Different breast examination techniques and diagnostic applications

Different breast examination techniques and diagnostic applications

1. Recommendations for carrying out examinations

   • Patient consent
   • Axillary trichotomy is not necessary
   • Come any day of the menstrual cycle
   • It can come during periods of pregnancy and lactation
   • The clinical examination must be carried out without gloves, since wearing them loses sensitivity.
   • You must consider the signs and symptoms of the pre- and transmenstrual period of the menopausal woman. It is performed on any day of the month.

2. Palpation

   • It is done with the palm of the hand or with the fingertips in a gentle and methodical way, to look for lesions in the breasts, armpits and supra and subclavicular regions.
     • Neighborhood of the chest wall, the patient lies with the arms loose at the sides. The examiner's right palm is placed between the right clavicle and her sternum and slides down to the nipple to feel for any superficial bulges
     • Manual digital palpation One hand is placed with the palmar surface facing up under the patient's right hand, with the fingers of the other hand passed over the breast tissue to locate possible lumps by compressing them between the fingers and with the hand extended.
   • Lymph node palpation
     • Central axillary: Examination of the axillary nodes, with the palmar surface of the fingers grouped and inserted in the axilla to the bottom, they should be placed just behind the pectoral muscles.
       • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
     • Examination of the supraclavicular node: Fingers hooked over the clavicle and rotated over the entire supraclavicular fossa.
       • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
   • Supine patient
     • Delimitation of tumors size, shape, consistency, mobility, borders, surface, pain, bilaterality and position.
       • Gentle, firm pressure on the chest wall
         • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • Mental division of the breast into quadrants
         • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • Parallel lines method: first down and then up until you reach the nipple
         • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • Radial lines method: from the edge of the breast hemisphere to the nipple.
         • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • Circular lines method: starting at the outer edge of the breast tissue with movements spiraling towards the nipple.
         • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • Gentle expression of the nipple - at the time of the examination, it should be pressed on the breast towards the nipple.
       • Second, third and fourth fingertips slightly flexed.
         • • Tomoda de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf

3. ultrasound

   • • Breast ultrasound is an imaging technique that translates the different sound frequencies generated by an organ
   • BIRDS classification for ultrasound
     • Ultrasound pattern: describes the composition of the breast
     • Mass: Defined as a space-occupying lesion
     • Calcifications
     • Special cases: These are specific lesions that appear on ultrasound.
     • Vascularization.

4. Mammography

   • • Mammography consists of an X-ray image diagnostic examination of the mammary gland
     • Screening mammography: recommended in an asymptomatic patient without any risk factors and without any clinical findings
     • Diagnostic mammography: It is that mammography that is requested in a patient who comes to the consultation with breast symptoms or presents findings on clinical examination.

5. Magnetic resonance

   • • Diagnostic imaging tool that relies on radiofrequency waves emitted by protons from the examined tissue
     • It is divided into categories
       • Focus: uptake, pinpoint
       • No masses: catchment area
       • Capture kinetics: initial phase and tariff phase.
       • Location
       • Mass: Injury deal with three-dimensional spaces
       • Associated findings: They may appear isolated or associated with abnormal uptake.
     • https://www.grupmanchon.com/exploraciones/ es-grup-manchon- diagnostico-imagen-barcelona- imagen-mamaria- -magnetica- mama.html

6. It is important to perform a correct breast examination technique to detect suspicious lumps and, where appropriate, make the diagnosis and initiate timely treatment.

   • Inspection
     • The inspection is done with the naked eye, the patient will be sitting with her chest and arms uncovered, under adequate lighting and with the examinee standing in front of her.
     • Static inspection
       • with the upper extremities hanging along the trunk in a relaxed position.
       • Montgomery tubercles: they are scattered, not sensitive and non-suppurating. They are a common finding.
       • Clinical signs that can be found during inspection
         • Inverted nipple (umbilication) or change in direction of the nipple
         • Skin retraction.
         • Changes in skin color.
         • Discharge from the nipple.
         • Discharge from the nipple.
         • Rash or ulceration
         • Venous network.
     • Dynamic Inspection
       • with his hands behind his neck. This posture increases stress on the suspensory ligament, and retraction data can be observed that can pass unnoticed during static inspection
         • • imagen tomada de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • with the torso leaning towards forehead: sitting and leaning forward from the waist; this posture also induces tension on the suspensory ligaments.
         • • imagen tomada de https://www.medigraphic.com/pdfs/facmed/un-2018/un182i.pdf
       • You are asked to press your hips with your hands and with your shoulders rotated backwards, or press your palms together to contract your pectoral muscles, revealing deviations from contour and symmetry.

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