Inspection Size S ymmetry some variation is normal Shape Contour flattening masses and dimpling S kin color edema rashes thickening and venous pattern S cars previous surgery injuries ID: 703886
Download Presentation The PPT/PDF document "Disorders of the Breast Breast Exam" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Disorders of the BreastSlide2
Breast ExamSlide3
Inspection
Size
S
ymmetry (some variation is normal)
Shape
Contour (flattening, masses, and dimpling)
S
kin (color, edema, rashes, thickening, and venous pattern)
S
cars (previous surgery, injuries)Slide4
Inspection
Patient arm maneuvers
Overhead
Waist
Leaning forwardSlide5
Palpation
Lymph nodes
Cervical
Axillary
Supraclavicular Slide6
Palpation
Bimanual palpation with patient sitting
Use right hand above the left hand below to palpate right breast. Use pads of fingers to compress breast tissue (check for consistency, nodules, masses, and tenderness).
Repeat for left side by standing on left side and reversing hands (left on top, right on bottom)Slide7
Palpation
Palpation while patient supine
Ask patient to put arm overhead
Use flat part of fingers (and a rotary motion) against chest wall using radial or spiral pattern
Note tissue consistency, elasticity, nodules, indurations, masses, and tenderness
Palpate all quadrants of breast (including up to clavicle and towards axilla)Slide8
Palpation
While supine
Inspect and palpate nipples
Look for size, shape, inversion, rashes, ulceration, discharge, scaling, crusting, elasticity, retraction, areolar edema and masses
Gently grasp and compress nipple and areolar tissue between thumb and index finger, noting color consistency and quantity of any dischargeSlide9
Exam findings suspicious for breast cancer
Hard, immovable lesion with irregular borders
Axillary
adenopathy
Skin changes – erythema, thickening, dimpling (
peau
d’orange
)
Inflammatory breast cancerMetastatic disease Bone (back or leg pain)
Liver (abdominal pain, nausea, jaundice)
Lungs (SOB, cough)Slide10
Risk for Breast Cancer
1 in 8 women cumulative lifetime risk of breast cancer
Woman age 50-59, lifetime risk of having breast cancer is 1 in 36
Woman age 70-79, risk increases to 1 in 24Slide11
Risk Factors for Breast Cancer
Age
Smoking
Prior personal history
Mammographic breast density
Family history
Genetics
BRCA 1&2 mutations
Nullparity
Late childbearing
1
st
pregnancy > 30 years
Early menarche
Late menopause
Fibrocystic changes with
atypia
History of breast radiation
Hormone exposure
Obesity
Excessive alcohol use
>2 drinks/daySlide12
Benign Breast Disorders
Fibrocystic changes
Most common
Cyclical, bilateral, pain, and engorgement
No discrete or well-defined mass, but breast tissue frequently nodular
Fibroadenoma
2
nd
most commonFibrous and glandular tissueOccurs in young women
Firm, painless, mobile massSlide13
Benign Breast
D
isorders
Intraductal
Papilloma
Commonly found in
peri
and menopausal women
Bloody, serous, or turbid nipple discharge
Excisional biopsy often neededGalactocele
Cystic dilation of duct filled with thick, milky fluid
Common in women breast feeding
Secondary infection causes mastitis
Needle aspiration often curativeSlide14
Benign Breast Disorders
Fat necrosis
Occurs after blunt trauma, operative procedures, or radiation therapy
Breast cystSlide15
Algorithm for palpable breast abnormalities < 30 years old
* If
no
cytologic
expertise available, initial ultrasound preferred
.
• If cytology indicates cancer, treat as appropriate. If
nondiagnostic
, indeterminate or
atypia
, do ultrasound.Slide16
Algorithm for palpable breast abnormalities > 30 years old
When lesions are palpable, clinically directed biopsies are often the most efficient. Fine-needle aspiration (FNA) is the biopsy of
choice
* May
be useful to incorporate a staging MRI into the
managementSlide17
Nipple Discharge
Lactation
Galactorrhea
Bilateral milky nipple discharge
Usually caused by
hyperprolactinemia
Medications (antipsychotics, antidepressants,
antiemetics
, antihypertensive, opioid)
Endocrine tumorsEndocrine abnormalities (hypothyroid)
Neurogenic stimulation
Stress
Purulent nipple discharge – associated with
periductal
mastitisSlide18
Nipple Discharge
Pathologic (suspicious)
Unilateral, localized to a single duct, persistent, and spontaneous
Can be serous, sanguineous, or
serosanguineousSlide19
Algorithm for spontaneous nipple discharge (non-lactating)
* Breast ultrasound is recommended for imaging all patients with nipple discharge. Mammograms are recommended for women ≥ age 30.Slide20
Mastalgia
Cyclical
Associated with changes in menstrual cycle
Bilateral, most severe in upper outer quadrant of breast
Noncyclical
More likely unilateral and variable location
Some causes:
Large pendulous breasts
Hormone replacement therapy
Duct ectasia
Mastitis or breast abscess (common in lactating women)
Inflammatory breast cancer
Hidradenitis
suppurativaSlide21
Workup mastalgia
History and physical exam
Looking for signs suggesting malignancy
Clinical judgment on any diagnostic imaging studies
For focal pain without a mass, or a history/exam not consistent with classic cyclical pain
Targeted ultrasound or mammogramSlide22
BI-RADS mammographic assessment categoriesSlide23
Management algorithm for abnormal mammogramsSlide24
Resources
https://www.apgo.org/education/clinical/breast-exam.html
https://www.apgo.org/binary/TC40.pdf
http://www.uptodate.com