In recent years, with the use of ultrasound and mammography in routine medical checkups and increased public awareness of breast diseases, more and more patients are seen in the outpatient clinic for “breast nodules”, and many are concerned about whether the nodules are early breast cancer or localized cancer. Clinical management is difficult, and whether to operate or biopsy is a difficult choice.
Breast nodules are a more general term clinically used to refer to smaller lumps as nodules, which can occur in any area. Smaller breast lumps can be called breast nodules. Most “breast nodules” are detected by ultrasound or specialized physical examinations, such as breast ultrasound depicting hypoechoic nodules or substantial nodules, and physical examinations describing breast nodules. Some women who pay attention to self-examination can often touch the hard nodules in their breasts and come to the clinic. In fact, breast nodules are morphological changes in the breast tissue, a vague diagnostic term or a clinical manifestation. Abnormal abnormalities in the breast that can be palpated or detected on imaging are collectively referred to as breast nodules or breast lumps until a qualitative diagnosis is made. Normal physiological conditions of the breast and benign and malignant breast diseases can manifest as nodules. In other words, a breast nodule is a symptom, not a diagnosis of disease.
Clinical diagnosis of breast nodules
(i) Detailed history questioning
Are the nodules newly discovered or pre-existing? Premenstrual pain? How does the size of the nodule relate to the menstrual cycle? Is there nipple discharge? History of breast surgery? Family history? History of medication use? etc.
(ii) Meticulous physical examination
1. Define the six characteristics of the nodule (age, number, size, shape and border, texture, mobility).
2. Pay attention to the traces of external manifestations of the nodules.
(iii) Imaging examination
1, breast ultrasound: ultrasound examination technology is mature and non-invasive, non-radiation, can be repeated, especially for breast cysts diagnostic rate of more than 90%, Chinese women’s breast is small and dense gland, through the mass elasticity index and blood flow signal determination can be initially identified benign and malignant, is the first choice for the initial screening of nodules benign and malignant. However, it is difficult to determine the nature of small nodules, and the ultrasound examination is more dependent on the level of the examining doctor.
2.Mammography: mainly for breast cancer screening, it is generally used for physical examination of women above 40 years old with high fat content in breast gland, to identify benign and malignant breast lumps with calcification, to review breast cancer patients, and to clarify whether there are multiple foci and the extent of lumps in breast cancer patients. If the patient’s breast gland is dense, small nodules may be missed.
3.Magnetic resonance examination of breast: MRI has good contrast and can be observed in three dimensions, which can show the edge, location, signal intensity and invasion range of breast lesions, but breast MRI requires special equipment and is expensive.
Clinical management of breast nodules
Most breast nodules are clinically benign and do not need to be overly concerned, but the nature of breast nodules should be further clarified by timely examination at a breast specialist. The treatment of breast nodules cannot be generalized and should be determined in detail according to the patient’s condition.
(a) Indications for surgical treatment or puncture biopsy.
1.For clinical physical examination and imaging consideration of malignant lesions, appropriate treatment procedures will be performed.
2. In principle, surgical treatment or puncture biopsy is recommended for nodules with a diameter of more than one centimeter.
3. For persistent solitary nodules with unclear borders or rich blood flow and hard texture, surgery or puncture biopsy pathology may be considered to clarify the diagnosis to prevent missing breast cancer and delaying treatment.
4. For nodes that continue to increase in size during the follow-up process, surgery is recommended even if benign lesions are considered.
5.For special lesions reported by puncture pathology, such as ductal or lobular atypical hyperplasia, intraductal papilloma, etc., surgical excision or re-biopsy is required because malignant lesions cannot be excluded.
6. Surgical treatment or puncture biopsy should also be recommended for breast nodules that are clinically difficult to differentially diagnose. (Especially for middle-aged and elderly patients, with family history and other high-risk factors)
(B) Chinese medicine treatment and life conditioning: Breast nodules and periodic breast pain caused by clinically defined lobular hyperplasia can be relieved by the auxiliary application of some Chinese medicine treatment.
(iii) The importance of observation and follow-up: For those breast nodules diagnosed as benign lesions by imaging or biopsy, regular review is recommended regardless of whether they are surgically removed or not. The purpose is to observe whether there is any change in the nature and size of the nodules and whether there are any de novo lesions. For palpable nodules, patients can certainly observe changes in size through self-examination of the breast, but changes in the internal structure and new lesions that are not palpable are not detectable. Most patients with breast hyperplasia have multiple hypoechoic nodules on ultrasound, which in most cases are signs of cystic hyperplasia of the breast.