Key points for diagnosis of breast cancer

The key points for diagnosing breast cancer are as follows:

1. Medical history

A lump is often the first symptom of breast cancer. It is important to ask about the time of onset, growth rate, recent changes, pain, and the nature of the pain, the time and nature of nipple erosion and discharge, whether there is a lump in the armpit, and whether there is pregnancy and breastfeeding. Menstrual history and family history are also important.

2. Physical signs

First, start with a comprehensive examination, paying attention to the metastasis of the chest, abdomen, and pelvis. The examination of the breast should first check the healthy side, then the affected side, and the examination should be sequential and careful. Visual examination should be performed first, paying attention to whether the breasts are symmetrical, whether there are any abnormalities in appearance, whether there are any inflammatory changes in the skin, and whether there are orange peel-like edema. Palpation is done with fingers. When examining the breast, extend the upper arm over the head to check the inner half of the breast, and lower the upper arm to check the outer half of the breast. When a lump is found, record the location according to the three-band area and four quadrants, and describe the nature and activity of the lump in detail. Press the areola to see if there is any discharge. If there is fluid discharge, record the nature of the fluid. When examining the supraclavicular lymph nodes, pay attention to the sentinel lymph nodes deep at the origin of the sternocleidomastoid muscle. When examining the axillary lymph nodes, lift the patient's upper arm with one hand, press the axilla with the other hand, then put the upper arm down, hold the patient's elbow with the hand, and examine the axillary lymph nodes. The subclavian lymph nodes are difficult to detect because they are covered by the pectoral muscles, but when there are multiple lymph nodes metastases, they will feel full.

3. X-ray examination

Mammography is a common method for diagnosing breast cancer. Common breast diseases can generally be divided into masses or nodules, calcifications, skin thickening, ductal shadow changes, etc. on X-ray films. When the density of the mass is high and there are burr signs on the edge, it is very helpful for diagnosis. When the burr is longer than the diameter of the lesion, it is called a star lesion. The mass shown in the X-ray film is often smaller than the clinical palpation, which is also one of the signs of malignancy. The shape, size, and density of the calcification points in the film should be noted, and the number and distribution of the calcification points should also be considered. When the calcification points are clustered, especially concentrated within 1 cm, there is a high possibility of breast cancer. When there are more than 10 calcification points, there is a high possibility of malignancy.

4. Ultrasound

Ultrasound examination is non-destructive and can be used repeatedly. Ultrasound examination is more valuable for those with dense breast tissue, but its main purpose is to distinguish whether the mass is cystic or solid. The accuracy rate of ultrasound examination in diagnosing breast cancer is 80%-85%. The strong echo band formed by the infiltration of the tumor into the surrounding tissue, the destruction of the normal breast structure, and the local thickening or depression of the skin above the mass are all important reference indicators for diagnosing breast cancer.

5. Thermal image inspection

The image shows the body surface temperature difference. Since cancer cells proliferate quickly and have rich blood supply, the corresponding body surface temperature is higher than that of surrounding tissues. This difference can be used to make a diagnosis. This diagnostic method lacks accurate image standards, the abnormal thermal area does not correspond to the tumor, and the diagnostic consistency rate is poor. It has been used less and less in recent years.

6. Near infrared scanning

The wavelength of near infrared light is 600-900 μm, which can easily penetrate soft tissue. Infrared light can be used to penetrate different density tissues of the breast to display various grayscale shadows, thereby showing breast lumps. In addition, infrared light is highly sensitive to hemoglobin, and the blood vessels of the breast are clearly displayed. Breast cancer often has increased local blood supply and thickened blood vessels nearby. Infrared light can show better images of this, which is helpful for diagnosis.