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ASSESSMENT OF BREAST SYMPTOMS/LUMPS

Specialists Without Borders Seminar in Surgery Rwanda, September 2010. ASSESSMENT OF BREAST SYMPTOMS/LUMPS. Professor P Grantley Gill. SIGNS AND SYMPTOMS AT PRESENTATION Palpable mass Thickening, Pain Mass or pain in the axilla Nipple discharge Oedema or erythema of the skin.

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ASSESSMENT OF BREAST SYMPTOMS/LUMPS

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  1. Specialists Without Borders Seminar in Surgery Rwanda, September 2010 ASSESSMENT OF BREASTSYMPTOMS/LUMPS Professor P Grantley Gill

  2. SIGNS AND SYMPTOMS AT PRESENTATION Palpable mass Thickening, Pain Mass or pain in the axilla Nipple discharge Oedema or erythema of the skin www.specialistswithoutborders.org

  3. www.specialistswithoutborders.org • CAUSES OF BREAST LUMPS • Fibroadenoma • Cyst • Fibrocystic change • Cancer • Duct ectasia • Fat necrosis • Haematoma

  4. www.specialistswithoutborders.org • BREAST CANCER RISK FACTORS • Age • History of breast cancer • Family history of breast cancer, especially in first degree relatives • Specific genetic mutations e.g. BRCA-1, BRCA-2 • Benign breast “cancer” atypical hyperplasia • Early menarche, late menopause • Late first pregnancy/no pregnancy • Exogenous oestrogens • Radiation • Diet, alcohol

  5. www.specialistswithoutborders.org • EXAMINATION OF BREAST • Inspection • Palpation • Lymph node basins (axilla, neck) • Contralateral breast

  6. www.specialistswithoutborders.org • INSPECTION

  7. www.specialistswithoutborders.org • NIPPLE RETRACTION

  8. www.specialistswithoutborders.org • SKIN DIMPLING

  9. www.specialistswithoutborders.org • PAGET’S DISEASE

  10. PAGET’S DISEASE www.specialistswithoutborders.org

  11. www.specialistswithoutborders.org • TRIPLE ASSESSMENT OF A BREAST LUMP • Clinical • Imaging • Mammography • Ultrasound • Pathology • Fine needle aspiration cytology (FNAC) • Core biopsy

  12. www.specialistswithoutborders.org • PALPABLE LYMPH NODES

  13. www.specialistswithoutborders.org • MAMMOGRAPHIC STAGING • Masses • Asymmetry • Architectural distortion • Calcification • Skin changes

  14. www.specialistswithoutborders.org • NORMAL FATTY REPLACEMENT

  15. www.specialistswithoutborders.org • NORMAL INVOLUTION

  16. www.specialistswithoutborders.org • DENSE BREASTS

  17. www.specialistswithoutborders.org • DENSE BREASTS – RETROAREOLAR TISSUE LEFT

  18. www.specialistswithoutborders.org • DENSE BREASTS +++ ALL OF LIFE

  19. www.specialistswithoutborders.org • ULTRASOUND • A: Fibroadenoma • B: Carcinoma

  20. www.specialistswithoutborders.org • FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)

  21. www.specialistswithoutborders.org

  22. www.specialistswithoutborders.org • FNAC INTERPRETATION AND ACTION

  23. www.specialistswithoutborders.org • TRIPLE ASSESSMENT OUTCOME

  24. www.specialistswithoutborders.org • CONCLUSION • Confirm malignancy in ≥90% by triple assessment • Open biopsy if not possible

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