1. The Breast Clinic Index case Year 2 Michaelmas term

2. 37 year old lady Noticed lump in right breast 2 weeks ago

3. 45 year old woman Noticed lump in breast two weeks ago

4. 28 year old woman Noticed lump in left breast two weeks ago

5. 65 year old man Noticed lump in breast two weeks ago

6. You are doctor in breast clinic You have 15 mins with this patient and have to decide what the lump is likely to be due to What are you going to ask in the history? What are you going to examine?

8. Discussion- What are the common causes of a breast lump?

9. Discussion What specific questions would you ask in the history to help differentiate between the different causes of breast lump?

10. Discussion What specific things would you check on examination of the breast What other parts of the body would you examine?

11. After 15 mins What happens to the patient next?

12. Triple Assessment History and Examination Breast Imaging Histology if solid lump

13. Breast Imaging Mammography Ultrasound Ultrasound guided core biopsy

14. Typical appearance of a breast cancer on mammography

15. Features of breast cancer on mammography Radio-opaque area or mass Irregular edges with fine lines (spiculation) Calcification Asymmetry DCIS may be seen as micro calcification- like sand

16. Ultrasound breast cancer

18. Ultrasound of the breast mass Solid mass Dark with shadowing behind Can measure and then biopsy the mass Ultrasound the ipsilateral axilla to look for enlarged Lymph nodes Give radiological Score of 1 to 5

19. Ultrasound guided biopsy

20. Histological diagnosis Ultrasound guided core biopsy using a large needle and taking several cores under local anaesthetic Occasionally do fine needle cytology if v small lesion or technically difficult e.g near implant

21. Histological types Adenocarcinoma: Ductal 75% Lobular 10% Other types 10-15% Define grade of tumour, 1 to 3 Immunohistochemical staining for receptors: oestrogen, HER2 Give Histological score of 1 to 5

22. Multidisciplinary Team Breast Clinicians, Radiologists, Pathologists, Nurses, Data managers Review of Clinical, Imaging and Pathology Check all correlate Plan of treatment decided for patient Avoids mistakes being made!