Breast Examination Flashcards
What is the following clinical sign and what does it indicate?
lumpectomy (small scar)
What is the following clinical sign and what does it indicate?
mastectomy (large diagonal scar).
What is the following clinical sign and what does it indicate?
Nipple inversion is a normal finding in a significant proportion of women (e.g. congenital or weight-loss associated nipple inversion). However, if nipple inversion develops without a clear precipitant, the possibility of underlying pathology should be considered. Possible pathological causes of nipple inversion include breast cancer, breast abscess, mammary duct ectasia and mastitis.
What does nipple discharge suggest?
Nipple discharge is benign is most cases (e.g. pregnancy, breast-feeding) however less commonly it can be associated with mastitis or underlying breast cancer (rare).
What is the following clinical sign and what does it indicate?
Scaling of the nipple and/or areola associated with erythema and pruritis are typical features of Paget’s disease of the breast (see the example image). Paget’s disease is associated with underlying in-situ or invasive carcinoma of the breast.
What is the following clinical sign and what does it indicate?
Puckering of breast tissue is typically associated with invasion of the suspensory ligaments of the breast by an underlying malignancy that results in ligamentous contraction which draws the skin inwards.
What can cause erythema of the breast?
Erythema of the breast tissue has a wide range of causes including infection (e.g. mastitis or breast abscess), trauma (e.g. fat necrosis) and underlying breast cancer.
What is the following clinical sign and what does it indicate?
Peau d’orange (dimpling of the skin resembling an orange peel) occurs due to cutaenous lymphatic oedema. The dimples represent tethering of the swollen skin to hair follicles and sweat glands. Peau d’orange is typically associated with inflammatory breast cancer.
What is tethering and what does it indicate?
Repeat inspection with the patient pressing their hands into their hips to contract the pectoralis muscles.
If a mass is visible, observe if it moves when the pectoralis muscle contracts which suggests tethering to the underlying tissue (e.g. invasive breast malignancy).
If a breast lump is detected, what charachterestics should you assess?
- Location
- Size
- Shape
- Consistency
- Mobility
- Fluctuance
- Overlying skin changes
How would you describe the location of a breast lump?
Location
Which quadrant of the breast is the mass located within?
How far away from the nipple is the mass located?
How would you describe Size and shape of a breast lump?
Size and shape
What are the approximate dimensions of the mass?
What shape is the mass?
How would you describe Consistency of a breast lump?
Consistency
What is the consistency of the mass on palpation? (e.g. smooth/firm/stony/rubbery)
How would you describe Overlying skin changes of a breast lump?
Overlying skin changes
Are there any changes to the skin overlying the mass? (e.g. erythema/puckering)
How would you describe Mobility of a breast lump?
Mobility
Assess the degree of mobility the mass has:
Does it move freely?
Does it move with the overlying skin?
Does it move with pectoral contraction?
How would you describe Fluctuance of a breast lump?
Fluctuance
Hold the mass by its sides and then apply pressure to the centre of the mass with another finger. If the mass is fluid-filled (e.g. cyst) then you should feel the sides bulging outwards.
If nipple discharge is present, what should you note?
- Colour (e.g. blood-stained, green, yellow)
- Consistency (e.g. thick, watery)
- Volume
What does milky discharge indicate?
Milky discharge: normal during pregnancy and when breastfeeding (bilateral). Galactorrhoea (nonpuerperal lactation) is pathological and caused by the presence of a prolactinoma.
What does purulent discharge suggest?
Purulent discharge: thick yellow, green or brown discharge with an offensive smell. Possible causes include mastitis and central breast abscess.
What does watery and bloody discharge suggest?
Watery and bloody discharge: several possible causes however ductal carcinoma in situ is the most important diagnosis to consider.
What do Enlarged, hard, irregular lymph nodes suggest?
Enlarged, hard, irregular lymph nodes are suggestive of metastatic spread.
What further investigations/ examinations would you do?
Mammography: typically used in patients over the age of 35.
Ultrasound: typically used in patients under the age of 35 due to increased density of breast tissue making mammography less effective.
Biopsy: fine-needle aspiration or core biopsy may be considered if a breast lump needs further histological assessment.
