Anatomical guide: breast examination methods

(a) * check the main content and significance.

(1) Whether the breast is symmetrical or not, whether there is a localized bulge, and if there is, it means that there is a lesion; Whether there is a local depression, that is, dimple sign, if it appears, it means that cancer or fat necrosis involves Cooper's ligament; The presence or absence of superficial vein dilatation, if unilateral, is mostly a sign of malignant tumor, if bilateral, is mostly caused by pregnancy, breastfeeding or cervical root vein compression.

(2)*: Normal * should be symmetrical, pointing forward and slightly downward. Different heights are often caused by cancer. * should distinguish between congenital and cancerous invagination. * Cleavage can be caused by baby biting or strong sucking. If accompanied by inflammatory exudation, be alert to eczema-like cancer.

(3)* Skin: redness, swelling, heat and pain are mostly caused by inflammation, and large areas of redness, congestion and edema should be alert to inflammatory breast cancer. Pay attention to whether there is orange peel-like change, which is the result of cancer invading superficial lymphatic obstruction.

(B) * Consultation method

1. When the patient takes a sitting position or a lying position, the examiner should be on the side of the patient, with his fingers together and his palms pressed.

You can hold it with your left hand and touch it with your right hand.

3. The order of examination is * the upper outer region (including horny process), the lower outer region, the lower inner region, the upper inner region and the central region (*, areola), and finally the regional lymph nodes are examined. Be careful not to pinch it with your hands.

4. The correct way to ask about the armpit: (Take the left side as an example) face the patient, relax the left upper limb and put it on the examiner's left forearm, and slide the palm of the right hand lightly and steadily to check the axilla tip, chest wall and pectoralis major.

5. Lymph node grouping: central group, pectoral muscle group, subscapular group and subclavian group collected by Medical Education Network. Axillary group ⅰ lymph nodes: located from the lateral to the outer edge of pectoralis minor muscle; Axillary II lymph nodes: located before and after pectoralis minor muscle.

6.* Causes of discharge

(1) Hemorrhagic secretions are more common in breast ductal tumors and less common in ductal cancers.

(2) Brown secretion is common in ductal tumor or cystic hyperplasia of breast, and occasionally in breast cancer;

(3) Yellow or yellow-green secretions are common in cystic hyperplasia of breast and occasionally in breast cancer;

(4) Serous leucorrhea can be seen in cystic hyperplasia of breast, early pregnancy or normal menstrual period;

(5) Breast secretions are more common after breastfeeding, such as amenorrhea, which often indicates pituitary hyperfunction;

(6) Taking estrogen and birth control pills can lead to serous secretion of bilateral mammary glands before menstruation. * Spills should be routinely smeared for cytological examination.

7. Ordinary * Special Inspection Methods

(1)*X-ray examination: ① molybdenum target X-ray photography; ② Dry plate electrostatic photography: Advantages: high resolution for calcification points. It has "edge enhancement effect", produces obvious relief feeling and strong image contrast. The above two methods are widely used in the current census work; The most important advantage is that the edge of the mass is clearer. (3) Catheter endoscopy.

(2) Other physical examinations: ① Near infrared scanning; ②B-ultrasound; ③ LCD temperature * image; ④CT； ⑤ Nuclear magnetic resonance.

(3) Biopsy: The most reliable methods to determine the nature of mass include mass resection, pathological examination and fine needle aspiration biopsy.