DOC-20240806-WA0hhhhhhcchjgvbhgfhhg002..pptx

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1. MANAGEMENT(INVESTIGATION AND TREATMENT) OF BENIGN DISEASES OF BREAST MODERATED BY : DR. A bhishek Sharma Sir PRESENTED BY : Kriti Sharma (62)

2. CONTENTS Triple assessment Ultrasound MRI Mammography Benign breast diseases

3. Triple Assessment

4. Soft tissue radiographs are taken by placing the breast in direct contact with ultrasensitive film and exposing it to low-voltage, high-amperage x-rays. The dose of radiation is approximately 0.1 cGy and, therefore, mammography is a very safe investigation. The sensitivity of the investigation increases with age as the breast becomes less dense. MAMMOGRAPHY:

5. VIEWS OF MAMMOGRAPHY : CRANIOCAUDAL MEDIOLATERAL OBLIQUE (More breast tissue visualised and axilla is appreciated )

6. 1.SCREENING: Strong family history Risk of breast cancer >20% on (GAIL Index/BRCA Pro score) In such cases start screening by 35 years of age BRCA mutation First degree relative of patient with Breast cancer Start screening at 25 years of age,MRI is done, at 30-35 years switched to mammography . 2. DIAGNOSTIC: After 40 years of age INDICATIONS

7. MAMMOGRAPHY FINDINGS BENIGN TUMOUR: Well differentiated Halo surrounding Lesions Macrocalcification Popcorn calcification MALIGNANT TUMOR: Irregular spiculated lesion Microcalcification

8. Ultrasound is useful in young women with dense breasts in whom mamograms are difficult to interpret . It can also be used to localise impalpable areas of breast pathology. It is not useful as a screening tool and remains operator dependent. Describes vascularity of lesions ULTRASOUND:

9. INDICATIONS To differentiate solid lesion and cyst Pregnant lady with Breast lump Young patient with dense breast ADVANTAGE In this Patient will not expose to any ionising radiations It is good way to differentiate fluid filled cyst from solid tumour . Noninvasive Less expensive

10. To distinguish scar from recurrence in women who have had previous breast conservative therapy for cancer To assess MULTIFOCALITY AND MULTICENTRICITY in lobular cancer and To assess the extent of high- grade ductal carcinoma in situ (DCIS). It is the best imaging modality for the breasts of women with implants; Used as a screening tool in high-risk women MRI –guided biopsy may be performed for lesions not visible on ultrasound or mammogram . MAGNETIC RESONANCE IMAGING

11. INDICATIONS: High Risk Patients Neoadjuvant Chemotherapy : As it clearly depicts tumor size and vascularity before and during therapy. Occult Breast Cancer Lobular Carcinoma : As it is difficult to diagnose via mammography because multicentricity and multifocality . Detecting Breast Cancer In Women With Implants Post Operative Evaluation

12. . Cytology is obtained using a 21G or 23G needle and 10-mL syringe with multiple passes through the lump with negative pressure in the syringe. The aspirate is then smeared on to a slide, which is air dried or fixed. It is least invasive technique of obtaining a cellular diagnosis and is rapid . FINE NEEDLE ASPIRATION CYTOLOGY

13. If FNAC is negative , a tru cut biopsy or vaccum assisted biopsy using 14 G biopsy probe is taken . This is useful in management of microcalcification or complete excision of benign lesions such as fibroadenoma . CORE NEEDLE BIOPSY / TRUCUT BIOPSY

14. Benign Diseases Of Breast

15. DUCT PAPILLOMA Most common cause of bloody nipple discharge ( from single duct) 10% cases are associated with DCIS. DIAGNOSIS: USG and cytology of discharge. TREATMENT: MICRODOCHECTOMY - Tennis Racquet Incision. Single duct & lump excised .

16. DUCT ECTASIA/ PERIDUCTAL MASTITIS This is a dilatation of the lactiferous ducts, filled with debris which act as irritant and leads to periductal inflammation. Toothpaste like or colored ni pple discharge , subareolar mass, abscess, nipple retraction are the most common symptoms.

17. Antibiotic therapy may be tried, the most appropriate agents being CO-AMOXICLAV OR FLUCLOXACILLIN AND METRONIDAZOLE . Surgery consists of excision of all of the major ducts (HADFIELD’S PROCEDURE) - cone excision of multiple ducts . TREATMENT

18. Superficial manifestation of a underlying malignant condition the subdermal layer and it usually associated with a carcinoma within the breast. It is usually unilateral. Nipple areolar complex destroyed. DIAGNOSIS : Punch Biopsy – paget cells are present in epidermis. TREATMENT: Mastectomy done and evaluation of the axillary nodal status . PAGET’S DISEASE OF BREAST

19. It is usually bilateral. Nipple areolar complex not destroyed. It is usually associated with eczema elsewhere on the body. TREATMENT : Its is treated with 0.5% hydrocortisone. ECZEMA

20. Most common beingn cause of breast lump Age group: 15- 25 years. Firm, mobile and painless Arises from hyperplasia of a lobule,2-3 cm in size. Indications For Surgery: Cosmetic Painful Rapid increase in size Family history Giant fibroadenoma ( 5 cm in diameter) DIAGNOSIS :USG AND MAMMOGRAM FIBROADENOMA SCARLESS FIBROADENOMA SURGERY Radio Frequency Ablation Vaccum Assisted Biopsy System (MAMMOTOME)

21. Based on histopathological exam. Fibroadenoma can be of two types : 1.Pericanalicular : hard type 2.Intracanalicular Type of incisions : 1.Peri- aerolar 2. Inframammary incision ( gillard Thomas incision ) – when fibroadenoma is in lower half of breast .

22. BREAST CYST These occur most commonly in 35 to 55 year old age group and usually present as a painless lump They are often multiple, may be bilateral and can mimic malignancy. Diagnosis : USG,FNAC,MAMMOGRAPHY to rule out associated carcinoma.

23. TREATMENT: If symptomatic, large, complex ASPIRATE Monitor patient and no need to send fluid for cytology. NON BLOODY ASPIRATE CYST RESOLVES COMPLETELY BLOODY ASPIRATE RESIDUAL CYST Send fluid for cytology and EXCISE CYST.

24. BACTERIAL MASTITIS Bacterial mastitis is the most common variety of mastitis It is associated with lactation in the majority of cases. It is most commonly caused by STAPHYLOCOCCUS AUREUS . Generalised cellulitis with inflammation, fever, malaise can be present . If not treated progresses to access formation . DIAGNOSIS – USG

25. During the cellulitic stage, the patient should be treated with an appropriate antibiotic, such as FLUCOXACILLIN AND CLAMOXICLAV Support to breast , local heat , Analgesics will help to relieve the pain . If pus is present atleast 2 attempts of USG guided aspiration of pus is needed still if pus exist incision and drainage should be done . TREATMENT Feeding from the affected side may continue if the patient can manage .

26. Fibroadenosis Also k/a fibrocystic disease of breast / cyclical mastalgia with nodularity/Mammary dysplasia. It is an estrogen dependent condition. Most common in upper and outer quadrant . It is an exaggerated response of breast stroma and epithelium to hormones and growth factors .

27. Classification – 1.Nonproliferative – moderate hyperplasia of ductal luminal cells. 2.Proliferative without atypia ( severe hyperplasia ) 3.Proliferative with atypia – is risk for breast cancer .

28. Clinical features: B/ L,painful,diffuse,granular,tender,swelling Swelling is fluctuant,transilluminate Common in upper outer quadrant Pain and tenderness are more just prior to menstruation ( cyclical mastalgia ) Subsides with pregnancy ,lactation and after menopause Not fixed to skin,muscle or chest wall.

29. Investigations : 1. FNAC 2. Ultrasound 3. Mammography

30. Treatment : Conservative Mng . Medical ( drugs ) – Evening primrose oil in mod.pain is the drug of choice. Danazol Tamoxifen S urgery : 1. Subcutaneous mastectomy 2. Excision of cyst or localised excision of diseased tissue .

31. Indications : Intractable pain Persistent bloody discharge Florid epitheliosis on fnac

32. PHYLLODES TUMOR These benign tumours, also known as cystosarcoma phyllodes , usually occur in women over the age of 40 years but can appear in younger women also. They present as a large, sometimes massive tumour with an uneven surface

33. TREATMENT : 1.Wide excision with 1 cm margin or subcutaneous mastectomy to avoid recurrence . 2. If malignant ,total mastectomy is indicated with adjuvant chemotherapy . Diagnosis: It is made by TRUCUT/EXCISIONAL BIOPSY .

34. MASTALGIA CYCLICAL NON CYCLICAL Can be due to: 1 .TIETZE SYNDROME TREATMENT: Locally inj.of TRIAMCINOLONE in combination with lidocaine at the point of max.tenderness . 2.MONDOR’S DIASEASE TREATMENT: ANALGESIC S Seen in fibroadenosis Pain more at beginning of cycle DIAGNOSIS : USG TREATMENT: Lifestyle changes, weight reduction, less tea and coffee VITAMIN E AND PRIMROSE OIL CAPSULE IF PAIN PERSISTS Low dose tamoxifen Danazol

35. Thank You!