Breast HX, Examination + Investigations

Question 1

What might people present with if they have breast disease?

Answer 1

New lump or change in lump size/consistency 
Change/distortion of breast shape 
Skin changes= rashes or infections 
Nipple changes= detraction or distortion
Nipple discharge= blood stained 
Infection 
Mastalgia (pain)

Question 2

What is important ask when someone presents with changes to their breast?

Answer 2

Location
Duration
What the change is
Whether the changes are related to the menstrual cycle i.e. cyclical
Menstrual history (menarche, LMP, menopause)
Drug history (OCP + HRT)
Family HX of breast and ovarian cancer

Question 3

Why is it important to ask about menstrual and drug history in women presenting with a breast lump or changes?

Answer 3

These factors can effect the level of oestrogen exposure which is a risk factor for breast cancer
-increased oestrogen exposure= increased risk

Therefore:

• early menarche and late menopause
• nulliparous (pregnancy is protective)
• whether breast feeding
• whether had hysterectomy

Question 4

What are the 3 positions used to examine the breasts? What should you be looking for in these positions?

Answer 4

Hands in lap
Hands behind head
Hands on hip

Looking for:

• asymmetry
• scars
• lumps or swellings
• skin changes
• changes around the nipple

Question 5

How should you palpate the breast during an examination?

What features should you comment on about the lump?

Answer 5

3 middle fingers in circular motion in clock pattern from periphery to centre.
Palpate the nipple
Ask patient to squeeze nipple if they have been experiencing discharge

Features:

• site (quadrant of the breast)
• size
• mobility + fixity
• fluctuance

Question 6

Which LN should you palpate as part of a breast examine and how is this done?

Answer 6

Axillary LN

• support patients arm
• palpate the 4 walls of axilla and the apex

Supraclavicular and cervical

• from behind
• both hands at same time to compare

Question 7

When is US and mammography indicated to investigate the breast and why?

Answer 7

USS

• <40= more dense breast tissue when younger makes a mammogram hard to interpret
• pregnancy or lactation= want to avoid radiation exposure

Mammography

• > 35
• symptomatic= can get more views
• screening process= MLO and CC views

Question 8

What is the difference between a core biopsy and fine needle aspiration cytology (FNAC)?

Answer 8

Core:

• preserves architecture so can differentiate between invasive and in-situ disease
• can grade tumour
• can look for receptor status

FNAC:
-isolated cells so can only look at types of cells rather than the nature of the cells in breast tissue
I.e. looking to identify malignant changes to nuclei

Question 9

What is the triple assessment?

Answer 9

Physical examination
Radiological imaging i.e. US +/- mammogram
Biopsy (core biopsy or FNAC)