25 Breasts

Inflammatory Breast Carcinoma

Inflammatory breast cancer can be easily confused with mastitis, as there is usually no palpable breast mass and ultrasound and mammography similarly are often negative. As such, it is imperative to perform a biopsy of the skin, which may show cancer cells invading the subdermal lymphatics. Additional workup should include a breast MRI (which is more likely to show the breast cancer in this setting than ultrasound and mammogram), as well as consideration for needle biopsy of the lymph nodes.

New Bumps

A diagnostic mammogram should be ordered in a woman over the age of 30 who presents with a new breast mass. Mammography helps to look for suspicious calcifi cations in other areas of the affected breast, characterize the mass, as well as evaluate the contralateral breast. It is important to note that the mammogram may be normal despite the presence of a palpable breast cancer. For this reason, a tissue biopsy is recommended for palpable breast masses regardless of the mammogram results. Tissue sampling is best performed via ultrasound-guided core needle biopsy. Ultrasound also provides more information about the mass (cystic vs. solid). Fine-needle aspiration (B) is rarely used as it relies on cytology rather than histology. MRI (C) is not routinely needed. Follow-up examination in 3 months (D) without a biopsy would be inappropriate. Genetic testing (E) would be indicated if this patient had a strong family history of breast or ovarian cancer, but would not be done until tissue diagnosis of breast cancer is confi rmed.

Invasive Ductal

• lumpectomy, sentinal node biopsy, radiation to breast, chemo