Clinical Examination and Imaging

Chapter 1 - Diagnosis and Staging of Breast Cancer and Multidisciplinary Team Working

Family history of BC, age at menarche, number of births and pregnancies, age at first birth, history of breast biopsies and breast operations, date of the last menstrual period, use of hormone replacement therapy and detection of breast tumour in mammography screening are the key events to note.

The breasts should be palpated when the patient is sitting or standing, the arms hanging freely as well as elevated (A, B). The examination is repeated when the patient is lying supine (C, D).

Clinical Examination Imaging Figure 1

Lesions located in the upper parts of the breast are best detected with the patient sitting or standing (A, B). Lesions in the lower parts of the breast may become obvious only when the patient is lying supine with the arms elevated (D).

Clinical Examination Imaging Figure 2

The triple diagnostic approach consists of breast inspection and palpation, breast imaging usually with mammography and ultrasound, and a core needle biopsy (CNB) of the breast lesion.

When one of the components of the triple diagnostic approach is suspicious, a repeated core biopsy or surgical biopsy should follow, even when the other components do not suggest cancer.

Breast imaging should precede a biopsy, since a haematoma or other tissue alterations may interfere with image interpretation. Breast imaging usually consists of mammography and ultrasound examination of the breast and the axilla.

Dr Mazen Sudah, Department of Radiology, Kuopio University Hospital, Dr Katja Hukkinen, Department of Radiology, Helsinki University Hospital and Dr Päivi Heikkilä, Department of Pathology, Helsinki University Hospital, for radiological and histopathological photographs.

Typical findings suggestive of cancer in mammography include an irregular mass, star-like (stellate) or spicular lesions, microcalcifications and structural distortions. The sensitivity of mammography is lower in patients with dense breast tissue, typically associated with younger age.

BC usually causes an echo-poor irregular lesion in ultrasonography.

Benign and malignant lesions cannot always be reliably distinguished by breast imaging. Some BCs resemble a benign lesion, viewed as a regular and well-defined mass.

Revision Questions

  1. What are the key events to note in the patient history?
  2. What components are included in the triple diagnosis?
  3. What are the findings typical of BC at mammography?

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Last update: 13 October 2017