Review
ABSITE questions we miss by Dr. Meyers: 1/29/2009
Breast:
1. Rx intraductal papilloma.
Most commonly present with bleeding/bloody nipple d/c. Generally resect via major duct excision or needle loc if seen on imaging. Remember, this isn’t malignant or premalignant, it’s a benign condition.
2. Anat level 3 LN’s (8 senior residents missed this in 2005)
Never know how ? was written, so may have been misleading. But remember pec minor separates levels of axilla. I= lateral to II=posterior to and III= medial to pec minor and extends to Halstedt’s ligament/thoracic inlet.
3. Contraindications to BCT in stage I breast cancer. (8 senr residents missed 2005)
Prior irradiation, inability to get negative margins, inappropriate size/breast ratio, inflammatory breast cancer. This was from 2005, so they may have wanted you to say a T3/4 tumor is a contraindication. It probably is if you don’t give neoadjuvant chemo, so if that’s the picture that is painted, then that’s the answer. Remember: + nodes is not a contraindication to BCT.
4. Breast tumor indic for SLN.
For our purposes, SLN indicated for any invasive cancer except T4. For test purposes, they might restrict it to T1 or T2 tumors. Of course, any patient with clinically proven nodes is not a SLN candidate, they need an ALND. Remember, mastectomy not a contraindication for SLN. Also remember, on the test DCIS is not an indication unless undergoing mastectomy (in real life there are a couple others, but those are gray areas).
5. Rx DCIS.
Remember, this is a form of breast cancer. Don’t need to worry about nodes (see above), but rx is same as invasive cancer. BCT + XRT or mastectomy.
6. Rx DCIS in male.
Mastectomy. (same is true for invasive cancer)
7. Rx Ca breast with negative SLN.
Do not need to do ALND. Only need to attend to breast which will be either BCT or mastectomy depending on tumor. This question may have been getting at additional therapy. Any ER+ tumor would get Tamoxifen x 5 years. In older
Breast:
1. Rx intraductal papilloma.
Most commonly present with bleeding/bloody nipple d/c. Generally resect via major duct excision or needle loc if seen on imaging. Remember, this isn’t malignant or premalignant, it’s a benign condition.
2. Anat level 3 LN’s (8 senior residents missed this in 2005)
Never know how ? was written, so may have been misleading. But remember pec minor separates levels of axilla. I= lateral to II=posterior to and III= medial to pec minor and extends to Halstedt’s ligament/thoracic inlet.
3. Contraindications to BCT in stage I breast cancer. (8 senr residents missed 2005)
Prior irradiation, inability to get negative margins, inappropriate size/breast ratio, inflammatory breast cancer. This was from 2005, so they may have wanted you to say a T3/4 tumor is a contraindication. It probably is if you don’t give neoadjuvant chemo, so if that’s the picture that is painted, then that’s the answer. Remember: + nodes is not a contraindication to BCT.
4. Breast tumor indic for SLN.
For our purposes, SLN indicated for any invasive cancer except T4. For test purposes, they might restrict it to T1 or T2 tumors. Of course, any patient with clinically proven nodes is not a SLN candidate, they need an ALND. Remember, mastectomy not a contraindication for SLN. Also remember, on the test DCIS is not an indication unless undergoing mastectomy (in real life there are a couple others, but those are gray areas).
5. Rx DCIS.
Remember, this is a form of breast cancer. Don’t need to worry about nodes (see above), but rx is same as invasive cancer. BCT + XRT or mastectomy.
6. Rx DCIS in male.
Mastectomy. (same is true for invasive cancer)
7. Rx Ca breast with negative SLN.
Do not need to do ALND. Only need to attend to breast which will be either BCT or mastectomy depending on tumor. This question may have been getting at additional therapy. Any ER+ tumor would get Tamoxifen x 5 years. In older