Breast and Endocrine Surgery
What the exam tests
This domain covers triple assessment of breast disease, breast cancer biology and axillary management, plus thyroid, parathyroid and adrenal surgical disease.
Core rules
- Triple assessment means clinical examination, imaging and pathology. Use ultrasound and core biopsy for a solid breast mass; FNA is not adequate for primary breast diagnosis.
- Report breast imaging with BI-RADS and thyroid cytology with the Bethesda system.
- Breast cancer management depends on ER, PR and HER2 status, grade, stage and menopausal state; sentinel node biopsy is standard for clinically node-negative invasive cancer.
- Thyroidectomy risks include recurrent laryngeal nerve injury and hypoparathyroidism; document voice change and check calcium.
- Primary hyperparathyroidism is confirmed by raised calcium with inappropriately normal or high PTH; localise before focused parathyroidectomy.
- Phaeochromocytoma requires alpha blockade before surgery to prevent intraoperative crisis.
Worked example
A 48-year-old woman has a 2 cm breast lump. Examination, mammography and ultrasound are suspicious; core biopsy shows grade 2 invasive ductal carcinoma, ER positive, HER2 negative. Axillary ultrasound is normal, so breast-conserving surgery with sentinel node biopsy is planned, followed by radiotherapy and endocrine therapy.
Traps
Not examining the axilla; using FNA alone for a breast lump; forgetting calcium and vitamin D after thyroid surgery; and operating on a phaeochromocytoma without alpha blockade.