The discovery of a lump in the breast is the main reason for breast patients to visit the clinic. Although various examination instruments are becoming more advanced, manual palpation is still the first priority, because the many different features of the lump derived from palpation are an important basis for determining the nature of the lump and are corroborated with the instrumental examination. In the case of population census and remote areas with poor medical conditions, where it is difficult to take pictures or examine everyone with instruments, manual examination is particularly important, and medical resources and the burden on the public can be saved through screening.
Hardness
Generally speaking, cancerous tumors are the hardest. Fibroadenomas and bruised breast cysts are also hard, but they are flexible and elastic, resembling rubber lumps, while cancerous tumors feel like wooden blocks. As for the hardness of the most common breast growths, it depends on their severity and the type of growth, but they are mostly pliable. Generally speaking, the harder the swelling, the more dangerous it is.
Mobility
When the lump is touched, the mobility of the lump can be sensed by fixing the edges of the lump with each of two fingers, sensing the size of the lump and pushing it back and forth relative to each other. Fibroadenomas and some lobular sarcomas are the most mobile and can slip out from under the fingers with slight pressure (even the local anesthetic used during surgery can cause them to shift out of position). Carcinoma and inflammation adhere to surrounding tissues due to their infiltrative nature, limiting their mobility, and the more advanced they are, the more immobilized they become. However, certain carcinomas in situ also have considerable mobility in their early stages. As for the mobility of the hyperplasia, it depends on its hardness and thickness, and the thin lamellar hyperplasia has little mobility. Some benign subcutaneous or intradermal masses are also less mobile because they are attached to the skin.
Clarity of contour
Benign tumors can be more clearly palpable in terms of their borders, extent and shape. Carcinomas and inflammatory conditions are blurred because they are infiltrative and extend to the periphery. Mammary hyperplasia also does not have clear boundaries, but its firmness, shape, tenderness and relationship to menstruation are different from those of tumors.
The appearance of dimple sign (dimpling of the skin within 1x1cm) or orange peel sign (pore enlargement and skin thickening of varying size) is associated with
1. Cancer invading the suspensory ligament of the breast or adhering to the local skin.
2. Inflammation or even necrosis of local tissues, fat or glands caused by various reasons (mainly trauma).
3.Some small benign tumors superficially located under the skin may appear as superficial dimples when the skin activity of the corresponding area is restricted when the breast is held up.
4.Patch contracture or deep suture release after breast surgery, leaving a traumatic cavity.
5, chronic inflammation prolonged for a long time, skin edema, can appear orange peel sign.
Nipple condition
The nipple and the swelling behind the nipple can be examined by a combination of finger to finger pinching and flat palpation, if the nipple has retraction or points away from the nipple, the relationship with the swelling should be carefully examined. If there is extruded effusion, the swelling should be inspected for changes in volume. Theoretically, any overflow during non-lactation is abnormal. In general, the darker the color, the more dangerous it is. If there are superficial ulcers and oozing from the nipple and areola, like eczema like a skin disease, one must be alert for eczema-like carcinoma, which can often be palpated as a solid swelling behind the nipple. Inverted nipples are mostly caused by congenital dysplasia and can be pulled out by manipulation. If the invagination is due to breast cancer, it is mostly recent and progressive, and it is difficult to pull out by manipulation, and hard nodes can often be palpated behind the nipple. In addition, the former is only nipple invagination, while the latter can have different degrees of invagination along with the areola.
Lymph nodes
If hard and clear lymph nodes can be palpated in the axilla and there is a suspected cancer in the breast, it often indicates that lymph nodes have metastasized. If no suspicious mass is found in the breast, but axillary lymph nodes can be palpated, it is often due to reactive enlargement of local lymph nodes left over from previous breast inflammation or surgery. However, one should be alert to the possibility of occult breast cancer metastasis.
In addition, for sagging breasts, a “thick lump” is often palpable in the upper part of the breast. In this case, both thumbs should be used to lift the breast from the bottom, so that the upper part is loose, and the rest of the fingers should be used to examine it to avoid illusion, or in a lying position.
Parametrial breast
If the swelling in the anterior axillary line is soft, it is mostly a parametrium. The degree of development of the parametrium varies greatly and theoretically any lesion of the breast, the parametrium can appear, but in practice the incidence is very low. Parametrium should be differentiated from axillary lymph nodes. (Some parametrial breasts are located under the rib cage with only a trace of an underdeveloped nipple).
Fillers
Some fillers that have undergone augmentation surgery resemble breast masses and can be differentiated by palpation and careful examination of the surface scars in the context of the overall breast.
Male breast enlargement
Most of them are associated with long-term use of certain cardiovascular drugs or abnormal liver function or a history of trauma. They generally present in two types: a hard nodule behind the nipple or an overall diffuse bulge. The former is well defined. The latter should be distinguished from a well-developed pectoralis muscle, with the nipple of the diffuse augmentation located in the center of the augmentation and the nipple of the toned pectoralis muscle located in the lower third of the augmentation. The hardness and contour of the two kinds of augmentation are also different.
The above is a little bit of the author’s rough experience, and the clinical judgment must be combined with the accompanying circumstances of the swelling, such as the patient’s age, the time of swelling discovery and the trend of change, the presence of obvious triggers, the degree and pattern of pain, and the results of other instrumental examinations, so that the preoperative diagnosis can be eight or nine times better.