Absite Breast

Front 1

Blood supply to breast

Back 1

Internal thoracic
Thoracoacromial
Long thoracic
Intercostal

Front 2

Treatment of Mondor's Disease

Back 2

NSAIDs

Front 3

Management of fibrocystic diesease with atypical hyperplasia

Back 3

resect no need for neg margins

Front 4

Fibroadenoma work up

Back 4

<30 U/S or mammo then FNA or core needly biopsy
>30 excisional biopsy

Front 5

Management of green vs bloody vs serous vs spontaneous discharge

Back 5

Green (fibrocystic usually) reassure if cyclical and nonspontaneous
Bloody --> galactogram and excision
Serous (cancer) excisional bx

Front 6

Diffuse papillomatosis

Back 6

swiss cheese mammo
40% get breast CA

Front 7

DCIS

Back 7

50-60% ipsi cancer
5-10% contra breast
premalignant
Need 2- mm margin

Front 8

most aggressive DCIS

Back 8

comedo

Front 9

Treatment of DCIS

Back 9

mastectomy for high grade (comedo, multicentric, multifocal) + SLNB?
lumpectomy/xrt + tamoxifen if ER +?
No ALND
Need negative margins

Front 10

LCIS

Back 10

40% breast CA in either breast (70% ductal)
5% synchronous breast CA @ time of dx
not premalignant

Front 11

Treatment of LCIS

Back 11

observe or tamoxifen or b/l mastectomy
NO ALND!

Front 12

Symptomatic breast mass work up

Back 12

<30 y.o
1.) U/S
2.) FNA if solid
3.) exc bx if FNA is nondx

Front 13

Management of bloody cyst fluid

Back 13

excisional biopsy (also indicated if clear and recurs)

Front 14

Management of suspicious vs indeterminate calcifications on mammo

Back 14

stereotactic needle excisional bx in former and core needle bx in latter

Front 15

BIRADS

Back 15

1 Neg
2 Benign
3 Probably benign (6 month f/u)
4 Suspicious
5 Highly malignant

Front 16

Which level of nodes need to be sampled in SLND

Back 16

level 1 (lateral to pec minor)

Front 17

Most important prognostic staging factor?

Back 17

# of positive nodes

Front 18

Most common site of metastasis

Back 18

bone

Front 19

Greatly increased risk for breast CA

Back 19

BRCA gene in fam hx of breast CA
>= 2 primary relatives with b/l breast CA or premeno breast CA
DCIS
LCIS
fibrocystic dz with ADH

Front 20

moderate risk for breast CA

Back 20

Fam hx of breast other than b4
early menarche
late meno
nulliparity
first birth after age 30
radiation
previous breast CA
high fat diet
proliferative benign disease
HRT

Front 21

Treatment of male breast cancer

Back 21

MRM

Front 22

Inflammatory cancer has what type of invasion?

Back 22

dermal lymphatic

Front 23

Absolute contraindications to breast conserving therapy in invasive CA

Back 23

1) 2 or more primary tumors in separate quads
2) Pregnancy (unless in 3rd trimester)
3) Diffuse malignant appearing microCa
4) History of XRT
5) Persistent positive margins

Front 24

When is SLNB indicated?

Back 24

<1cm tumors and no clinically positive nodes

Front 25

When do you have to do formal ALND during SLND

Back 25

when you can find radiotracer or dye

Front 26

Contraindications to SLND

Back 26

Pregnancy
multicentric disease
neoadjuvant
clinically positive nodes
prior axillary surgery
inflammatory or locally advanced

Front 27

complications of ALND

Back 27

axillary vein thrombosis (early) or lymphatic fibrosis (over 18 months)

Front 28

Indications for XRT after mastectomy

Back 28

<4 nodes
<5cm (T3)
inflammatory CA
+ margins
T4

Front 29

Chemo for breast CA

Back 29

5FU +cyclophosphamide + methotrexate
OR
Adriamycin + cyclophosphamide
for 3-6 months

Front 30

Paget's disease

Back 30

DCIS or ductal CA in breast
MRM if cancer is present otherwise mastectomy

Front 31

Cystosarcoma phyllodes

Back 31

10% mal
no nodal mets (hematogenous rare)
stromal/epithelial (giant fibroadenomas)
WLE with NEG MARGINS
no ALND

Front 32

Do you need negative margins or ALND in cystosarcoma?

Back 32

yes neg margins no ALND

Front 33

Stewart Treves syndrome

Back 33

lymphangiosarcoma

Front 34

Pregnancy w/ mass

Back 34

U/S no mammo
core needle bx or FNA
MRM unless 3rd trimester (lumpectomy + ALND + XRT after birth)

Front 35

What should you avoid in children with breast masses?

Back 35

excisional biopsies

Front 36

Best management of pathological nipple discharge?

Back 36

ductogram and direct duct excision

Front 37

Paget's disease

Back 37

>97% have underlying CA
~50% with underlying mass

Front 38

Treatment of Paget's disease

Back 38

mastectomy + axillary staging
OR
wide excision of nipple/areola, axilary staging and XRT

Front 39

SLND

Back 39

High false neg rate
1-3% risk of lymphedema
Frozen section has a 10-15% FN rate and 1% FP
low axillary recurrence if negative

Front 40

Chance of breast CA in LCIS and management

Back 40

Marker not premalignant
Not palpable, no calcifications
incidental finding in premeno
1% chance of breast CA/year
(40% bilateral lifetime)
5% synchronous breast CA
Tamoxifen provides 50% risk reduction

Front 41

Surgical procedure of choice for LCIS

Back 41

Bilateral total mastectomy would be procedure of choice because incidence of cancer is equal for both breasts

Front 42

Gail model factors

Back 42

Age
Age @ menarche (not menses)
# of 1st degree relatives (not 2nd)
# of breast biopsies
atypical ductal hyperplasia

Front 43

Effect of tamoxifen on survival and recurrence in invasive CA vs in situ

Back 43

improved survival (25%) and decreased recurrence (16%) in invasive, NOT IN SITU (reduces risk of developing CA by 50%)

Front 44

Main difference in surgical management of DCIS vs LCIS

Back 44

DCIS needs negative margins