Breast Surgery — Flashcards

Flashcard 11: What breast sx involves removal of palpable extent of breast + Nipple areola complex + overlying skin + level I axillary lymph nodes?_____

Answer: Extended simple mastectomy

Flashcard 12: According to the T category under AJCC classification of breast cancer, tumor with macroscopic changes incl. ulceration and satellite skin nodules is _____

Answer: T4b

Flashcard 13: What is the recommended management for a patient with Ductal Carcinoma In Situ (DCIS) and a Van Nuys Prognostic Index (VNPI) score of 7, 8, or 9?

Answer: Breast-conserving surgery (excision) + Radiotherapy

Extra: The Van Nuys Prognostic Index (VNPI) guides the treatment of Ductal Carcinoma In Situ (DCIS) based on tumor size, margin width, nuclear grade/necrosis, and age. Scores and recommended management: • 4, 5, 6: Excision alone • 7, 8, 9: Excision + Radiotherapy • 10, 11, 12: Mastectomy

Flashcard 14: A Silverstein Van Nuys Prognostic Index (VNPI) score of 4, 5, or 6 is managed with _____

Answer: Excision alone

Extra: The Silverstein Van Nuys Prognostic Index (VNPI) for DCIS determines treatment based on total score (4–12). **Management by Score:** * **4, 5, 6:** Excision alone (Low risk) * **7, 8, 9:** Excision + Radiotherapy (Intermediate risk) * **10, 11, 12:** Mastectomy (High risk) **Parameters (each scored 1 to 3):** 1. **Size:** <15mm, 16–40mm, >40mm 2. **Margin:** ≥10mm, 1–9mm, <1mm 3. **Pathology:** Non-high grade w/o necrosis, Non-high grade w/ necrosis, High grade 4. **Age:** >60y, 40–60y, <40y *Note: Some modified protocols allow excision alone for a score of 7 if the margin is ≥ 10 mm.*

Flashcard 15: The latest guidelines for the management of breast abscess specify that _____ aspirations under antibiotic cover should be attempted before an incision and drainage is done

Answer: multiple

Flashcard 16: According to the Van Nuys Prognostic Index (VNPI) for DCIS, what is the recommended management for a patient with a score of 7, 8, or 9?

Answer: Excision + Radiation therapy

Extra: The Van Nuys Prognostic Index (VNPI) is used to guide the management of Ductal Carcinoma In Situ (DCIS) based on the risk of local recurrence. **Parameters (scored 1-3 each):** 1. Tumor size 2. Margin width 3. Pathological classification (Nuclear grade & necrosis) 4. Age **Management based on score:** * **4, 5, 6:** Excision (Breast Conserving Surgery) alone * **7, 8, 9:** Excision + Radiation therapy * **10, 11, 12:** Mastectomy

Flashcard 17: Breast tumors more than _____ centimeters in diameter are included under locally advanced breast cancer (LABC)

Answer: 5

Flashcard 18: What breast sx involves removal of all of breast + Nipple areola complex + overlying skin + level I+II+/-III axillary lymph nodes (Pec. minor divided)?_____

Answer: Scanlon's Modified radical mastectomy

Flashcard 19: A Silverstein-Van Nuys Prognostic Index (VNPI) score of 8 is managed with _____

Answer: Excision + Radiation Therapy (RT)

Flashcard 20: What breast sx involves removal of all of breast + Nipple areola complex + overlying skin + level I+II+/-III axillary lymph nodes (Pec. minor removed)?_____

Answer: Patey's Modified radical mastectomy