The Breast Clinic

Index case

Year 2 Michaelmas term

37 year old lady

• Noticed lump in right breast 2 weeks ago

45 year old woman

• Noticed lump in breast two weeks ago

28 year old woman

• Noticed lump in left breast two weeks ago

65 year old man

• Noticed lump in breast two weeks ago

You are doctor in breast clinic

• You have 15 mins with this patient and have to decide what the lump is likely to be due to

• What are you going to ask in the history?

• What are you going to examine?

Discussion-

• What are the common causes of a breast lump?

Discussion

• What specific questions would you ask in the history to help differentiate between the different causes of breast lump?

Discussion

• What specific things would you check on examination of the breast

What other parts of the body would you examine?

After 15 mins

• What happens to the patient next?

Triple Assessment

• History and Examination

• Breast Imaging

• Histology if solid lump

Breast Imaging

• Mammography

• Ultrasound

• Ultrasound guided core biopsy

Typical appearance of a breast cancer on mammography

Features of breast cancer on mammography

• Radio-opaque area or mass

• Irregular edges with fine lines (spiculation)

• Calcification

• Asymmetry

• DCIS may be seen as micro calcification- like sand

Ultrasound breast cancer

Ultrasound breast cancer

Ultrasound of the breast mass

• Solid mass

• Dark with shadowing behind

• Can measure and then biopsy the mass

• Ultrasound the ipsilateral axilla to look for enlarged Lymph nodes

• Give radiological Score of 1 to 5

Ultrasound guided biopsy

Histological diagnosis

• Ultrasound guided core biopsy using a large needle and taking several cores under local anaesthetic

• Occasionally do fine needle cytology if v small lesion or technically difficult e.g near implant

Histological types

• Adenocarcinoma:• Ductal 75%• Lobular 10%• Other types 10-15%• Define grade of tumour, 1 to 3 • Immunohistochemical staining for receptors:

oestrogen, HER2• Give Histological score of 1 to 5

Multidisciplinary Team

• Breast Clinicians, Radiologists, Pathologists, Nurses, Data managers

• Review of Clinical, Imaging and Pathology

• Check all correlate

• Plan of treatment decided for patient

• Avoids mistakes being made!