat accordingly like resection, danazol, duct removal etc.

6th- its really difficult to describe how much you should know about the classification but atleast know where the difference in management comes...i mean where do we do radical mastect, where MRM and where chemo or radiation etc.

hope that would have helped a bit.


  #3

whooo... that looks big from here, but it just took around 2 minutes....i like thatsmiling face


  #4

thanks. what I found in first aid was this for a unsuspicious breast mass like age<35, mobile mass, no family history, size change with cycle go for FNA.


For a suspicious mass go for core or excisional biopsy. Suspicious mass would include age>35, positive family history, firm or rigid mass, skin changes, axillary lymphadenopathy, skin changes.

Mammography is used for screening as drduck said and after a mass is found in mammography we would go for FNA or excision biopsy depending on what is written above. Ultrasonogram is used to screen younger women.


  #5

d/d of a breast mass includes fibrocystic disease, fibroadenoma, mastitis, fat necrosis and breast cancer. I think it would do if we know how to differentiate them clinically and the initial steps in their management.rolling eyes


  #6

i agree use the 35 years cut off


  #7

Workup if Nonsuspicious Mass (<35 age, No family hx, movable and fluctuant, or size changes with cycle)

1. Ultrasound (if<35) or Mammogram (if>35): It will show either a solid mass or a cystic mass.

If Solid Mass is Seen
Do FNA and send it for Cytology
-If Malignant --> tx
-If Benign/Inconclusive --> Repeat FNA + Cytology or Open Surgery Biopsy

If Cystic Mass is Seen
Do FNA and send it for Cytology
-If Clear fluid/Mass Disappears --> Follow-up in 6 to 8 weeks. If cyst reappears then do another FNA aspirate + Core Biopsy.
-If Residual mass or Thickening --> Mammography + Excision Biopsy(if>50) or Just Excision Biopsy(if <40).
-If Bloody Fluid --> Mammography + Excision Biopsy(if>50) or Just Excision Biopsy(if <40).

Workup for Suspicious Mass(>35, (+) Family hx, Fixed, rigid, firm mass, axillary adenopathy, skin changes)
1. Mammography Excisional or Core Biopsy
-If DCIS/Cancer --> tx as protocol
- Negative --> Reassurance and Follow-up


If the same problem in 45 yr old female what would we do next?? and further workup.
Mammogram is next step and follow the the nonsuspicious mass algorithm.

If 45 yr old patient has microcalcifications seen on mammography. next step?
Mammography guided Core Biopsy.

If patient has fixicity of skin and a underlying mass next step??
Mammography Excisional or Core Bx(look at suspicious mass algorithm.)

If patient has fibrocystic disease which reoccured after aspiration what would you do??
FNA and Core Biopsy







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