phyllodes - benign, borderline or lagnant
Anatomy and Physiology
Epidemiology
Risk factors
40 to 60 grey of rationation which is usually curative of another malignancy
long duration of breast feeding is protective
DCIS is premalignant so 100% but LCIS is not pre-malignant
OCP more than years, Meno more than 55, menarch less than 12
protective - less than 30 years pregnancy, multiparity, breastfeed more than 6 months,
Gail model - calculates risk from parameters, next 30 yeasr
Genetics
Histology & Anatomy & Spread
valveless veins
Clinical Presentation
ductal hyperplasie
permeation or embolisation
Diagnosis
USG vs mammoprahy
mammogaphy features
classifications
Investigations
FNAC vs Biopsy
FNAC - only cells and not basement membrane, core biopsy - painful, more time
true cut is a brand name
Mammography
non-palpable stuff also can be visualised
Bi-RATS classifications for mamo
started at age 35 for high risk
Staging
(metastatic screenings)
Management
axillary node clearance - upto level 2, level 3 clearance can be done if nodes are hard and sus
sentinel node biopsy - nipple area complex area, dye, radiactive, frozen section biopsy within half hour, they do this first,
assume micromet when node positive
total vs nipple sparing
age - sensitivy is 90% only after 40 years for mamo therefore before 40 USG is recommended
USG - 70%
MRI - expensive every year, if young pt can afford it then breast conservation can be done, other hard for survelliance
Lateral - long
superior - short
skin - superficial
at east three dimensions need to be oriented by the house officer
??
sentinel node guided axillary sampling
lateral - posterior - medial
onco type genetic hifi stuff 40 genes
AI (letrozole, anatrazole, estemesasheevrf) at rish osteoporosis then bisphosphonates
neoadjuvant chemotherapy - chemotherapy before surgery
SUMMARY
FOLLOW UP?
monthly for six months
six monthly till five years
yearly after that
Breast lump case
Surgery made easy case
Mastectmy post operative case
Post mastectomy case
Gynaecmastia case
Ariyathna
Ariyathne 2
Banagala
Cases
prep ladder
Prep Ladder
MARROW
