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  #1  
Old 11-22-2012
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Default 65 year-old woman with bloody nipple discharge

An otherwise healthy, 65-year-old woman comes to the physician because of bloody discharge from the right nipple for 2 weeks. On examination, no retraction, erosion, or other abnormal change is present. Palpation reveals an ill-defined, I-em nodule located deep in the right areola. Which of the following is the most appropriate next step in diagnosis?

(A) Cytologic examination of nipple discharge
(B) Mammography alone
(C) Ultrasonography
(D) Biopsy under mammographic localization
(E) Mammography followed by fine-needle cytology
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Old 11-22-2012
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D biopsy under mammorgraphy
u wanna find out CA.
bloody discharge mostly likely is intraductal papilloma. however confirm with bx.
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Quote:
Originally Posted by heartbeat View Post
An otherwise healthy, 65-year-old woman comes to the physician because of bloody discharge from the right nipple for 2 weeks. On examination, no retraction, erosion, or other abnormal change is present. Palpation reveals an ill-defined, I-em nodule located deep in the right areola. Which of the following is the most appropriate next step in diagnosis?

(A) Cytologic examination of nipple discharge
(B) Mammography alone
(C) Ultrasonography
(D) Biopsy under mammographic localization
(E) Mammography followed by fine-needle cytology
Yea, I agree. It's mostly D. Biopsy under mamographic localization.

Not A- Because you probably need to confirm after this test either ways.
Not B- Mamagram by itself will not be as informative.
Not C- Intraductal Pappiloma's sometimes small enough to evade USG.
But Why not E ? - My justification is probably because an accurate biopsy including tumor markers, etc. if needed will not be able to be done via an FNAC.
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its NOT E coz. FNAC destroys tissue architecture. so if its a Ca u cant see .
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(E) Mammography followed by fine-needle cytology

You need to have the whole picture.
Quote:
Breast biopsy with needle localization is used for the diagnosis of impalpable breast lesions.
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Last edited by Novobiocin; 11-22-2012 at 08:16 AM.
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i would say D............
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Quote:
Originally Posted by slamdunk View Post
its NOT E coz. FNAC destroys tissue architecture. so if its a Ca u cant see .


Quote:
Diagnostic mammography is performed in symptomatic women (eg, when a breast lump or nipple discharge is found during self-examination or an abnormality is found during screening mammography). This examination is more involved, time-consuming, and expensive than screening mammography and is used to determine the exact size and location of breast abnormalities and to image the surrounding tissue and lymph nodes. Women with breast implants or a personal history of breast cancer will usually require the additional views used in diagnostic mammography.
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Last edited by Novobiocin; 11-22-2012 at 08:24 AM.
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Quote:
Originally Posted by Novobiocin View Post
(E) Mammography followed by fine-needle cytology

You need to have the whole picture.
i think ur right novo.....since the lesion is palpable, we need to search for lesions in other areas of the breast by doing mammography and later proceed with FNA......great catch...
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Quote:
Originally Posted by heartbeat View Post
Which of the following is the most appropriate next step in diagnosis?
(A) Cytologic examination of nipple discharge........

Rule # 1 : Never change your answer
Rule # 2: If in doubt refer to rule #1
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Last edited by Novobiocin; 11-22-2012 at 08:45 AM.
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  #10  
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okie doc. yup you are right!

Last edited by slamdunk; 11-22-2012 at 08:46 AM.
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Old 11-26-2012
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The correct answer is E. Nipple discharge in the non lactating breast may be the presenting sign of a number of diseases, the most common of which are intraductal papilloma, carcinoma, and fibrocystic changes. Carcinoma is more likely in women older than 50. Regardless of whether this sign is present, a clinically malignant palpable mass in a postmenopausal woman should be investigated with mammography followed by fine-needle cytology (or excisional biopsy) MTB3 page 417. The features suspicious for malignancy in this case include ill defined margins of the mass and the hemorrhagic nature of the discharge.

#Cytologic examination of nipple discharge (choice A) may reveal malignant cells but is associated too frequently with false negative results to be reliable.

#Biopsy under mammographic localization (choice D), i.e., a "stereotactic" biopsy, is not necessary in this case because the lesion is palpable and can be easily sampled by fine-needle aspiration or conventional biopsy.
Quote:
Originally Posted by Novobiocin View Post
]Breast biopsy with needle localization is used for the diagnosis of impalpable breast lesions.
Nice
Quote:
Originally Posted by Novobiocin View Post
(A) Cytologic examination of nipple discharge........

Rule # 1 : Never change your answer
Rule # 2: If in doubt refer to rule #1
hhhhha

Last edited by heartbeat; 11-26-2012 at 05:19 AM.
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