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Describe I detail about breast topic for surgery postgraduate study purpose. Anatomy, malignant and non malignant breast pathologies, relevant Histopathology, clinical features, investigation (triple assessment), staging, management, recent advances

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breast cancer management surgery sentinel lymph node

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breast cancer neoadjuvant chemotherapy CDK4/6 immunotherapy recent advances

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breast cancer CDK4/6 inhibitor trastuzumab deruxtecan PARP inhibitor

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The comprehensive surgical PG notes are compiled above. Here is a structured summary of what has been covered, drawn from Sabiston, Bailey & Love, Fischer's Mastery, Robbins Pathology, Mulholland & Greenfield, and recent PubMed meta-analyses:

What This Document Covers (Index)

  1. Surgical Anatomy - Position, Cooper's ligaments, TDLU, blood supply (internal mammary 60%), Batson's plexus (haematogenous spread route), lymphatic drainage (levels I/II/III axillary nodes, internal mammary nodes), sentinel node concept
  2. Non-Malignant Pathologies - ANDI framework, fibrocystic change, ADH/ALH (cancer risk markers), fibroadenoma (breast mouse, biphasic histology), phyllodes tumour (haematogenous spread, wide excision), breast abscess (lactational vs. periareolar/duct fistula), duct ectasia (Hadfield's operation), intraductal papilloma (microdochectomy), fat necrosis (mimics cancer), gynaecomastia
  3. Malignant Pathologies - Epidemiology, BRCA1/2 biology, full classification (DCIS subtypes, ILC Indian-file pattern, IDC NOS, special types), inflammatory breast cancer (T4d, dermal lymphatic emboli), Paget's disease
  4. Histopathology - Nottingham grading, IHC (ER/PR/HER2/Ki-67), molecular subtypes (Luminal A/B, HER2-enriched, TNBC), prognostic implications, ILC E-cadherin loss
  5. Clinical Features - Full examination technique, peau d'orange, signs of advanced disease
  6. Triple Assessment - Clinical (E1-5) + Radiological (mammography, USS, MRI, BI-RADS 0-6) + Pathological (FNAC C1-5, CNB B1-5, SLNB)
  7. AJCC 8th Edition Staging - Full T/N/M classification, anatomic vs. prognostic staging, genomic assays (Oncotype DX, MammaPrint)
  8. Management - MDT, BCS vs. mastectomy, ALND vs. SLNB (Z0011 trial), oncoplastic surgery, reconstruction (DIEP/TRAM/LD/implants), adjuvant RT, endocrine therapy, chemotherapy, targeted therapy
  9. DCIS Management - Surgery, RT, endocrine therapy, SentiNot trial
  10. Recent Advances - HER2-low (T-DXd/DESTINY-Breast04), TNBC immunotherapy (KEYNOTE-522), PARP inhibitors (OlympiA), CDK4/6 inhibitors (monarchE), oral SERDs (elacestrant/ESR1 mutations), liquid biopsy, ultra-hypofractionation RT, genomic assays
  11. Landmark Trial Table - 12 key trials condensed for exam revision
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