The Triple Assessment Flashcards
What is the breast triple assessment?
A hospital based assessment clinic that allows for the early and rapid detection of breast cancer.
It is a one-stop clinic that a patient can be referred to by their GP as a 2 week wait referral if they have signs or symptoms or suspicious finding on their routine breast cancer screening mammography.
History and examination are performed by a breast surgeon or associate specialist.
Explain history
Ask about presenting complaint
Ask about potential risk factors
Ask about FH and current medications
Explain inspection in breast examination
Inspect by bed and check for any ovious masses, scars or asymmetry.
Ask the patient to place their hands by their sides and compare both breasts.
Look for any skin changes or ulceration like erythema, puckerin or peau d’orange.
Look for any nipple discharge or inversion
Ask the patient to place both hands behind their head and repeat this inspection.
This is to find any asymmetry
Inspect the axillae for masses
Ask patient to place both hands on their hips and repeat the inspection.
Explain palpation in breast examination
Ask patient to place both hands behind their head.
Examine each quadrant of the breast, including the axillary tail.
Using a flat hand, press the breast against the underlying chest wall, rolling the underlying tissue. - Start with normal side first and examine painful areas last.
If you palpate a lump, note their position, size, shape, consistency, overlying skin changes and mobility.
Examine the fixity of the lump to pec major by asking the patient to push against your hand with their hand outstretched.
Examine both axilla in turn (hold the opposite hand in your other hand.
Palpate for lymphadenopathy (apical, anterior, central, posterior and medial in the axilla)
Palpate the spine for tenderness, palpate the abdomen for hepatomegaly, percuss and auscultate the lungs for masses.
Imaging in triple assessment.
Mammography
USS
MRI is not in the mainstay triple but can be useful in assessment of lobular breast cancer.
Explain mammography
Involves compression views of the breast across oblique and craniocaudal view.
This allows for detection of mass lesions or microcalcifications.
Explain ultrasound scanning
More useful in women <35 and in men due to the density of breast tissue.
This is also used during core biopsies.
What is required for any suspicious mass or lesion.
Core biopsy sent for full histology to allow for differentiation between invasive and in-situ carcinoma.
This is not fine needle aspiration as that only provides cytology
Why is histology important?
Provides diagnosis
Can give information about tumour grading and staging.
What is the overall risk index in triple assessment?
Suspicion for malignancy is graded according to this index.
