//fpnotebook.com/
Clinical Breast Exam
Aka: Clinical Breast Exam, Breast Exam
- See Also
- Breast Self Exam
- Breast Anatomy
- Breast Mass
- Breast Cancer Screening
- Breast Cancer Risk Factors
- Efficacy: Clinical Breast Exam
- USPTF does not recommend for or against CBE or SBE
- Insufficient evidence to date
- Contrast with Mammogram which is USPTF B rating
- (2002) Am Fam Physician 65(12):2537-44 [PubMed]
- Sensitivity of Clinical Breast Exam
- CBE detects 3-24% of cancers missed by Mammography
- Especially in Women younger than age 50
- Limitations of Clinical Breast Exam
- High False Positive Rate
- As few as 4% of abnormal CBE are Breast Cancer
- Bobo (2000) J Natl Cancer Inst 92:971-6 [PubMed]
- Misses >40% of cancers diagnosed by Mammography
- Requires practice for confidence and proficiency
- Technique accounts for 29% variance in sensitivity
- Fletcher (1989) J Gen Intern Med 4:277-83 [PubMed]
- References
- Baines (1997) J Natl Cancer Inst Monogr 22:125-9 [PubMed]
- Sirovich (1999) Surg Clin North Am 79(5):961-90 [PubMed]
- History: Focused
- Self Breast Exam performance
- Breast Lump
- Nipple Discharge
- Skin Changes
- Breast Pain
- Exam: Timing
- Lactation: Nurse or pump before exam
- Optimal during Follicular Phase (Estrogen only)
- Less engorgement
- More comfortable
- Preferably between days 5-10
- Exam: High risk areas for Breast Cancer
- Upper Outer Breast
- Most common location for Breast tumors
- Sub-Areolar (Deep to Areola)
- Second most common location for Breast tumors
- Technique: Sitting Position Exam
- Advantages of Sitting Position
- Axillary fat pad moves forward, exposes nodes
- Duplicates upright position of shower exam
- Skin retraction highlighted on Pectoralis contract
- Observation (From front and side in every position)
- Focus points on observation of Breast
- Symmetry
- Skin retraction or dimpling
- Skin Color and texture
- Nipple and Areola
- Positions
- Arms at side
- Arms over head (exposes lateral, inferior Breast)
- Hands on hips
- Contracts Pectoralis muscle
- Accentuates Cooper Ligament tumor involvement
- Examine Lymph nodes
- Supraclavicular
- Infraclavicular
- Axillary
- Technique: Supine Position Exam
- Focus points on palpation of Breast
- Background nodularity (fibroadenomas)
- Asymmetry
- Dominant mass
- Nipple Discharge
- Positioning
- Ipsilateral arm abducted, flexed
- hand behind head
- Palpation patterns
- Wedge Pattern
- "Spokes of a wheel" OR "Hands of a Clock"
- Palpate in radial pattern around Breast
- Circular Pattern
- Spiral pattern from nipple to outer Breast
- Vertical Strip
- Similar to plow lines on a field
- Technique
- Use pads of the 1st 3 fingers
- Start with light, then medium, then deep pressure
- Interpretation
- Benign mass findings
- No skin change
- Smooth, soft, mobile lesion with well defined margins
- Malignant mass findings
- Hard, immobile lesion with irregular margins