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The Breast Examination


The breast examination should be conducted in a standardized fashion and all findings should be reported according to a standard or universal nomenclature. Although we prefer using a location description and code, a diagram of the female breast can be helpful to further identify the location of a breast lesion.

The Breast Examination

1. Aspect of the Breasts
The breast should be examined with the patient in upright position and lying down. The following should be reported:
1. Overall appearance
2. Deformities and skin alterations (dimpling and retractions)
3. Color changes (cellulitis, mastitis)
2. Examination of the Breasts
With time each physician develops his own particular method of examining breasts. The examination should evaluate each quadrant of the breast and each finding should be reported by location and type. As such, the breast is divided into four quadrants: Upper outer, upper inner, lower outer and lower inner.
If a palpable lesion is identified, it should be reported by quadrant and/or clockwise topographic location, i.e., 1 o'clock, 2 o'clock, etc.
A breast lesion is first reported as nondominant versus dominant lesion. Nondominant lesions are lesions with ill-defined limits or borders and are felt to be part of the normal breast parenchyma. A dominant breast lesion is a defined lesion with a size and the characteristics of a mass.
All lesions are reported by size, consistency and mobility. A typical report would be: Palpable, Hard, Dominant Mass, 2 cm in size at 2 o'clock (LUOQ), Mobile.
The physician should always compare the suspicious breast quadrant to the contralateral quadrant.
Most physicians will perform an aspiration on all palpable masses to differentiate a cystic from a solid lesion.

3. Examination of the Nipples

The nipple should be carefully examined for superficial skin changes and discharge. Discharges should be classified as bloody versus nonbloody/physiological. If a discharge can be expressed from the nipple from a specific location, this location should be reported.

4. Examination of the Axillary Regions

Both axillae should be examined carefully and any lymphadenopathy should be reported.

5. Examination of the Supraclavicular Regions

Both supraclavicular fossa should be examined and abnormal lymphadenopathy reported.

6. Physical Examination

A Physical Examination should always be performed in conjunction with the breast examination.

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