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Investigations for Cancer Breast |
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Written by Administrator
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Friday, 11 December 2009 07:10 |
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Investigations for Cancer Breast:
(I) For early detection of CA. breast:
· The aim is to diagnose CA. breast in stage I or stage II as the prognosis is better with the earlier diagnosis . this is done by:
(1) Mass examination of women in cancer age in special clinics:
µ To become "cost effective" it is localized to high risk groups:
a- Spinsters above the age of 30.
b- Nullipara or first full term above 30 ys of age .
c- Family history of CA. breast in 1st degree relatives.
d- Carcinoma of contra lateral breast.
µ Annual examination is recommended.
(2) Self examination:
All women above the age of 30 ys instructed to examine her breast infront of a mirror for:
a- Dimpling, nipple retraction.
b- Change in the size and level. c- Palpation of a mass.
(3) Mammography :
Types:
1- Ordinary soft tissue radiography using x ray film .
2- Xeroradiography: using special aluminum plate with an electrically charged selenium layer.This type can give a more clear positive film.
Indications:
1- Detection of impalpable CA. breast "To".
2- Differentiation bet. benign & Q malignant lump.
3- Annual examination of high risk group
Findings Benign lesion Malignant lesion - Homogenous opacity with smooth border
- Coarse calcification in 30% of cases
- No 2ry changs in the breast skin or nipple
dense at the center with irregular speculated border
Microcalcification in 30% of cases thickened skin, nipple retraction and high vascularity
(4) Thermography:
Idea: Malignancy = vasularity =temp.
Fallacies :
1- Infection ® False + ve results.
2- Some tumours are not hot ® False -ve results.
(5) Ultrasonography:
Indications:
a- Instead of mammography in radiologically dense breasts. ® for diagnosis of carcinoma.
b- Ultrasonic guided needle biopsy.
(II) For pre-operative histopathological diagnosis:
(1) Fine needle aspiration cytology:
Better done under ultrasonic guide.
It need a skilled pathologist.
(2) Core needle biopsy "true cut needle biopsy".
Small incision is done under local anaesthesia then ®
The needle is introduced to take a core of tissues.
It is accused by causing dissemination ?
(3) Excision biopsy:
For suspicious small lumps giving - ve F.N.A.C. & - ve C.N.B.
(4) Frozen section section biopsy:
ÄDisadvantages:
1- Prolong the time of operation.
2- The patient cann't know if she was going to remove breast or not .
(III) For detection of metastasis:
1- Chest x-ray ® pulmonary and pleural metastasis .
2- Bone scanning ® osteolytic metastases.
3- Liver scanning ® In 5% of cases .
(IV) Follow up after surgey SOURCE: Prof. AYMAN SALEM'S BOOK
Copyright: (Vascular Society of Egypt ) & (Medical Educational web)
Not to be reproduced without permission of Vascular Society of Egypt
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