OncoLog, Volume 46, Number 11/12, November/December 2001 Page: Clinical Discussion
12 p. : ill.View a full description of this periodical.
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mammogram and s uaeiine tavaiiaoie
ultrasound __on the Internet)
Tissue diagnosis by image-guided FNA or
ACR category core biopsy* or excisional biopsy** after Excisional
4 or 5 needle localization biopsy No
FNA or core biopsy
Ateyrpiaia Excise Benign?
or radial scar
Diagnostic
Pathologic Benign mammogram Yes
diagnosis concordant with Yes in 6-12 months
Specimen radiograph to confirm presence diagnostic imaging
of mammographically suspicious calcification studies? No Return to appropriate
in the cores. screening (Panel 1)**
* Intraoperative specimen radiograph if Repeat imaging Refer to Breast
microcalcifications or occult mass. and biopsy Malignant Cancer Practice
**This chart is available on the Internet and was Guideline (available
published in the Fall 2001 issue of Compass. on the Internet)
ACR = BI-RADS, Breast Imaging Reporting and
Data System of the American College of Radiology
FNA = fine-needle aspirationVer:Compass/3/4/#4
LAIl 11116 FI'13Ul" ' 1 " I 47 '"11O
the nipple to express fluid is no
longer recommended for clinical
assessment or self-examinations in
women who have no symptoms of
breast abnormality. However, further
evaluation is indicated for spontaneous
nipple discharge noted on the bra or
nightgown. Imaging studies followed
by ductal excision are indicated in
cases where discharge is spontaneous,
unilateral, appears to come from
a single duct, and is either clear
serious ) or bloody. In such a setting,
ductography is often useful to provide
a roadmap for surgical excision of the
duct. Testing the discharged fluid for
occult blood is not necessary, as it
would not change the treatment.
Skin Changes
One of the most common
diagnostic errors, according to Dr.
Bevers, is when symptoms of redness
and swelling of the breast are treated
as an infection. In the absence of an
obvious cause for mastitis (such as
breast feeding), these symptoms-
especially in women more than 35
years old-are highly suspicious and
should be considered to be cancerous
until proven otherwise. In this setting,
Dr. Bevers advises extensive diagnostic
testing. "Keep looking, even in the
face of normal findings," she says,
"until an absolutely satisfactory
explanation is reached or a cancer
diagnosis is made."
Authors' Perspectives
Failing to diagnose breast cancer
or failing to diagnose it in a timely
fashion places both patient and
physician at risk. Our experts advise:
" A methodical workup according to the
guidelines. A sequenced, structured
approach helps, says Dr. Stelling,
in terms of both allaying patient(Continued on next page)
Breast Screening/Diagnostic Guidelines (5)
ABNORMAL FINDINGS ON CLINICAL BREAST
EXAM AFTER BOTH BREASTS EXAMINED: Clinical follow-up as indicated
NIPPLE DISCHARGE Educate patient to stop milking of
< 40 yr nonspontaneous nipple discharge
Instruct patient to report any Continue appropriate screening
Nonspontaneous and spontaneous discharge (Panel 1)*
Educate patient to stop milking of
- ischnreruACR category nonspontaneous nipple discharge
1 or 2 Instruct patient to report any
spontaneous discharge
-_4 r Diagnostic
mammogram Refer to mammographic
abnormality (Panel 2)*
ACR category Educate patient to stop milking of
0, 3, 4, or 5 nonspontaneous nipple discharge
Instruct patient to report any
spontaneous discharge
Bilateral and milky Endocrine evaluation physician I Return to appropriate
discharge Rule out pregnancy referral and screening (Panel 1)*
disposition
No
ACR category Ductogram and
Spontaneous,- 1, 2, or 3 dutxcsn Malignant?
2or3 duct excision
unilateral,
single duct, and Diagnostic Yes
serous or mammogramYe
sanguinous No
discharge ACR category Cancer
4 or5 dagnoedRater to Breast Cancer Practice
Yes Guideline (available on the
Internet)
Consider ductogram if necessary
to establish two different
etiologies for discharge* This chart is available on the Internet and was
published in the Fall 2001 issue of Compass.
ACR = BI-RADS, Breast Imaging Reporting and
Data System of the American College of RadiologyData System of the American College of Radiology Ver:Cowpass/3/4/#5
Ver:Cormpass/3/4/#5
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University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 46, Number 11/12, November/December 2001, periodical, November 2001; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth903627/m1/5/: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.