Breast and Endocrine Surgery
Breast
Use triple assessment: clinical, imaging (ultrasound under 40, mammogram plus ultrasound over 40) and tissue. Fibroadenomas are well-defined, mobile and common in young women; a breast abscess needs drainage, not just antibiotics. Breast cancer subtypes are defined by oestrogen receptor, progesterone receptor, HER2 and grade. Sentinel node biopsy is standard for clinically node-negative invasive disease; axillary dissection is reserved for involved nodes or failed mapping. Paget's disease is an eczematous nipple change with underlying carcinoma. Inflammatory breast cancer is a clinical diagnosis with peau d'orange and needs urgent referral, not a course of antibiotics.
Thyroid
Assess a nodule with TSH, ultrasound and fine-needle aspiration (Bethesda). Papillary carcinoma spreads via lymphatics; follicular carcinoma is diagnosed by capsular or vascular invasion, not cytology; medullary carcinoma secretes calcitonin and may be part of MEN2; anaplastic is rapidly progressive. Complications of thyroidectomy: recurrent laryngeal nerve injury (hoarseness), external branch of superior laryngeal nerve injury (voice fatigue), hypocalcaemia and haematoma causing airway compromise.
Parathyroid and adrenal
Primary hyperparathyroidism presents with stones, bones, abdominal groans and psychic moans; diagnosis is raised calcium with inappropriately high PTH. Localise with ultrasound and sestamibi; intraoperative PTH confirms cure. Phaeochromocytoma: alpha-blockade before beta-blockade. Incidental adrenal masses need biochemical exclusion of function and imaging characteristics.
Rule of thumb
In thyroid fine-needle aspiration, follicular neoplasm is a surgical diagnosis - the answer is hemithyroidectomy, not repeat aspiration.