A lady who is 9 weeks pregnant comes with a 2.5 cm mass in the upper outer quadrant of left breast. Ultrasound failed to show any abnormality. The ideal management will be to:
Correct Answer: Finger guided core biopsy
Description: Ans. b. Finger guided core biopsy (Ref: Schwartz 9/467; Sabiston19/2035-2037; Bailey 26/818, 25/846)Most breast lesions in pregnancy are benign but biopsy should be done to rule out malignancy. Core-needle biopsy with or without ultrasound guidance is a safe and reliable method for obtaining tissue."Fewer than 25% of the breast nodules developing during pregnancy and lactation will be cancerous. Ultrasonography and needle biopsy are used in the diagnosis of these nodules. Open biopsy may be required. Mammography is rarely indicated because of its decreased sensitivity during pregnancy and lactation; however, the fetus can be shielded if mammography is needed. --Schwartz 9/467"Because of the changes in the breast tissue with pregnancy, imaging modalities may be difficult to interpret. If used with appropriate shielding, mammography carries a limited risk to the fetus. Mammography has a high false-negative rate due to the increased density of the fibroglandular breast tissue, however.: so it has limited usefulness in the evaluation of the pregnant patient. Ultrasonography can safely be performed as an initial evaluation or in conjunction with mammography. Ultrasound is able to distinguish solid from cystic lesions in 97% of patients and is helpful in guiding fine-needle aspiration or biopsy Although MRI does not use ionizing radiation, the two main risks to the fetus from the magnetic field and electromagnetic radiation are heating and cavitation. With other reliable imaging modalities available, MRI is not currently recommended for breast imaging in the pregnant patient. Tissue diagnosis is essential.Core-needle biopsy with or without ultrasound guidance is a safe and reliable method for obtaining tissue. Fine-needle aspiration may be a reliable alternative to core-needle or open biopsy. "--Sabiston 19/2035Breast Career during PregnancyOccurs in 1 of every 3000Q pregnant womenMC non-gynecologic malignancy associated with pregnancyQ.Ductal carcinoma is MC type, accounting for 75-90%Q of breast cancer in pregnancy.Clinical Features:Presents as painless palpable massQ with or without nipple discharge Axillary LN metastases in upto 75% patientsApprox. <25% nodules developing during pregnancy and lactation will he cancerousQPresent at a later stage of disease because breast changes occurring in hormone-rich environment of pregnancy obscure early cancer.Diagnosis:USG and needle biopsyQ are used for diagnosisMammography is rarely indicated due to its decreased sensitivity during pregnancy & lactationTreatment: Mainstay of therapy is surgical resection.Stage I & IIMastectomy with axillary dissectionQLABCNACT after 1st trimester + MRM in 2nd trimester + RT after deliveryQLABC in PregnancyMRM can be performed during first and second trimester (increased risk of spontaneous abortion after first-trimester anesthesia), chemotherapy after first trimester & radiotherapy after delivery.Chemotherapy during first trimester carries a risk of spontaneous abortion & 12% risk of birth defects, given after first trimester.No evidence of teratogenecity by chemotherapy during second and third trimester.Breast cancer in pregnancy have prognosis stage by stage similar to that of non-pregnant patientElective termination of pregnancy to receive appropriate therapy without the risk for fetal malformation is no longer routinely recommended because no improvement in survival has been demonstrated.=
Category:
Surgery
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now