breast carcinoma investigations.pptx ppt

Breast ca

1. BREAST CARCINOMA Investigations and staging

2. Risk factors Modifiable: Obesity Nulliparity Breastfeeding - protective,>12 months Age at first child birth Use of HRT->10 yrs Smoking(per 20 yrs ) & alcohol Radiation exposure Non-modifiable: Increasing age Early menarche Late menopause Family history Genetic predisposition - BRCA1 – more aggressive with basal subtype – poor prognosis BRCA2 – luminal subtype with better prognosis.

3. Pathology M/c type - invasive ductal cell carcinoma- nonspecific type MOLECULAR Classification of breast cancer

4. INVESTIGATIONS: Triple assessment Ultrasonography Mammography MRI PET- Positron emission tomography Needle biopsy Vacuum assisted biopsy

5. Triple assessment

6. Diagnosis of breast cancer Investigation of choice for diagnosis - trucut biopsy Investigation of choice for staging- PET CT

7. Clinical breast examination

8. Ultrasonography Primary imaging modality in young women with dense breast tissue Distinguish cystic from solid lesion s. A well- circumscribed, mobile, solid mass in young women — Fibroadenoma Solid mass with irregular shape & ill-defined margins— malignancy & requires biopsy USG axilla is performed when cancer diagnosed, with guided percutaneous biopsy of any suspicious lymph nodes.

9. Mammography Initial screening tool for asymptomatic women First investigation in older women who presents with breast symptoms Mammography reporting BI-RADS– Breast imaging reporting and data system Benign Malignant Well defined lesion Irregular spiculated margins Macrocalcification Micro calcification Halo surrounding lesion Architectural distortion

10. MRI Women with dense breast or discordant or equivocal findings on mammogram/ USG. To distinguish scar from recurrence in women who have had previous breast conservation therapy for cancer. To assess multifocality and multicentricity and, in lobular cancer, high grade ductal carcinoma in situ( DCIS) women with breast cancer(BRCA) gene or other genetic mutations or a strong family history & breast implants To assess recurrence after surgery

11. PET- Positron emission tomography Staging investigation in patients with T3, T4, N2, N3 breast cancer and in patients with T1, T2, N0, N1 breast cancer with features suggestive of metastasis inflammatory lesions may give false-positive results very expensive

12. Needle biopsy 14G for breast tissue and 18G for axillary nodes Core needle biopsy always be taken under image guidance Needle tip should be used to take a sample from only solid part of the mass, avoiding cystic degeneration and blood vessels around the lesion

13. Vacuum assisted biopsy The sampling error decreases as the biopsy volume increases and using 8G or 11G needles allows more extensive biopsies to be taken useful in management of microcalcifications and removal of benign lumps such as Fibroadenoma.

14. TNM staging T - tumor size or depth N - lymph Nodes M - metastasis cTNM - clinical tTNM - pathological rTNM - recurrent mTNM- multiple yTNM - after neoadjuvant therapy aTNM - autopsy

15. T stage Tx - can’t be assessed To- no evidence of primary tumor Tis- in situ cancer( DCIS,paget ) T1mi- tumor </=1mm T1a- tumor >1mm but < /= 5 mm T1b - tumor >5mm but < /= 10mm T1c - tunnel >10mm but < /= 20mm T2- tumor >20mm but < /= 50mm T3- tumor >50mm T4a - involvement of chest wall( pectoralis muscle not considered) T4b- involvement of skin( dimpling and retraction not considered) T4c- T4a+T4b T4d- inflammatory breast cancer

16. N stage N0- no LN Nx- can’t be assessed N1- mobile axillary LN N2a- fixed or matted LN N2b- internal mammary LN+ absence of axillary LN N3a- ipsilateral infraclavicular LN N3b- ipsilateral internal mammary LN+ axillary LN N3c- ipsilateral supraclavicular LN

17. M stage M0- no distant metastasis Mx- distance metastasis can’t be assessed M1- distance metastasis present