Breast lumps physical examination

Physical examination of patients with breast lumps should perform both in sitting position and supine position to examine all 4 quadrants of breast. Careful physical examination may lead to diagnosis. Breast physical exam should include information about, number, size, location, shape, mobility, consistancy of masses, nipple discharge, and axillary lymph nodes.

Physical examination of patients should be perform both in sitting position and supine position to examine breast abnormalities.^[1]

• Patients with breast lumps usually appear well.

• Patients with breast lumps usually have normal vital signs.

• Patient’s breast skin may develop with dimpling, redness, and peau d’ Orange particularly in inflammatory breast cancer.

• HEENT examination of patient with breast lumps is usually normal.

• Lymphadenopathy maybe present in cervical and supraclavicular lymph nodes and determination of size, mobility, and number are essential.

• Pulmonary examination of patients with breast lumps is usually normal.

• Cardiovascular examination of patients with breast lumps is usually normal.

• Breast examination must consider all 4 quadrants of both breast while patients are in sitting position and supine position.^[1][2]
• General inspection of both breast for probable findings of nipple changes, asymmetric changes and notable masses.
• Size, location, shape, mobility, consistency, and number of lesions should be mentioned.
• Axillary lymph nodes must be examined for adenopathy.
• Examination of nipple discharge:
  • From one duct or multiple ducts
  • Presence or absence of galactorrhea
  • Presence or absence of blood
  • Type of discharge such as being clear, viscous, watery or bloody
• Determination of chest wall tenderness:
  • Examination of costochondral junction
  • Examination of lateral chest wall while the patient is lying down at 90 degrees on her side in order to move the breast away
  • Comparison of pain from chest wall and breast tissue

Discrete solitary breast lump:

• Firm and rubbery lump in women <30 years is suggestive of:
  • Fibroadenoma
• Firm and discrete lump in women aged 30-50 years is suggestive of:
  • Fibroadenoma
  • Cyst
  • Fibrocystic changes
  • Usual ductal hyperplasia
  • Atypical ductal hyperplasia
  • Atypical lobular hyperplasia
• Firm and discrete lump in women > 50 years is suggestive of:
  • Cyst
  • Invasive cancer
  • Ductal carcinoma in situ

• Abdomen examination of patients with breast lumps is usually normal.

• Back examination of patients with breast lumps is usually normal.

• Genitourinary examination of patients with breast lumps is usually normal.

• Neuromuscular examination of patients with breast lumps is usually normal.

• Extremities of patients with breast lumps is usually normal.

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