standardized approach to a woman presenting with …...standardized approach to a woman presenting...
TRANSCRIPT
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Standardized Approach to a Woman Presenting with a Palpable Lump
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Downstaging
� Where early detection and treatment are available and accessible: � 5-year survival rates exceed 80%
� Breast cancer can be detected early through early diagnosis and screening � Early diagnosis: based on awareness of signs and
symptoms of cancer; entails recognizing warning signs and taking prompt action
� Screening: systematic use of testing, such as mammography, across an asymptomatic population to detect and treat cancer or pre-cancers
WHO 2014 http://www.who.int/cancer/publications/mammography_screening/en/ 2
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Triple Test
1. Clinical Breast Examination
2. Diagnostic mammography
3. Ultrasound
� Biopsy
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Clinical Breast Examination
� Potential for high false positives (up to 80%)
� Patient factors
� Examiner factors
� Currently positive CBEs need referral and evaluation � Barriers for >85% living in rural communities in
Africa
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Imaging the World
BR 1,2,3 BR 4,5
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Rural Ugandan Experience
� Community outreach and education
� 212 women with self-detected lump screened with CBE at community health center
� 44 (21%) had palpable lump
� 11 (28%) examined by ultrasound at a community health center had a suspicious mass
� Only four underwent biopsy and all diagnosed with breast cancer (2 with early stage)
� 75% with palpable lumps on CBE did not need a biopsy or referral
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Diagnostic Ultrasound
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Causes of Palpable Lumps
� Normal breast tissue
� Rib
� Cyst
� Mass
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Normal Breast Tissue
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Rib
Rib
Muscle
Rib
Muscle
Pleura
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Palpable Lump
Mass
Rib
Muscle
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Biopsy Sampling Technique
Pre Biopsy Image Post Biopsy Image
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Specimen Collection
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Diagnostic Mammography
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CC
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MLO
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ML ML SPOT MAG
Diagnostic Mammography
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Palpable Lump
Mass
Rib
Muscle
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Quality Control
� Communicating and Reporting � Breast Imaging Reporting and Data System (BI-RADS)
� Optimal reading environment
� Equipment
� Technical staff
� Access
� Minimize risk � Following patient outcomes � Minimize false positives and negatives
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BI-RADS
� ACR Breast Imaging Reporting and Data System (BI-RADS)
� Using BIRADS lexicon allows for more consistent, more accurate assessments and recommendations and supports tracking/medical audit of program
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� Terms to describe lesions (lexicon)
� Terms for assessments and associated recommendations
� Guidelines for follow-up and outcome monitoring � Definitions for medical audit � Desirable goals in practice
Key BI-RADS Components
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Simplified BIRADS Report
1. Finding Shape Margin Echogenicity 3. BI-RADS and Recommendation
Mass Round/Oval Circumscribed Hyperechoic 0- Needs additional
images
Irregular Not Circumscribed Not Hyperechoic 1 – Negative-Clinical follow-up
Normal Finding 2. Location: 2 – Benign – Clinical follow-up
Special Cases: Infection Right Left Axilla Subareola 3 – Probably Benign – Short interval follow-up
Cyst Lymph Node ________o’clock ______cmfn 4 – Suspicious - FNA
Fat Necrosis Galactocele Size:________________cm 5 – Highly Suspicious - FNA
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The End