The breast examination should be
conducted in a standardized fashion and all findings
should be reported according to a standard or universal
nomenclature. Although we prefer using a location
description and code, a diagram of the female breast can
be helpful to further identify the location of a breast
lesion.
The Breast
Examination
- 1. Aspect of the
Breasts
- The breast should be examined with the
patient in upright position and lying down.
The following should be reported:
- 1. Overall appearance
- 2. Deformities and skin alterations (dimpling
and retractions)
- 3. Color changes (cellulitis, mastitis)
- 2. Examination of the
Breasts
- With time each physician develops his own
particular method of examining breasts. The
examination should evaluate each quadrant of
the breast and each finding should be
reported by location and type. As such, the
breast is divided into four quadrants: Upper
outer, upper inner, lower outer and lower
inner.
- If a palpable lesion is identified, it should
be reported by quadrant and/or clockwise
topographic location, i.e., 1 o'clock, 2
o'clock, etc.
-
- A breast lesion is first reported as nondominant
versus dominant lesion.
Nondominant lesions are lesions with
ill-defined limits or borders and are felt to
be part of the normal breast parenchyma. A
dominant breast lesion is a defined lesion
with a size and the characteristics of a
mass.
-
- All lesions are reported by size, consistency
and mobility. A typical report would be:
Palpable, Hard, Dominant Mass, 2 cm in size
at 2 o'clock (LUOQ), Mobile.
-
- The physician should always compare the
suspicious breast quadrant to the
contralateral quadrant.
-
- Most physicians will perform an aspiration on
all palpable masses to differentiate a cystic
from a solid lesion.
3. Examination of the
Nipples
The nipple should be carefully examined for
superficial skin changes and discharge. Discharges
should be classified as bloody versus
nonbloody/physiological. If a discharge can be
expressed from the nipple from a specific location,
this location should be reported.
4. Examination of the
Axillary Regions
Both axillae should be examined carefully and any
lymphadenopathy should be reported.
5. Examination of the
Supraclavicular Regions
Both supraclavicular fossa should be examined and
abnormal lymphadenopathy reported.
6. Physical Examination
A Physical Examination should always be performed
in conjunction with the breast examination.
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