A 60-year-old lady comes with blood stained discharge from the nipple with family history of breast cancer. Next best step for her will be:
Ans. d. MRI (Ref: Schwartz 9/447-450; Harrison 19/e p526; Sabiston 19/830-832; Bailey 26/799-801. 25/828-829)A 60-year-old lady comes with blood stained discharge from the nipple with family history of breast cancer. Next best step for her (high risk female) will be MRI for screening of breast cancer."There is current interest in the use of MRI to screen the breasts of high-risk women and of women with a newly diagnosed breast cancer In the first case, women who have a strong family history of breast canceror who carry known genetic mutations require screening at an early age, but mammographic evaluation is limited because of the increased breast density in younger women. In the second case, an MRI study of the contralateral breast in women with a known breast cancer has shown a contralateral breast cancer in 5.7% of these women. "--Schwartz 9/450"However, the ACS suggests (hat younger women who are BRCA1 or BRCA2 carriers or untested first-degree relatives of women with cancer; women with a history of radiation therapy to the chest between ages 10 and 30 years; women with a lifetime risk of breast cancer of at least 20%; and women with a history of Li-Fraumeni. Cowden, or Bannuyan- Riley-Ruvalcaba syndromes may benefit from MRI screening, where the higher sensitivity may outweigh the loss of specificity. "--Harrison 19/e p526Investigations in CA BreastMammography* Initial investigation for symptomatic breast in women >35 years & for screeningQ* IOC for microcalcificationQSonomamogram (Ultrasound Breast)* Breast ultrasound that produces picture of internal structures of the breast* Initial investigation for palpable lesions in women <35 yearsQ (dense breast)* Not useful in screening* Useful in distinguishing cysts from solid lesions* Used to localize impalpable areas of breast pathologyDuctoscopy* It uses a microendoscope for direct visualization of ductal system of the breast and aspiration of lavage fluid to be used in cytological analysis* Ductoscopy allows a targeted approach to the diagnosis of intraductal breast diseases* Ductoscopy can serve as an adjunct to established techniques of breast imaging but is not a substitute* Perforation of the lactiferous sinus in the immediate retroareolar space is a common complicationPET scan* IOC for detecting recurrences in scarred breastQ* Useful in multifocal disease and in helping detect axillary involvementIndications for Breast MRI1. Lobular carcinomaQ: Difficult to detect and measure by conventional method because of multifocal and infiltrating growth pattern.2. Staging of primary breast cancerQ3. Occult primary tumour with malignant axillary lympbadenopathy and normal mammogram and breast USGQ.4. Screen younger women with high familial risk of breast cancerQ5. Assessing the integrity of breast implantQ
Ductoscopy
Sonomammogram
Nipple discharge cytology
MRI
Breast