Benign breast disease
| Nonproliferative | |
| Simple cysts | |
| Proliferative without atypia | |
| Ductal hyperplasia without atypia | No additional treatment |
| Intraductal papilloma |
Can harbor areas of DCIS Surgical excision; 16% upgraded to malignancy |
| Fibroadenoma |
Most common benign breast tumor Excision if symptomatic or growing in size |
| Proliferative with atypia | |
| Atypical ductal/lobular hyperplasia |
Share some cytologic features with DCIS/LCIS Increased RR of subsequent breast cancer (RR 3.7-5.3) in either breast Surgical excision; upgrade in 10-20% |
Mammography - findings categorized in BI-RADS
| BI-RADS 0 | Incomplete assessment | Repeat mammogram or ultrasound |
| BI-RADS 1 | Negative | Screening mammograms |
| BI-RADS 2 | Benign (fibroadenoma, cyst) | Routine follow up |
| BI-RADS 3 | Probably benign (< 2% malignant) | Diagnostic mammogram or US q6-12 mo x 2 years |
| BI-RADS 4 | Suspicious | Consider biopsy |
| BI-RADS 5 | Probably malignant (> 94%) | |
| BI-RADS 6 | Biopsy-confirmed malignancy |
Staging:
| Tx | cannot assess primary tumor |
| T0 | no evidence of primary tumor |
| Tis | Ductal carcinoma in situ (DCIS) Paget's disease of the nipple not a/w underlying DCIS or invasive carcinoma |
| T1 | ≤ 20 mm in greatest dimension |
| .T1mi | ≤ 1 mm |
| .T1a | > 1 mm, ≤ 5 mm |
| .T1b |
> 5 mm, ≤ 10 mm |
| .T1c |
> 10 mm, ≤ 20 mm |
| T2 | > 20 but ≤ 50 mm in greatest dimension |
| T3 | > 50 mm in greatest dimension |
| T4 | Any size invading into chest wall and/or skin (ulceration, macroscopic skin nodules) |
| .T4a | Extension to chest wall, not including only pectoralis muscle adherence/invasion. |
| .T4b | Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d'orange) of the skin, which do not meet the criteria for inflammatory carcinoma. |
| .T4c | Both T4a and T4b |
| .T4d | Inflammatory carcinoma (skin changes involving > 1/3 of breast) |
Operations