Breast Surgery RPN Perioperative Program

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Questions and Answers

What characterizes lobular carcinoma in situ (LCIS)?

Abnormal cells in the lining of a duct

Abnormal cells in the lining of a lobule (correct)

Cancer that has spread to other organs

A tumor size over 5 cm with lymph node involvement

Which surgical procedure is typically performed when the tumor size is less than 2 cm with no axillary lymph node involvement?

Simple Mastectomy

Sentinel Lymph Node Biopsy

Axillary Lymph Node Dissection

Lumpectomy (correct)

In the context of specimen management, what is the purpose of the 'Silk Marking Stitch'?

To prevent specimen contamination

To signify the specimen has been processed

To ensure tissue orientation for analysis (correct)

To label the specimen for identification

What factor is NOT typically considered when determining surgical treatment options?

Emotional impact of diagnosis Signup and view all the answers

In the sequence of specimen communication, who should verify the completed specimen form before sending it to the lab?

Circulating Nurse Signup and view all the answers

What is the main purpose of a Sentinel Lymph Node Biopsy?

To determine the prognosis of the diagnosis Signup and view all the answers

Which statement accurately describes a Modified Radical Mastectomy?

It includes the removal of breast tissue and all axillary contents. Signup and view all the answers

What is the key difference between an Incisional biopsy and an Excisional biopsy?

An Excisional biopsy removes the entire mass with a small margin. Signup and view all the answers

Which of the following is a characteristic feature of a fibroadenoma?

Painless, solid mass Signup and view all the answers

What is the primary blood supply to the breast?

Internal mammary artery Signup and view all the answers

In the context of SLNB, what does a positive result indicate?

There is a requirement for axillary dissection and adjunctive therapy. Signup and view all the answers

Why does the surgeon wait in the operating room during the 'Quick Section' results?

To prepare for the next surgical step. Signup and view all the answers

What differentiates a sentinel node biopsy from an axillary node biopsy?

Sentinel node biopsy targets the first draining lymph node Signup and view all the answers

Which procedure could be combined with a Lumpectomy?

Sentinel Lymph Node Biopsy Signup and view all the answers

Which screening method is recommended for women aged 55 and older?

Biennial screening Signup and view all the answers

What is the purpose of using a Gamma-Tracer Probe during the SLN biopsy?

To identify the sentinel lymph node. Signup and view all the answers

What type of biopsy is considered the preferred method due to its cost-effectiveness and minimal invasiveness?

Core needle biopsy Signup and view all the answers

Which risk factor is NOT associated with breast cancer?

Regular exercise Signup and view all the answers

What is the primary reason for conducting an Axillary Lymph Node Dissection?

To confirm the stage of disease. Signup and view all the answers

Which statement about mammography is true?

It can detect masses smaller than 1 cm Signup and view all the answers

What is the significance of the TNM classification in breast cancer staging?

It evaluates tumor size, node involvement, and metastasis Signup and view all the answers

Which benign lesion is characterized by tissue inflammation and fibrosis with possible nipple discharge?

Ductal ectasia Signup and view all the answers

Which type of imaging is particularly useful for staging tumors in dense breast tissue?

MRI Signup and view all the answers

Study Notes

Overview of Breast Surgery

Breast surgeries aim to diagnose and treat various breast diseases, primarily breast cancer, the most common cancer among women.
Incidence of breast cancer is about 1 in 8 women, with early detection leading to decreased rates.

Anatomy of the Breast

Breasts consist of bilateral mammary glands extending from the 2nd to the 6th rib.
Structures include 12 to 20 lobes, each with a single duct that opens at the nipple, surrounded by a pigmented areola.
The Tail of Spence extends laterally towards the axilla.

Blood Supply & Lymphatics

Blood is supplied by the internal mammary artery, intercostal arteries, and pectoral branches of axillary arteries.
Lymphatic drainage primarily follows blood vessels to axillary and internal thoracic nodes.

Nerve Supply

Nerve innervation comes from anterior lateral intercostal nerves, medial intercostal nerves, and the cervical plexus.

Benign Breast Lesions

Common types include:
- Fibroadenoma: Solid, painless mass, most prevalent among women under 30.
- Fibrocystic Changes: Tender, mobile, often fluctuates in size.
- Ductal Ectasia: Inflammation with nipple discharge.
- Intraductal Papilloma: Non-palpable mass causing nipple discharge.

Breast Cancer Risk Factors

Key risk factors include age, genetic predisposition (BRCA1), previous breast cancer history, radiation exposure, family history, obesity, and dense breast tissue.

Screening Technologies

Annual screenings recommended for women aged 45-55; biennial screenings for those over 55.
High-risk individuals should start screenings at 30.
Common technologies:
- Mammography: Detects abnormalities as small as 1 cm.
- Ultrasound: Differentiates solid from cystic lesions.
- MRI: Assists with dense tissue imaging and tumor staging.
- Molecular Breast Imaging: Detects cancers in dense tissues missed by mammograms.

Diagnostic Testing Methods

Fine-Needle Aspiration Biopsy (FNAB): Differentiates solid vs. cystic masses; uses a small needle to collect tissue.
Core Needle Biopsy: More accurate and cost-effective, ideal for palpable and suspicious lesions.
Open Breast Biopsy: Obtains tissue for diagnosis from the lesion site.

Staging of Breast Cancer

Cancer is classified using the TNM system: Tumor size, lymph node involvement, and metastasis.
Stages range from 0 (in situ) to 4 (spread to other organs).

Surgical Treatment Options

Options depend on tumor characteristics and patient preferences:
- Lumpectomy: Removal of tumor plus surrounding tissue.
- Sentinel Lymph Node Biopsy: Removes a limited number of lymph nodes for staging.
- Axillary Lymph Node Dissection: Removes several lymph nodes for comprehensive staging.
- Simple Mastectomy: Entire breast removal without lymph node dissection.
- Modified Radical Mastectomy: Removal of breast tissue and axillary nodes, sparing the chest muscle.

Surgical Considerations

Perioperative care includes managing emotional impact, ensuring specimen management, and maintaining sterile instruments.
Proper communication regarding specimen handling, marked with "Silk Marking Stitch" for orientation.

Important Surgical Instruments

Lahey Thyroid Forcep: Retrieves breast biopsy specimens.
Gamma-Tracer Probe & Methylene Blue Dye: Used for identifying sentinel lymph nodes during SLNB procedures.

Post-Operative Monitoring

Close observation for surgical site healing, management of pain, and monitoring for potential complications such as lymphedema.

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Description

This quiz focuses on the critical aspects of breast surgery, including anatomy, identifying benign vs. malignant lesions, and understanding surgical interventions. It also covers the importance of specimen handling and various surgical techniques such as sentinel node biopsies. Test your knowledge on key concepts related to breast disease management.