Q) 47 year old premenopausal lady with a 3X 3cm left breast lump with IDC grade III, TNBC.
On examination, there is a single subcentimetric mobile soft mobile ipsilateral axillary LN palpable. Usg nodes no loss of hilum. Management of axilla?
a) SLND
b) ALND
c) Radiotherapy only
d) No treatment
Ans a
Selective lymph node dissection
ACOSOG Z0011 trial 0 (stages I and II) in patients who undergo breast conservation therapy, axillary lymph node dissection does not improve locoregional control or survival.
This trial has demonstrated the safety of limiting axillary surgery to the SLNB without performing formal axillary dissection for sentinel node positivity.
This avoids of the morbidity of the axillary dissection.
If node is positive the patient should receive adjuvant chemotherapy and radiation therapy.
Q ) Hereditary diffuse Gastric carcinoma is associated with which breast cancer A. Ductal carcinoma NOS subtype B. Lobular carcinoma C. DCIS D. Metaplastic carcinoma
📘 Theme: Breast Surgery – DCIS (NEET SS / MCh / FMAS High Yield)
Clinical Breast Surgery MCQ
According to the RTOG 9804 trial, which of the following criteria defined a favourable (good-risk) ductal carcinoma in situ (DCIS)?
A. Less than 3.5 cm in size with a 2 mm free resection margin
B. Less than 2.5 cm in size with a 2 mm free resection margin
C. Less than 3 cm in size with a 3 mm free resection margin
D. Less than 2.5 cm in size with a 3 mm free resection margin
Answer: D. Less than 2.5 cm in size with a 3 mm free resection margin
Explanation
The RTOG 9804 trial evaluated radiotherapy in patients with good-risk DCIS treated with breast-conserving surgery. Eligible patients had low- or intermediate-grade DCIS measuring ≤2.5 cm with surgical margins of at least 3 mm. These criteria were used to define favourable DCIS.
Why other options are incorrect
A: Tumour size criterion was not 3.5 cm.
B: A 2 mm margin did not meet the RTOG 9804 eligibility requirement.
C: The size cutoff was ≤2.5 cm, not 3 cm.
High-yield teaching points
RTOG 9804 enrolled patients with "good-risk" DCIS.
Eligibility required DCIS ≤2.5 cm and margins ≥3 mm.
The study demonstrated a reduction in ipsilateral breast recurrence with radiotherapy.
RTOG 9804 is frequently cited when discussing omission of radiotherapy in selected low-risk DCIS patients.
Q) In terms of cure best results in inflammatory carcinoma breast are seen with-
a) Surgery alone
b) Chemotherapy
c) Radiotherapy
d) All of the above
Ans wer
d)
Inflammatory carcinoma of the breast is a rare aggressive tumor that blocks the sub dermal lymphatics as a result of which cutaneous edema is common . Differentiating it from a breast abscess is important and biopsy is diagnostic. It is also responsible to peau d orange
Treatment is multidisciplinary and involves, chemotherapy followed by surgery followed by radiotherapy.
Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.
Simple nipple inversion occurring at puberty or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.
Suction pumps and cosmetic surgery can also help.
Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.
Duct ectasia - slit like retraction of nipple . ALso seen in duct ectasia is green, black or blood stained discharge from nipple
Ref - Bailey 801
Grading of benign nipple inversions for management
In grade I, the nipple is easily pulled out manually and maintains its projection quite well. It has minimal fibrosis thus, manual traction and a single, buried purse-string suture are enough for the correction.
Grade II (majority) the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.
In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.
Q) Popcorn calcification in breast is seen in which condition
a) Fibroadenoma
b) Periductal fibrosis
c) Carcinoma breast
d) Duct ectasia
Free answer to Surgery MCQs
a
Calcifications associated with fibroadenomas have been termed popcorn calcifications because of their large size and dense, coarse appearance. Calcifications in fibroadenomas usually begin at the periphery and then involve the central portion of the fibroadenoma.