Is there a role of BSE ?

What is the role of CBE in breast cancer

screening
 Do you always do ultrasound as a
complimentary to mammography
Is it complimentary or substitute to M/M
 Indications
Of
contrast enhanced MRI breast today
Should it be done in all cases of newly
diagnosed cases of breast ca
 Is there any role of
PET scan
in staging of early breast ca
 Primary tissue diagnosis

Core needle biopsy / FNAC

Prefence?
 High risk patient
Who is a high risk patient
Is there a method to calculate the risk
 High risk patient
Indications of genetic counseling
Chemoprevention- drugs used
Can chemoprevention be done without
genetic counseling
Sentinal node biopsy- contraindications

Clinical situation- sentinal node negative

on frozen section, micrometastasis on
paraffin section, what is the significance
Optimal investigations for early operable
breast ca

How much to do ?
 - 45 yr old female, 4cms tumor,
clinically axilla negative, ultrasound
abdomen & chest xray normal, bone scan
shows one or two hot spots suspicious for
metastasis
Next what?
Known case of extramammary cancer i.e.
ovarian , endometrial or cx ca
Presenting with a lump breast ? malignant
Intraductal breast ca
Choice of surgery
-BCS
-Mastectomy
-skin sparing mastectomy with
reconstruction
-45 yr old female,premenopausal
-3.5 cm lesion, one node positive no
metastasis, ER & PR positive

Choice of chemotherapy drugs

-50 yr old female,perimenopausal
-2.5 cm lesion, node negative, Mo
-ER & PR positive

Choice of drugs
 Where to use anthracycline
Where to use taxanes
Choice of taxanes
Duration of adjuvant chemotherapy
-Role of Herceptin in adjuvant setting
-IHC positivity & FISH positivity
-Duration of Herceptin
-40 yr old female
-4 cm lesion, node positive
-ER & PR Positive
-Chemotherapy completed
Choice of hormonal manipulation
Ovarian ablation, LHRH agonist or
tamoxifen
Premenopausal females
Only hormonal treatment
Criteria for selection
-Elderly individual 80 yrs
-2 cm lesion, 1 or 2 node positive
-ER & PR positive

Choice of adjuvant treatment

-50 yr old female
-4cm lesion, three L.N. positive
-MRM done
 - Partial breast irradiation
-Selection of patients
- Is it standared of care today in
selected patients
- 75 yr old female
-2cm lesion node negative
-ER & PR strongly positive

Choice of adjuvant treatment

&
Choice of drugs