The incidence of breast diseases is increasing and more and more women are paying attention to regular breast examinations. However, there are some problems in breast physical examination or census, such as we often meet breast cancer patients who have metastasized and often say to doctors, “I just had a physical examination not long ago, why wasn’t breast cancer found which?” In fact, these patients may not have chosen the right examination method during physical examination, and the methods of breast examination are as follows.
I. Self-examination
Since breast cancer may show typical manifestations, women can perform breast self-examination to detect some breast diseases or even breast cancer in time. The time to perform breast self-examination is appropriate to be done about 10 days after menstruation. There are three main methods: visual examination, palpation and squeezing.
1. Visual examination: Take off your shirt and face a mirror with good light. Observe whether there is any change in the size and color of the bilateral breasts, whether they are symmetrical, and whether there are any abnormal sunken nipples. Raise your arms and observe whether your breasts can move naturally with them, and whether there are local bulges, wrinkles, dimples, etc.
2. Palpation: Touch the breasts for lumps and check for enlarged axillary lymph nodes. The four fingers should be put together and examined in an orderly manner with the palm end of the fingers.
3.Squeezing method: Use the thumb and four fingers on each side of the areola to squeeze the breast and observe whether there is milk or liquid flowing from the nipple.
Second, the doctor check
The doctor’s examination focuses on finding breast lumps, nipple and areola abnormalities (tumors located in or close to the deep nipple may cause nipple retraction; eczema-like carcinoma of nipple may manifest as itching, erosion, rupture, crusting, flaking and burning pain of nipple skin), nipple overflow, breast skin changes (dimple sign, orange peel-like changes, satellite skin nodules, etc.). It is also necessary to check whether there is swollen axillary lymph nodes. In occult breast cancer, no lump can be felt on physical examination of the breast, and swollen axillary lymph nodes are often the first symptom.
Imaging examination
1. Ultrasound examination of breast: Ultrasound examination is non-invasive, convenient, fast, inexpensive and accurate, and has been increasingly used for people with suspected breast disease and breast screening or routine physical examination. Both breast and axillary lymph node examinations can be performed. It is suitable for people of all ages, such as young, pregnant and lactating women, and older women. It is possible to confirm suspicious abnormalities or lumps in the breast. Ultrasound can also guide interventional operations, evaluate breast lesions after implantation of prosthesis, etc. It is the first choice of reliable examination method for screening breast diseases in women in China.
2.Mammography: It can detect lumps and calcified shadows in the breast and is mainly used for the diagnosis of malignant breast lesions, the follow-up of benign lesions, and the examination of abnormal changes found by screening.
It is a routine examination method for European and American women’s breasts, but compared to European and American women, Chinese women’s breasts have more glandular components and less fat components, especially in young women, which means that Chinese young women’s breasts are denser and X-rays are not easy to penetrate, so the examination effect may not be good. Therefore, for young women, especially women under 35 years old who have no clear risk factors for breast cancer or no abnormalities seen in clinical examination, it is not Therefore, mammography is not recommended for young women, especially those under 35 years of age, who do not have clear risk factors for breast cancer or clinical examination.
3.Magnetic resonance imaging of breast: MRI is not used as a routine examination for breast cancer diagnosis. It can be used to assess the stage of breast cancer, determine the extent of ipsilateral breast tumor, and determine whether there are multifocal or multicentric tumors. It can be used to screen for contralateral breast tumors at the time of initial diagnosis. At the same time, it helps to evaluate the tumor extent before and after neoadjuvant therapy, treatment remission status, and whether breast-conserving treatment can be performed.
Pathological examination
Histopathological diagnosis is the basis for diagnosis and treatment of breast cancer, that is, without histopathological diagnosis, breast cancer cannot be treated with surgery or radiotherapy. The specimens for histopathological diagnosis are obtained from coarse needle aspiration, mastectomy or surgical excision.
V. Examination of nipple overflow
Nipple overflow, called “watery nipples” by the common people, is an important clinical symptom of breast disease. More than 80% of nipple overflow is caused by benign lesions, such as intraductal papilloma and ductal dilatation. Even benign intraductal papilloma has the possibility of malignant transformation, so it is important to pay attention to nipple overflow.
For patients with nipple overflow, mammography can be performed under mammography to show the lesions in the ducts of the breast.
2.Papillary overflow smear cytology examination This method is simple and quick, just squeeze out the nipple overflow, catch it with a slide, then scrape the end of the slide to make a smear, and then look for the lesion cells under the microscope.
3.Fiber ductoscopy is inserted into the milk duct through the small hole of the patient’s nipple overflow, which can locate and diagnose the suspected lesion site under direct vision, and if there is chronic inflammation of the milk duct, it can be directly treated by flushing.