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0 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | Radiologic Examination Mammography Ultrasound | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
1 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | Magnetic Resonance Imaging | 6 | 0.025 | 0.037 | 0.041 | 0.068 | 0.079 | 0.085 | 0.085 | 6 |
2 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | Pathologic Examination Triple-Test Evaluation Fine-Needle Aspiration Core Needle Biopsy | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
3 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | The Young Patient The Pregnant Patient | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
4 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | Fat Necrosis Hamartomas | 6 | 0.015 | 0.023 | 0.047 | 0.068 | 0.091 | 0.099 | 0.099 | 6 |
5 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | The breast mass is the most common symptom of women presenting to breast centers, accounting for more than half of the complaints. Although most are benign, the presence of a mass can cause considerable anxiety because of the concern for cancer. The most important task of the physi- cian evaluating a breast mass is to ... | 6 | 0.05 | 0.09 | 0.08 | 0.07 | 0.06 | 0.04 | 0.09 | 2 |
6 | Management of the Palpable | CHAPTER CONTENTS | null | nan nan | The presence of a mass should never be dismissed because of young age, male gender, or a lack of risk fac- tors such as a family history of cancer. Diagnostic delays of breast cancer are a common cause for litigation, and such claims are most frequently seen for non-Hispanic white women in their 40s who are premenopaus... | 6 | 0.095 | 0.1 | 0.075 | 0.06 | 0.03 | 0.025 | 0.1 | 2 |
7 | Management of the Palpable | HISTORY | null | nan nan | A thorough history is the first step in the proper evaluation of any breast mass. Historical elements must, at bare mini- mum, include a proper breast history which includes cur- rent and prior symptoms, risk factors for cancer, and the patient’s gynecologic and menstrual history. The etiology of | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
8 | Management of the Palpable | HISTORY | null | nan nan | previous masses should be detailed, and specifics about any current and prior breast problems must include the charac- ter, frequency, severity, and duration of the issue. | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.045 | 0.035 | 0.09 | 1 |
9 | Management of the Palpable | HISTORY | null | nan nan | Breast evaluation nearly always includes diagnostic imaging. The complete history must therefore include details about mammograms, ultrasounds, and magnetic resonance imaging (MRI), including the dates, findings, and follow-up for abnormalities on these studies. Although annual mam- mographic screening is currently rec... | 6 | 0.098 | 0.076 | 0.034 | 0.089 | 0.092 | 0.089 | 0.098 | 1 |
10 | Management of the Palpable | HISTORY | null | nan nan | Other symptoms such as palpable lymph nodes, breast pain, skin changes, nipple inversion, and the character of any discharge (including color, bilaterality, number of ducts involved, and spontaneity) should also be assessed, as these complete the history and may narrow the differential diagno- sis. While a complete rev... | 6 | 0.05 | 0.09 | 0.08 | 0.07 | 0.06 | 0.08 | 0.09 | 2 |
11 | Management of the Palpable | HISTORY | null | nan nan | Past medical history may also shed light on current findings, either clarifying an ongoing process, or sug- gesting something that can recur over a woman’s life- time. Mass-forming lesions are listed in Table 4-2. Certain | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
12 | Management of the Palpable | HISTORY | null | nan nan | benign entities may present as a recurring mass, such as pseudoangiomatous stromal hyperplasia, fibroadenomas, duct ectasia, mastitis, or abscess formation. | 6 | 0.015 | 0.023 | 0.046 | 0.078 | 0.091 | 0.087 | 0.091 | 5 |
13 | Management of the Palpable | HISTORY | null | nan nan | A discussion of past surgical history, including breast surgeries and needle biopsies, often reminds patients to | 6 | 0.025 | 0.037 | 0.048 | 0.019 | 0.065 | 0.023 | 0.065 | 5 |
14 | Management of the Palpable | HISTORY | null | nan nan | mention prior benign conditions such as fibrocystic change, simple cysts, fibroadenomata, and fat necrosis. Knowledge of a patient’s prior breast pathology is important for overall assessment and to help determine their risk of cancer. Often, patients are unfamiliar with specifics of their pathology and simply told tha... | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.04 | 0.03 | 0.09 | 1 |
15 | Management of the Palpable | HISTORY | null | nan nan | In men, the history should include additional questions about hepatic dysfunction, sexual dysfunction, and current medications to rule out potential causes of gynecomastia which can present as a central breast mass. Clearance of tes- tosterone can be impaired by hepatic dysfunction, resulting in increased peripheral co... | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.045 | 0.035 | 0.09 | 1 |
16 | Management of the Palpable | PHYSICAL EXAMINATION | null | nan nan | A presenting symptom that is designated as a new breast “mass” can span everything from a barely perceptible thick- ened region of the breast to a large fungating cancer or severe adenopathy. Physical examination is important prior to any diagnostic imaging so that the study can be chosen and targeted appropriately, an... | 6 | 0.001 | 0.099 | 0.099 | 0.099 | 0.099 | 0.099 | 0.099 | 2 |
17 | Management of the Palpable | PHYSICAL EXAMINATION | null | nan nan | In some cases, the physician will not detect any abnor- mality on the clinical breast examination even after focusing on the area of concern. In this situation, the patient should be reassured about the absence of worrisome findings and the physician should recheck to ensure that a screening mammogram has been performe... | 6 | 0.095 | 0.087 | 0.063 | 0.1 | 0.025 | 0.01 | 0.1 | 4 |
18 | Management of the Palpable | PHYSICAL EXAMINATION | null | nan nan | FIGURE 4-1 General schema for initial evaluation of a mass on examination based on its palpable characteristics. On presentation with the complaint of a mass, four findings can occur: (i) No abnormality noted, | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.06 | 0.055 | 0.09 | 1 |
19 | Management of the Palpable | PHYSICAL EXAMINATION | null | nan nan | (ii) a thickening that may be either uncertain or equivocal, (iii) a clini- cally benign mass, or (iv) a clinically suspicious mass. These characteristics determine the next appropriate step in evaluation. When the characteristics of a thickening are equivocal or uncer- tain, imaging is indicated. | 6 | 0.025 | 0.037 | 0.041 | 0.068 | 0.092 | 0.075 | 0.092 | 5 |
20 | Management of the Palpable | PHYSICAL EXAMINATION | null | nan nan | masses is limited, a follow-up examination in 2 to 3 months after the initial visit is appropriate. | 6 | 0.01 | 0.095 | 0.08 | 0.07 | 0.06 | 0.04 | 0.095 | 2 |
21 | Management of the Palpable | PHYSICAL EXAMINATION | null | nan nan | When the examination is complete, the patient can be characterized as having four possible findings: (i) no abnor- mality present, (ii) a thickening without the characteristics of a dominant mass, (iii) a dominant mass with benign char- acteristics on palpation, or (iv) a dominant mass with malig- nant characteristics ... | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.03 | 0.02 | 0.09 | 1 |
22 | Management of the Palpable | PHYSICAL EXAMINATION | Documentation | nan nan | The documentation of any findings present on physical examination should be performed consistently and include a description of the superficial appearance of the breasts, including the skin, nipples, and areolae, as well as whether a mass or retractions can be detected by observation alone, or with movement. Exanthems,... | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.045 | 0.035 | 0.09 | 1 |
23 | Management of the Palpable | PHYSICAL EXAMINATION | Documentation | nan nan | When documenting the characteristics of a mass, detail is of the utmost importance as it assists in the formulation of a differential diagnosis. Many women have diffusely nodu- lar breasts and therefore the size of the mass and its loca- tion should be detailed. At minimum, the mass should be described by indicating th... | 6 | 0.005 | 0.098 | 0.1 | 0.097 | 0.093 | 0.095 | 0.1 | 3 |
24 | Management of the Palpable | PHYSICAL EXAMINATION | The Axilla | nan nan | The location of some masses may be difficult to distinguish between being present in the tail of the breast or the low axilla. Although normal lymph nodes are usually not pal- pable, small nonsuspicious lymph nodes may be detectable especially in thin individuals, often described as “shotty” | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.04 | 0.03 | 0.09 | 1 |
25 | Management of the Palpable | PHYSICAL EXAMINATION | The Axilla | nan nan | nodes (the term originating from and referring to shot or pellets of lead and not “shoddy,” as in poor quality). Lymph nodes may vary in size from several millimeters to several centimeters when abnormally enlarged, and tend to be dis- crete oblong nodules that have greater freedom of move- ment than breast parenchymal... | 6 | 0.015 | 0.023 | 0.047 | 0.068 | 0.092 | 0.076 | 0.092 | 5 |
26 | Management of the Palpable | PHYSICAL EXAMINATION | The Male Breast | nan nan | In men, there is usually less breast tissue, except in those with gynecomastia. Most of the breast tissue is located behind and concentric to the nipple–areola complex, and gynecomastia is typically described as disc-like or plate- like. Eccentricity in relation to the nipple and areola should be noted as such lesions ... | 6 | 0 | 0.1 | 0.05 | 0.025 | 0.075 | 0.09 | 0.1 | 2 |
27 | Management of the Palpable | RADIOLOGIC EXAMINATION | Mammography | nan nan | When possible, mammograms should be obtained prior to a biopsy of any mass because of the consequent mammographic changes that may occur. The two exceptions to this are in evaluating the pregnant and very young patient | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.01 | 0.02 | 0.09 | 1 |
28 | Management of the Palpable | RADIOLOGIC EXAMINATION | Mammography | nan nan | (covered below). Hann et al. reviewed mammographic results immediately after stereotactic biopsy, and demonstrated that among 113 cases, 76% demonstrated changes due to the core biopsy, with 58 (51%) having a core biopsy–induced hema- toma (5). There were 31 (27%) lesions where the visualized lesion size changed, and t... | 6 | 0 | 0.094 | 0 | 0 | 0 | 0 | 0.094 | 2 |
29 | Management of the Palpable | RADIOLOGIC EXAMINATION | Mammography | nan nan | Prior mammograms from outside facilities should be obtained for comparison prior to any intervention. Review of all imaging by all treating physicians is critical for correla- tion to the palpable abnormality. If a breast cancer is diag- nosed histologically without the use of bilateral imaging, the clinician should en... | 6 | 0.09 | 0.085 | 0.075 | 0.1 | 0.095 | 0.09 | 0.1 | 4 |
30 | Management of the Palpable | RADIOLOGIC EXAMINATION | Mammography | nan nan | The inability to see a palpable mass on mammogram should prompt an ultrasound, but the inability to see the lesion on either set of imaging does not mean that the lesion should be disregarded. If the lesion is discrete, biopsy should be performed. MRI is sometimes performed as an additional step to evaluate a mass that... | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.045 | 0.035 | 0.09 | 1 |
31 | Management of the Palpable | RADIOLOGIC EXAMINATION | Mammography | Mammography in Men nan | Although mammography in men may confirm that a mass is of low clinical suspicion or assist in cases where body habi- tus makes a patient’s physical examination more difficult, it generally adds little to the workup of the palpable breast mass. The physical examination in males is particularly important, largely because... | 6 | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 1 |
32 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Cyst Evaluation nan | Cysts are most frequently seen between the ages of 40 and 49 years (8) but account for only 10% of masses in women | 6 | 0.005 | 0.02 | 0.03 | 0.07 | 0.06 | 0.01 | 0.07 | 4 |
33 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Cyst Evaluation nan | younger than 40, and 25% of masses in women overall (3). More than half of all women who have cysts develop more one than during their lifetime, which may present synchro- nously or metachronously. Ultrasound can characterize them as simple, containing a smooth, thin wall that is well circumscribed with few internal ec... | 6 | 0.07 | 0.06 | 0.08 | 0.07 | 0.08 | 0.08 | 0.08 | 3 |
34 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Cyst Evaluation nan | For those in whom the cyst recurs, repeat aspiration is acceptable, although with multiple recurrences, a mammo- gram (because of the small increase in risk of malignancy) and ultrasound (to further evaluate the cyst) should be con- sidered, and excision is an option primarily reserved for a suspicious lesion or when r... | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.04 | 0.03 | 0.09 | 1 |
35 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Solid Mass Evaluation nan | under 35 years of age in whom a clinical diagnosis of a fibroadenoma was made. Although imaging and histologic evaluation in this subset was not specified, in the 77 women where the mass persisted, only 56 (72%) were confirmed his- tologically to be fibroadenomas by FNA (13). | 6 | 0 | 0.098 | 0.094 | 0.098 | 0.098 | 0.098 | 0.098 | 2 |
36 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Solid Mass Evaluation nan | Combining imaging and physical examination for evalu- ation of the palpable mass improves cancer detection over imaging alone. van Dam and colleagues found that in their series of 201 patients, ultrasound and mammogram each had respective sensitivities for cancer detection of 78% and 94% and specificities of 94% and 55... | 6 | 0.06 | 0.03 | 0.02 | 0.01 | 0.01 | 0.01 | 0.06 | 1 |
37 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Solid Mass Evaluation nan | sound had a 76% sensitivity for cancer and an 88% specific- ity. Most notable was the significant sensitivity advantage that ultrasound had over mammography in women aged 45 and younger (85% vs. 72%), suggesting that ultrasound is a critical addition to mammography in the evaluation of breast lesions in young women (15... | 6 | 0.09 | 0.08 | 0.07 | 0.08 | 0.08 | 0.08 | 0.09 | 1 |
38 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Solid Mass Evaluation nan | Unfortunately, the common and benign fibroadenoma can be difficult to distinguish by imaging from the uncom- mon and malignant phyllodes tumors. Bode et al. reviewed ultrasonography and core biopsy with subsequent excision performed on 57 fibroadenomas and 12 phyllodes tumors, finding that 42% of the phyllodes tumors w... | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
39 | Management of the Palpable | RADIOLOGIC EXAMINATION | Ultrasound | Solid Mass Evaluation nan | FIGURE 4-2 Specific schema for evaluation of a discrete mass on examination. Evaluation workflow, including imaging and tissue diagnosis, based on the presence of a discrete mass on examination. If a mass is found to be clinically suspicious on examina- tion, imaging should still be performed, but in such as case a tis... | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.01 | 0.03 | 0.09 | 1 |
40 | Management of the Palpable | RADIOLOGIC EXAMINATION | Magnetic Resonance Imaging | nan nan | There are few indications for MRI in the workup of breast masses. MRI is best suited for settings where standard imag- ing techniques are insufficient, or where a patient’s elevated breast cancer risk outweighs the false-positives, costs, and disadvantages of the modality. The absence of a lesion noted on MRI does not ... | 6 | 0.002 | 0.003 | 0.004 | 0.006 | 0.01 | 0.001 | 0.01 | 5 |
41 | Management of the Palpable | PATHOLOGIC EXAMINATION | Triple-Test Evaluation | nan nan | Masses that are found to be solid on imaging require triple- test evaluation which refers to physical examination, radio- logic examination, and needle biopsy performed by core or fine-needle aspiration (FNA). The triple test requires concor- dance between the three aspects of evaluation and is not confirmatory if a ma... | 6 | 0.01 | 0.095 | 0.08 | 0.07 | 0.06 | 0.04 | 0.095 | 2 |
42 | Management of the Palpable | PATHOLOGIC EXAMINATION | Triple-Test Evaluation | nan nan | The triple test is performed even in cases where masses are considered benign on imaging because some malignant lesions can have a benign appearance. In one series of 191 patients, Steinberg et al. found the sensitivity and specific- ity of triple test to be 95.5% and 100%, respectively (18). In a smaller series of 46 ... | 6 | 0.09 | 0.095 | 0.08 | 0.085 | 0.09 | 0.09 | 0.095 | 2 |
43 | Management of the Palpable | PATHOLOGIC EXAMINATION | Triple-Test Evaluation | nan nan | on follow-up (20). | 6 | 0.015 | 0.03 | 0.045 | 0.06 | 0.075 | 0.085 | 0.085 | 6 |
44 | Management of the Palpable | PATHOLOGIC EXAMINATION | Triple-Test Evaluation | Postbiopsy Follow-Up nan | The triple test has been found to be the most accurate combination of modalities, but anxiety over a palpable mass remains an indication for surgical excision once the rele- vant literature and data have been disclosed to the patient. Prior to performing a core biopsy to complete the triple test there should be a discu... | 6 | 0.01 | 0.095 | 0.08 | 0.07 | 0.06 | 0.04 | 0.095 | 2 |
45 | Management of the Palpable | PATHOLOGIC EXAMINATION | Fine-Needle Aspiration | nan nan | FNA involves the use of a handheld syringe and needle to percutaneously aspirate a tumor mass in order to obtain cytology for evaluation. This was first described in detail by Martin and Ellis in 1930, and is most commonly employed for palpable breast lesions that do not require imaging in order to target the lesion. F... | 6 | 0.07 | 0.09 | 0.08 | 0.08 | 0.08 | 0.08 | 0.09 | 2 |
46 | Management of the Palpable | PATHOLOGIC EXAMINATION | Fine-Needle Aspiration | nan nan | FNA has the advantages of being easily performed with readily available equipment, requiring only a syringe and an appropriately sized needle. Its biggest limitations are that insufficient material may make proper diagnosis difficult, and FNA usually cannot rule out the presence of an inva- sive component for the uncom... | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
47 | Management of the Palpable | PATHOLOGIC EXAMINATION | Core Needle Biopsy | nan nan | Core needle biopsy is associated with slightly greater dis- comfort and higher cost, but provides more tissue than FNA and provides histologic architecture to better classify pathologic subtype. It is less morbid than excisional biopsy, and even in early series comparing core needle to excisional biopsy, the results we... | 6 | 0.04 | 0.08 | 0.09 | 0.09 | 0.09 | 0.09 | 0.09 | 3 |
48 | Management of the Palpable | PATHOLOGIC EXAMINATION | Incisional Biopsy | nan nan | (such as a large fungating cancer), a core biopsy or FNA is nearly always the preferred method of diagnosis, thereby avoiding the associated morbidities, including operative and anesthesia risks. Markers such as estrogen and proges- terone receptors as well as HER2/neu overexpression can be obtained from core biopsy, a... | 6 | 0.09 | 0.1 | 0.085 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
49 | Management of the Palpable | PATHOLOGIC EXAMINATION | Excisional Biopsy | nan nan | The surgical excision of a lesion in the breast with the intent to remove it entirely is referred to as an excisional biopsy. In 2013, excisional biopsy is no longer the standard of care for the initial diagnosis of palpable breast masses, except where needle biopsy is not feasible for technical reasons, is nonconcorda... | 6 | 0.005 | 0.098 | 0.076 | 0.045 | 0.089 | 0.09 | 0.098 | 2 |
50 | Management of the Palpable | PATHOLOGIC EXAMINATION | Excisional Biopsy | nan nan | Unfortunately, excisional biopsies are all too often per- formed without specimen orientation for the pathologist. For those excisional biopsies that demonstrate a malig- nancy, lack of orientation may necessitate complete reexci- sion of the entire cavity for even a single positive margin. This results in needless res... | 6 | 0.01 | 0.03 | 0.06 | 0.08 | 0.09 | 0.07 | 0.09 | 5 |
51 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Young Patient | nan nan | Assessment of the young female patient with a breast mass poses a challenge because of the difficulties in imaging dense breast tissue, because of the greater nodularity seen in those 30 and under whose breasts contain a lower pro- portion of fat, and because cosmetic and sexuality concerns about treatment tend to be g... | 6 | 0.001 | 0.099 | 0.001 | 0.099 | 0.099 | 0.099 | 0.099 | 2 |
52 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Young Patient | nan nan | 2 to 3 months at a different point during the menstrual | 6 | 0.05 | 0.09 | 0.08 | 0.07 | 0.06 | 0.01 | 0.09 | 2 |
53 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Young Patient | nan nan | cycle may demonstrate resolution of the lesion, implying fibrocystic change. If any question remains, needle biopsy should be performed, but if the results are felt to be non concordant, excision may be considered. | 6 | 0 | 0.1 | 0.095 | 0.08 | 0.07 | 0.06 | 0.1 | 2 |
54 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Young Patient | nan nan | Care must be taken when excising lesions in younger adolescents. In addition to considering the cosmetic out- come of the scar that will be lifelong for the patient, the cen- tral subareolar breast bud can be mistaken for a new breast mass. This subareolar tissue should be spared because this is the origin of the ducts... | 6 | 0 | 0.015 | 0.02 | 0.03 | 0.04 | 0.065 | 0.065 | 6 |
55 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Young Patient | nan nan | Young male patients referred for breast masses will pre- dominantly be adolescents found to have gynecomastia. Welch et al. reviewed all male breast patients at a large ter- tiary pediatric hospital that were referred for ultrasound. The patients were between 1 month and 18 years, and 72% of the 25 patients, between 7 ... | 6 | 0 | 0.094 | 0.094 | 0.094 | 0.094 | 0.094 | 0.094 | 2 |
56 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Pregnant Patient | nan nan | The pregnant patient poses a dilemma when presenting with a breast mass. During pregnancy, the proliferative effect of circulating hormones causes the breasts to become increas- ingly nodular and engorged, making the physical examina- tion extremely difficult. A nodule found prior to pregnancy or early in its course sh... | 6 | 0.095 | 0.092 | 0.063 | 0.045 | 0.087 | 0.09 | 0.095 | 1 |
57 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Pregnant Patient | nan nan | Even with shielding, mammography is incorrectly thought by many to be contraindicated during pregnancy, even by physicians, despite its delivery of only 0.5 mGy to the fetus in comparison to the 1.0 mGy of normal back- ground radiation that the fetus receives over the 9 months of pregnancy. Although MRI is safe, the ga... | 6 | 0.08 | 0.07 | 0.06 | 0.04 | 0.03 | 0.02 | 0.08 | 1 |
58 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Pregnant Patient | nan nan | If the mass is solid, needle biopsy should be attempted prior to mammogram since mammography will not provide a definitive diagnosis of a solid mass. Core biopsy in the pregnant patient prior to mammography will also reduce unnecessary fetal irradiation, even though the consequent risk is low. If malignancy is diagnose... | 6 | 0.015 | 0.023 | 0.047 | 0.068 | 0.092 | 0.089 | 0.092 | 5 |
59 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Pregnant Patient | nan nan | Ductal Carcinoma In Situ | 6 | 0.015 | 0.023 | 0.047 | 0.068 | 0.091 | 0.082 | 0.091 | 5 |
60 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Pregnant Patient | nan nan | As with any malignancy, ductal carcinoma in situ (DCIS) can be found in association with a mass, although it most commonly now presents as calcifications on mammogram without abnormal examination findings. Comedo DCIS is generally high grade and more likely to contain invasion which is why it is the only subtype likely... | 6 | 0 | 0.1 | 0.05 | 0.09 | 0.08 | 0.07 | 0.1 | 2 |
61 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Pregnant Patient | nan nan | Core needle biopsy is the current standard of care for the diagnosis of breast masses; however, 10% to 20% of lesions diagnosed as DCIS by core needle biopsy are found to be understaged on final excision, demonstrating invasion. Meijnen et al. evaluated 172 DCIS lesions diagnosed by core biopsy, and found that a mass o... | 6 | 0.095 | 0.08 | 0.06 | 0.04 | 0.03 | 0.02 | 0.095 | 1 |
62 | Management of the Palpable | SPECIFIC CLINICAL SETTINGS | The Patient with a Personal History of Cancer | nan nan | The patient who has a history of breast cancer has under- gone either breast-conserving therapy or mastectomy. In those women who have had BCT, surgical scarring and radiation-induced changes may make evaluation more dif- ficult. Mammography after BCT is less sensitive overall and specifically in the quadrant of the pr... | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
63 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hematoma | nan nan | Hematomas of the breast are most commonly reported as a result of iatrogenic intervention, either in evaluation of a breast lesion or subsequent to its treatment, although spontaneous hematomas have been reported. They have also been rarely reported to identically mimic carcinoma on presentation. Physicians most likely... | 6 | 0 | 0.02 | 0.03 | 0.04 | 0.06 | 0.07 | 0.07 | 6 |
64 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hematoma | nan nan | (24) to 51% (5). When any question about a lesion’s palpabil- ity exists, needle localization should be planned in case the thickened area is solely due to hematoma and resolves by the date of surgery, leaving a nonconcordant mass. | 6 | 0 | 0.036 | 0.078 | 0.094 | 0.051 | 0.051 | 0.094 | 4 |
65 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hematoma | nan nan | The appropriate management of a hematoma varies with its presentation. A palpable mass may be present with or without ecchymosis, which can sometimes extend laterally to the chest wall, below the inframammary fold and over to the opposite breast. In most cases, observation with use of | 6 | 0 | 0.1 | 0.095 | 0.08 | 0.07 | 0.06 | 0.1 | 2 |
66 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hematoma | nan nan | supportive garments and non-NSAID analgesics is sufficient, although hematomas in the postoperative period require a low threshold for reexploration. Expanding hematomas should be explored and evacuated with the intent to achieve hemostasis. | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
67 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Fat Necrosis | nan nan | Fat necrosis is a phenomenon that is occasionally seen in the breast due to its high fat content, and is significantly correlated with trauma or surgical intervention. Fat necro- sis results from lipase-induced aseptic saponification of adi- pose tissue that can create mass lesions that are tough to distinguish from ca... | 6 | 0 | 0.1 | 0.095 | 0.08 | 0.075 | 0.06 | 0.1 | 2 |
68 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Hamartomas, previously known as fibroadenolipomas or lipofibroadenomas because of their components, are benign lesions that are often palpable as a mass and can grow to extremely large sizes, pushing the breast tissue outward as they grow rather than replacing it. Although they have been reported in men, they are most ... | 6 | 0.01 | 0.095 | 0.08 | 0.07 | 0.06 | 0.03 | 0.095 | 2 |
69 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Neither FNA nor core biopsy can accurately make the diag- nosis of a hamartoma without correlation to imaging find- ings because of the variety of elements required to make a diagnosis. FNA results, at best, in a diagnosis of a non- specified benign lesion (28) because the cytologic features overlap with other benign d... | 6 | 0 | 0.015 | 0.03 | 0.04 | 0.06 | 0.007 | 0.06 | 5 |
70 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | If the diagnosis of hamartoma is entertained on evalua- tion of a breast mass, mammograms should be obtained and core biopsy attempted, while providing the pathologist with the imaging and clinical findings. Surgical excision may be required for definitive diagnosis, and clear margins should be sought because of the po... | 6 | 0 | 0.1 | 0.095 | 0.08 | 0.075 | 0.06 | 0.1 | 2 |
71 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Saslow D, Boetes C, Burke W, et al. American cancer society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007;57(2):75–89. | 6 | 0.1 | 0.3 | 0.4 | 0.2 | 0.3 | 0.2 | 0.4 | 3 |
72 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Vargas HI, Vargas MP, Eldrageely K, et al. Outcomes of surgical and sono- graphic assessment of breast masses in women younger than 30. Am Surg 2005;71(9):716–719. | 6 | 0.08 | 0.09 | 0.08 | 0.09 | 0.08 | 0.08 | 0.09 | 2 |
73 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Baker LH. Breast Cancer Detection Demonstration Project: five-year sum- mary report. CA Cancer J Clin 1982;32(4):194–225. | 6 | 0.076 | 0.082 | 0.088 | 0.093 | 0.093 | 0.088 | 0.093 | 4 |
74 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Hann LE, Liberman L, Dershaw DD, et al. Mammography immediately after stereotaxic breast biopsy: is it necessary? AJR Am J Roentgenol 1995;165(1):59–62. | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
75 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Hines SL, Tan WW, Yasrebi M, et al. The role of mammography in male patients with breast symptoms. Mayo Clin Proc 2007;82(3):297–300. | 6 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 1 |
76 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Borgen PI, Wong GY, Vlamis V, et al. Current management of male breast cancer. A review of 104 cases. Ann Surg 1992;215(5):451–457; discussion 457–459. | 6 | 0.08 | 0.06 | 0.03 | 0.07 | 0.08 | 0.08 | 0.08 | 1 |
77 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Sickles EA, Filly RA, Callen PW. Benign breast lesions: ultrasound detection and diagnosis. Radiology 1984;151(2):467–470. | 6 | 0.3 | 0.3 | 0.3 | 0.3 | 0.3 | 0.3 | 0.3 | 1 |
78 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of digi- tal versus film mammography for breast-cancer screening. N Engl J Med 2005;353(17):1773–1783. | 6 | 0.09 | 0.09 | 0.06 | 0.04 | 0.08 | 0.09 | 0.09 | 1 |
79 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Dupont WD, Page DL, Parl FF, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med 1994;331(1):10–15. | 6 | 0.2 | 0.2 | 0.1 | 0.2 | 0.2 | 0.2 | 0.2 | 1 |
80 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Frantz VK, Pickren JW, Melcher GW, et al. Indicence of chronic cystic disease in so-called “normal breasts”; a study based on 225 postmortem examinations. Cancer 1951;4(4):762–783. | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
81 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Wilkinson S, Anderson TJ, Rifkind E, et al. Fibroadenoma of the breast: a follow-up of conservative management. Br J Surg 1989;76(4):390–391. | 6 | 0.005 | 0.02 | 0.01 | 0.01 | 0.02 | 0.01 | 0.02 | 2 |
82 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | van Dam PA, Van Goethem ML, Kersschot E, et al. Palpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions. Radiology 1988;166(2):435–439. | 6 | 0.07 | 0.09 | 0.08 | 0.09 | 0.08 | 0.08 | 0.09 | 2 |
83 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Houssami N, Irwig L, Simpson JM, et al. Sydney Breast Imaging Accuracy Study: comparative sensitivity and specificity of mammography and sonog- raphy in young women with symptoms. AJR Am J Roentgenol 2003;180(4): 935–940. | 6 | 0.07 | 0.06 | 0.08 | 0.07 | 0.08 | 0.08 | 0.08 | 3 |
84 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Bode MK, Rissanen T, Apaja-Sarkkinen M. Ultrasonography and core nee- dle biopsy in the differential diagnosis of fibroadenoma and tumor phyl- lodes. Acta Radiol 2007;48(7):708–713. | 6 | 0.095 | 0.09 | 0.09 | 0.09 | 0.09 | 0.09 | 0.095 | 1 |
85 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Steinberg JL, Trudeau ME, Ryder DE, et al. Combined fine-needle aspira- tion, physical examination and mammography in the diagnosis of pal- pable breast masses: their relation to outcome for women with primary breast cancer. Can J Surg 1996;39(4):302–311. | 6 | 0.005 | 0.08 | 0.07 | 0.08 | 0.08 | 0.08 | 0.08 | 2 |
86 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Vetto J, Pommier R, Schmidt W, et al. Use of the “triple test” for palpable breast lesions yields high diagnostic accuracy and cost savings. Am J Surg 1995;169(5):519–522. | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
87 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Bicker T, Schondorf H, Naujoks H. Long-term follow-up in patients with mammary gland changes found unsuspicious by aspiration cytology. Cancer Detect Prev 1988;11(3–6):319–322. | 6 | 0 | 0.05 | 0 | 0 | 0.05 | 0 | 0.05 | 2 |
88 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Westenend PJ, Sever AR, Beekman-De Volder HJ, et al. A comparison of aspi- ration cytology and core needle biopsy in the evaluation of breast lesions. Cancer 2001;93(2):146–150. | 6 | 0.08 | 0.07 | 0.08 | 0.08 | 0.08 | 0.08 | 0.08 | 1 |
89 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 1994;193(2):359–364. | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
90 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Rosen PP. Pathological assessment of nonpalpable breast lesions. Semin Surg Oncol 1991;7(5):257–260. | 6 | 0.08 | 0.09 | 0.08 | 0.08 | 0.08 | 0.08 | 0.09 | 2 |
91 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | Welch ST, Babcock DS, Ballard ET. Sonography of pediatric male breast masses: gynecomastia and beyond. Pediatr Radiol 2004;34(12):952–957. | 6 | 0.08 | 0.06 | 0.07 | 0.08 | 0.08 | 0.08 | 0.08 | 1 |
92 | Management of the Palpable | OTHER MASS-FORMING LESIONS | Hamartomas | nan nan | C H A P T E R 5 | 6 | 0.087 | 0.092 | 0.063 | 0.041 | 0.078 | 0.063 | 0.092 | 2 |
93 | Management of Disorders of the Ductal System and Infections | null | null | nan nan | J. Michael Dixon and Nigel J. Bundred | 6 | 0.05 | 0.1 | 0.08 | 0.09 | 0.07 | 0.06 | 0.1 | 2 |
94 | Management of Disorders of the Ductal System and Infections | CHAPTER CONTENTS | null | nan nan | Nipple Discharge | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
95 | Management of Disorders of the Ductal System and Infections | CHAPTER CONTENTS | null | nan nan | Investigations | 6 | 0.05 | 0.09 | 0.08 | 0.1 | 0.07 | 0.06 | 0.1 | 4 |
96 | Management of Disorders of the Ductal System and Infections | CHAPTER CONTENTS | null | nan nan | Differential Diagnosis of Nipple Discharge Periductal Mastitis and Duct Ectasia Etiology | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
97 | Management of Disorders of the Ductal System and Infections | CHAPTER CONTENTS | null | nan nan | Nipple Inversion or Retraction | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.055 | 0.045 | 0.09 | 1 |
98 | Management of Disorders of the Ductal System and Infections | CHAPTER CONTENTS | null | nan nan | Operations for Nipple Discharge or Retraction | 6 | 0.025 | 0.0375 | 0.01875 | 0.046875 | 0.0375 | 0.025 | 0.046875 | 4 |
99 | Management of Disorders of the Ductal System and Infections | CHAPTER CONTENTS | null | nan nan | Breast Infection Mastitis Neonatorum Lactational Infection Nonlactational Infection | 6 | 0.085 | 0.092 | 0.076 | 0.081 | 0.083 | 0.084 | 0.092 | 2 |
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