The Breast

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 02/03/2015

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Chapter 9 The Breast

A. Generalities

The clinical breast examination (CBE) is an effective screening tool for breast cancer; its accuracy depends on methodology and operator. Most of the research data stress palpation over inspection.

11 Which bedside maneuver can help to detect breast abnormalities on inspection?

The most commonly taught and used maneuvers include a change in position of the patient’s arms and hands, first described by Haagensen (Fig. 9-2). To do so, ask the patient to carry out the following sequence:

Although these positions are commonly taught and practiced, they do take time. Moreover, the screening value of positioning (and even inspection) remains largely unproven. In a series of 296 breast cancers found on exam, 96% were discovered by palpation, 3% by visible nipple abnormalities, and only 1% by retraction alone. Yet, if the patient is symptomatic (or an abnormality is discovered during palpation), then careful inspection should definitely be carried out.

13 What is skin dimpling?

A slight depression or indentation in the breast’s surface (Fig. 9-3). This is an important clue to an underlying infiltrating carcinoma, causing fibrosis and retraction of the breast tissue. The same mechanism is responsible for nipple deviation.

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Figure 9-3 Nipple retraction and skin dimpling.

(From Seidel HM, Ball JW, Dains JE, Benedict GW: Mosby’s Guide to Physical Examination, 3rd ed. St. Louis, Mosby, 1995.)

19 Describe the proper patient position.

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