SU25.1-5 | Breast Surgery — Glossary

Aberrations of Normal Development and Involution — the concept that most benign breast conditions are exaggerations of normal hormonal physiology rather than true disease.

An endocrine agent blocking peripheral oestrogen synthesis, used for ER-positive breast cancer in post-menopausal women.

Removal of axillary lymph nodes for node-positive disease; effective for staging/control but carries a risk of lymphoedema.

The five clinical groups of axillary nodes — anterior (pectoral), posterior (subscapular), lateral (humeral), central and apical — palpated when examining for regional spread.

Surgical division of axillary lymph nodes relative to pectoralis minor — level I lateral, level II behind, level III medial — guiding staging and surgery.

The extension of breast glandular tissue from the upper outer quadrant towards the axilla, a common site for lumps and cancers.

The spectrum of non-cancerous breast conditions — the commonest reason for breast clinic referral — confirmed benign by triple assessment.

Breast Imaging-Reporting and Data System, a standardised scale (categories 0-6) classifying the suspicion of breast imaging findings and guiding action.

A fluid-filled, smooth, often tense lump (commonly perimenopausal) confirmed and usually treated by ultrasound and aspiration.

The clinical nickname for a fibroadenoma, reflecting how the mobile lump slips away under the examining fingers.

Magnetic resonance imaging of the breast reserved for selected cases — lobular cancers, implants, high-risk (BRCA) breasts and equivocal findings.

The conventional division of each breast into upper outer, upper inner, lower outer and lower inner quadrants plus the central nipple-areolar zone, used to localise findings.

Radiation-free imaging that is first-line in younger/dense breasts and in pregnancy; distinguishes solid from cystic lesions and guides biopsy.

Wide local excision of the tumour with a clear margin, always combined with whole-breast radiotherapy, giving survival equivalent to mastectomy in suitable early cancers.

An impartial person present during an intimate examination to provide reassurance and safeguard both patient and clinician; their presence is documented.

Fibrous bands from the deep fascia to the skin supporting the breast; infiltration and shortening by cancer causes skin dimpling/puckering.

A needle biopsy taking a core of tissue for histology; the preferred pathology test as it distinguishes invasive from in-situ disease and gives receptor status.

Dilatation and chronic inflammation of major breast ducts in older women, causing thick cheesy discharge and nipple retraction.

A benign papillary growth within a duct, classically causing blood-stained discharge from a single duct; treated by microdochectomy.

Non-invasive breast cancer with malignant cells confined within the duct by an intact basement membrane; a premalignant lesion often seen as microcalcifications on mammography.

Oestrogen and progesterone receptor expression marking endocrine-responsive tumours treatable with hormone therapy.

A benign reaction of breast fat to trauma forming a firm, sometimes tethered, cancer-mimicking lump that needs triple assessment to confirm.

A benign fibroepithelial tumour of a breast lobule; a smooth, firm, highly mobile 'breast mouse', most common in women 15-35 years.

Cyclical breast pain and lumpiness from an exaggerated hormonal response (ANDI); the commonest benign breast complaint.

Loss of a lump's mobility because it is attached to skin, underlying muscle or the chest wall; increasing fixity suggests malignant invasion.

Examining the breast with the palmar surface of the fingers (not the tips) in a systematic pattern to detect and characterise masses.

Fine-needle aspiration cytology — sampling cells from a lump; useful but limited because it cannot distinguish invasive from in-situ cancer or give receptors.

Human epidermal growth factor receptor 2 overexpression marking tumours that respond to anti-HER2 therapy (trastuzumab).

An aggressive cancer presenting with a red, swollen, peau-d'orange breast from dermal lymphatic involvement, mimicking infection.

An aggressive breast cancer that mimics infection with a red, swollen breast; suspected when an 'abscess' fails to resolve or arises outside lactation.

A voluntary decision by a patient with capacity, based on understandable information about the diagnosis, proposed treatment, realistic alternatives, material risks/benefits and outcomes; a continuing dialogue, not just a signature.

The three seated positions used to inspect the breast — arms by the sides, arms raised above the head, and hands pressed on the hips to tense pectoralis major — to reveal asymmetry, dimpling and fixity.

The lymph node chain alongside the internal thoracic vessels receiving a minority of breast lymphatic drainage, especially from medial tumours.

Invasive breast cancer of 'no special type' — the commonest invasive breast cancer (~70-80%), presenting as a hard irregular mass.

Invasive breast cancer of single-file lobular cells, with a tendency to be multifocal and sometimes bilateral and harder to detect.

A pus collection in the breast during breastfeeding, usually due to Staphylococcus aureus; treated by antibiotics, continued emptying and aspiration or drainage.

Non-invasive lobular proliferation that acts mainly as a marker of increased future breast cancer risk in either breast rather than a direct precursor.

The systematic description of a swelling by site, size, shape, surface, consistency, margin, mobility, fixity and tenderness.

Low-dose X-ray imaging of the breast; first-line for symptomatic women over ~35-40 years and able to show microcalcifications.

A training model used to demonstrate and rehearse breast examination technique before examining patients, as required for competency SU25.5.

Breast pain; usually benign, especially when cyclical and bilateral, and an uncommon presenting feature of cancer.

Removal of the whole breast, chosen for large or multifocal tumours, when radiotherapy is contraindicated, or by patient preference; reconstruction may be offered.

Tiny calcium deposits on mammography that may be the earliest, sometimes only, sign of in-situ or early invasive cancer.

Surgical excision of a single affected breast duct, used for a duct papilloma causing troublesome discharge.

Inward pulling or distortion of the nipple, which may be benign (duct ectasia) or a sign of underlying malignancy when of recent onset.

An eczematous, sometimes ulcerated change of the nipple-areola associated with underlying breast malignancy.

Orange-peel skin dimpling from dermal lymphatic oedema, a sign of locally advanced or inflammatory breast cancer.

Non-lactational inflammation around the subareolar ducts, typically in older women and associated with smoking.

A fibroepithelial breast tumour that can be benign, borderline or malignant, grows large, and requires wide local excision because of recurrence and possible malignancy.

The loose plane behind the breast over the pectoral fascia that normally allows free movement; fixity to it suggests deep invasion.

Identification and examination of the first (sentinel) axillary node draining a tumour, using dye/radiotracer, to stage a clinically node-negative axilla and avoid unnecessary clearance.

Restriction of skin movement over a breast lump from infiltration of Cooper's ligaments, demonstrated by dimpling on movement — a sign suggestive of malignancy.

A structured framework for breaking bad news — Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary.

Lymph nodes above the clavicle examined after the breast and axilla; involvement indicates advanced regional spread.

A selective oestrogen-receptor modulator used as endocrine therapy for ER-positive breast cancer, particularly in pre-menopausal women.

The site-specific cancer staging system describing tumour size/extent (T), regional nodal involvement (N) and distant metastasis (M).

A monoclonal antibody (anti-HER2 therapy) that benefits HER2-positive breast cancers, given with chemotherapy.

The combined evaluation of a breast complaint by clinical examination, imaging and pathology; together they achieve far higher sensitivity than any single test.

A tumour that is ER-negative, PR-negative and HER2-negative; it lacks endocrine and HER2 targets, is treated mainly with chemotherapy, and generally has a worse prognosis.

Removal of a lesion together with a rim of normal tissue (a clear margin); required for phyllodes tumour rather than simple enucleation.