This document discusses breast lumps and the evaluation process. It covers the anatomy of the breast, history taking, clinical examination techniques, and the "triple assessment" process of ultrasound, mammography, and biopsy to establish a diagnosis. The anatomy section describes the structure of the breast including lobes, ducts, and lymphatic drainage. The examination section provides details on inspecting and palpating the breasts and lymph nodes. The triple assessment discusses the use of imaging like ultrasound and mammography as well as biopsy techniques to diagnose breast lumps.

1. Breast Lumps
Presented by :-
DR Darayus P.Gazder

2. Contents
• Anatomy of Breast
• History taking
• Clinical examination
• Specific considerations
• Triple assessment
• Diagnosis

3. Anatomy of Breast
• Introduction to breast :
• Breasts (mammary glands) = modified sweat
glands

4. • The breast is composed of glandular, ductal,
connective, and adipose tissue. The mammary
glands are modified sweat gland and are
composed of 15-20 lobules, each drained by a
lactiferous duct. Each lactiferous duct
independently drains on the nipple. Areola
surrounds nipple
• In men, little fat is present in the breast, and the
glandular system normally does not develop.

5. • Lie in superficial fascia anterior to deep fascia of pec. major
BOUNDARIES :-
• Bounded by the clavicle superiorly
• Infra-mammary fold inferiorly
• The sternum medially
• Lateral border of the latissimus muscle laterally
• COOPERS LIGAMENT: Extends frm dermis of skin to the
pectoralis fascia and provides support to the breast.
• AXILLARY TAIL: Mistaken for a LN or Lipoma

6. Four Quadrants of the Breast
• Upper outer (superolateral) quadrant
• Upper inner (superomedial) quadrant
• Lower outer (inferolateral) quadrant
• Lower inner (inferomedial) quadrant

7. • The French term peau d'orange means skin of
an orange. Cutaneous lymphatic edmea
• Advaned malignancy leads to infiltration and
shortening of Cooper’s ligament
• Leads to irregular dimpling
of skin or retraction of nipple

8. • The lymphatic drainage of the breast deserves
special attention, due to its role in the
metastasis of cancer cells. The majority of
lymph (>75%), particularly from the lateral
quadrants, drains to the axillary lymph
nodes. The remainder of lymph drains to
either the parasternal nodes or the opposite
breast

9. History taking : The Lump
• Biodata : Age, Married, Number of children, Age
of last child, Lactating
• Onset : when was the lump first noticed
• Location : which side - right or left
• Single or multiple : how many ?
• Unilateral or bilateral
• Duration : since when did the pt notice the lump
• Progression : Has it changed in size (ca)
• Is there any pain : type, severity (painless in ca )
• Association with menstrual cycle

10. • Skin changes, nipple discharge or retraction
• Axillary / supraclavicular swelling
• Previous breast cancer
• H/o trauma, bone pain, fever or weight loss

11. Risk factors
• Female sex, older age
• Family history of breast ca
• Oral contraceptive pill / HRT
• Cycles (early menarche or late menopause)
• Pregnancy : lack of child bearing
• Lack of breast feeding
• Smoking, alcohol intake
• High fat diet

12. • Past medical history
• Surgical history
• Drug history
• Allergies
• Social history : support, activity level, smoking,
alcohol, drugs

13. Examination
• Specific considerations :
• Chaperone must be present
• Explain to them what the examination will
entail and gain the patients consent

14. Inspection
• Inspect the patient in upright position
• Make a general inspection of both breasts.
Look for any asymmetry, scars, obvious lumps
or nipple abnormalities (e.g. inversion or
discharge)
• You should also comment on any skin changes
(peau d’orange, eczema).

15. • Ask the patient to place her hands above her
head and repeat the inspection
• Look for any obvious mass

16. Palpation
• Start on the “normal” side first
• Ask the patient to place her hand behind her
head on the side you are examining
• Systematically examine all areas of the breast
with your hand laid flat on the breast. Start
from outside and work towards the nipple.
Imagine that the breast is a clock face and
examine at each ‘hour’

18. • LUMP : size, shape, position,consistency,
surface,overlying skin
• Don’t forget that the breast tissue extends
towards the axilla in the ‘axillary tail’
• Ensure you ask the patient if she experiences
any pain during examination

19. • Examine the other breast in the same manner
• Ask the patient to squeeze both nipples

20. Lymph node examination
• Examine both axillae for any enlarged lymph
nodes
• Whilst examining the patient’s axilla, you
should fully support the weight of that arm
with yours
• Examine the axilla with your other hand

21. • Ensuring that you feel all four walls (anterior,
posterior, medial and lateral) as well as feeling
into the apex of the axilla
• Repeat this on the other
side
• Palpate the supraclavicular
fossa on both sides to check
for lymphadenopathy
• Finally auscultate the chest

22. Triple assessment

23. ULTRASOUND
• Its useful in young women with dense breasts
• Distinguishes cyst from solid lesions
• Can be used to take biopsy of axillary tissue
when cancer is diagnosed and guided
percutaneous biopsy of any suspicious glands
may be performed

24. Mammography
• High voltage low Amp Xray (0.1cGY)
• Sensitive with Increasing age, as breast
becomes less dense.
• MLO and CC
• Classified as BIRADS

25. MRI
• Best imaging modality in women with implants
• Useful screening tool in high risk women (+FH)
• Useful to distinguish scar from recurrence in
women who have had previos BCT for cancer

26. FNAC
• Least invasive technique of obtaining a cell
diagnosis (21G or 23G)
• Rapid and very accurate investigation, but false
negatives do occur
• It cannot distinguish invasive cancer from in situ
disease
Corecut biopsy
• It allows histological diagnosis.
• It differentiates between DCIS and invasive disease.
• It also allows the tumor to be stained for receptor status