A 35 years old lactating mother presented with a painful breast lump. The most appropriate initial investigation should be: (AIIMS November 2013, Nov 2012)
Ans . b. USG (Ref: Sutton's Radiology 7/e p1456; Schwartz 9/e p467; Sabiston 19/e p2035-2037; Bailey 25/e p846) In a 35 years old lactating mother who presented with a painful breast lump. Most appropriate initial investigation should be ultrasound. Indications of Breast Ultrasound: (Sutton's Radiology 7/e p1456) Symptomatic breast lump in women <35 years Breast lump durine lactation and pregnancy Assessment of mammographic abnormality (+- further mammographic views) Assessment of MRI or scintimammography detected lesions Clinical breast mass with negative mammogram Breast inflammation Augmented breast (together with MRI) Breast lumps in males (together with MRI) Guidance of needle biopsy or localization Follow-up of breast carcinoma treated with adjuvant chemotherapy Mammography Screening modality of choice for breast cancer MRI: Indicated in scarred breast, implants and borderline lesions for breast conservation IOC for implant related complicationsQ Gold standard for imaging breast in females with implantsQ Breast Cancer during Pregnancy Occurs in 1 of every 3000Q pregnant women MC non-gynecologic malignancy associated with pregnancyQ. Ductal carcinoma is MC type, accounting for 75-90%Q of breast cancer in pregnancy Clinical Features: Presents as painless palpable massQ with or without nipple discharge Axillary LN metastases in up to 75% patients Approx. <25% nodules developing during pregnancy and lactation will be cancerousQ Present at a later stage of disease because breast changes occurring in hormone-rich environment of pregnancy obscure early cancer Diagnosis: USG and needle biopsyQ are used for diagnosis Mammography is rarely indicated due to its decreased sensitivity during pregnancy and lactation Treatment: Mainstay of therapy is surgical resection. Stage I and II Mastectomy with axillary dissectionQ LABC NACT after 1st trimester + MRM in 2nd trimester + RT after deliveryQ LABC in Pregnancy MRM can be performed during first and second trimester (increased risk of spontaneous abortion after first- trimester anesthesia), chemotherapy after first trimester and radiotherapy after delivery. Chemotherapy during first trimester carries a risk of spontaneous abortion and 12% risk of birth defects, given after first trimester. No evidence of teratogenecity by chemotherapy during second and third trimester. Remember: Breast cancer in pregnancy have prognosis stage by stage similar to that of non-pregnant patient Elective termination of pregnancy to receive appropriate therapy without the risk for fetal malformation is no longer routinely recommended because no improvement in survival has been demonstrated.
Mammography
USG
MRI
CT