INVESTIGATIONS FOR
BREAST DISEASES
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This document provides a comprehensive overview of the various investigations and diagnostic techniques used in the assessment and management of breast diseases. It covers a wide range of topics, including laboratory studies, imaging modalities, and histopathological examinations. The document delves into the triple assessment approach, radiological investigations, and the role of fine needle aspiration cytology, core needle biopsy, and sentinel lymph node biopsy in the diagnosis and staging of breast lesions. The information presented is highly relevant for healthcare professionals, students, and researchers in the field of breast healthcare.
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2021/2022
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INVESTIGATIONS FOR
BREAST DISEASES
INVESTIGATIONS
- (^) Laboratory studies: Routine Special
- (^) Imaging studies
- (^) Tissue diagnosis: Cytology Histology
CLINICAL EXAMINATION
- History โ Age, residence, social status, lump, pain, discharge ,retraction.
- Physical examination โ Inspection and palpation of breast along with examination of lymph nodes (axial group, brachial,subscapular,central,apical group of lymph nodes).
PALPATION METHODS
Palpation should be made in sitting ,semi recumbent (45 degree) and in recumbent position.
- (^) Method 1- Dial clock method
- (^) Method 2- Vertical lines method
- (^) Method 3 โ Wedges
- (^) Method 4 โ Circles
PALPATION OF AXILLARY GROUP OF
LYMPHNODES
- Pectoral group
- Brachial group
- Subscapular group
- Central group
- Supraclavicular group
MAMMOGRAPHY
- (^) It is a plain X-ray of soft tissue of breast using low voltage and high amperage X-rays.
- (^) Dose of radiation is 0.1Gy.
- (^) Two views
- Craniocaudal(CC)
- Mediolateral oblique(MLO)
Indications :
- Screening mammography:
40 years of age.
- Diagnostic mammography:
- In obese patients.
- Whenever conservative breast surgeries are planned.
- To find out spread.
- Mammography guided biopsy can be done.
- Evaluation and follow up in benign breast disease with malignant potential.
- Follow up mammography.
BREAST IMAGING REPORTING AND
DATA SYSTEM(BIRADS)
Grade Feature 0 Need further imaging 1 Negative 2 Benign- repeat mammography in 1 year 3 Probably benign-mammography after 6 months 4 Suspicious of carcinoma-biopsy 5 Highly suggestive of carcinoma-biopsy 6 Known carcinoma
BREAST ULTRASOUND
- (^) < 40 years of age.
- (^) No radiation exposure.
- (^) Young women with dense breast in whom mammogram are difficult to interpret.
- (^) Differentiate solid and cystic lesions.
MAGNETIC RESONANCE IMAGING(MRI) INDICATIONS
- (^) Breast implants โ intracapsular rupture
- (^) Screening tool for high risk patients.
- (^) Used to detect scar recurrences.
- (^) To assess multifocality and multicentricity
- (^) Intraductal pappilomas are seen.
HISTOPATHOLOGICAL INVESTIGATIONS FINE NEEDLE ASPIRATION CYTOLOGY(FNAC):
- (^) 21G or 23G needle used.
- (^) Not used anymore for breast lesions. Disadvantages:
- High false negative.
- Cannot differentiate between in-situ and invasive cancers.