Diagnosing Female Breast Lesions
Self-Examination
Because 95 per cent of breast cancers are detected by women themselves, top priority must be given to teaching all women how and when to examine their breasts. The nurse is in a unique position to offer this advice and to arrange for showings of the film Breast Self-Examination, available from local chapters of the American Cancer Society.
The method of self-examination of breasts should be performed monthly, in addition, breast examination by palpation should be included in the annual complete physical examination of all women. A breast examination should be done twice a year in women who have a family history of breast cancer.
Mammography
Mammography is a roentgenography of the breast without the injection of a contrast medium. It is a safe, simple, nontraumatic, gross diagnostic procedure. It complements but does not substitute for physical examination. With mammography, breast cancer can be demonstrated before signs and symptoms are present; however, it requires skilled roentgenologists to interpret the findings.
The importance is that it offers the following indications for mammography: (1) signs and symptoms of breast disease, (2) previous breast biopsy, (3) familial history of breast cancer, (4) survey of remaining breast after mastectom), (5) lumpy or large pendulous breasts, difficult to examine, (6) cancerophobia, and (7) adenocarcinoma, site undetermined.
Usually 3 views are taken. For the craniocaudal view, the patient is seated while an x-ray is taken from above looking downward. The other 2 views are mediolateral and axillary
Thermography
Abnormal circulatory signs may be detected by infrared photography. The patient is placed in a room under basal conditions (i.e., the room has been cooled to 21°C. or 70°F.) for 20 to 30 minutes. By means of a sophisticated heat-sensing apparatus, it is possible to detect minute amounts of heat generated in and around areas of increased blood supply. This method requires a well-trained radiologist to interpret abnormal patterns. A diagnosis is made only within the context of a thorough history and complete physical examination. With improved devices and techniques, thermography may prove a valuable diagnostic adjunct.
Xerography
In xerography, a selenium-coated plate is subjected to an electrical charge, the x-ray exposure is made, and the plate is then developed by a special process under careful monitoring. The result is a xerogram in which all tissues of the breast, including skin, are portrayed in a bas-relief effect. Although disadvantages exist with regard to the painstaking processing, xerography appears to hold promise in detecting early cancer. However, it has not yet been established as a routine diagnostic procedure.
Biopsy
This procedure can be done in the outpatient department or physician’s office. Following the injection of a local anesthetic, a No. 18 needle is directed into the site to be sampled. Upon suction of a syringe, tissue is drawn into the needle. This material is spread on a glass slide, fixed and stained before being sent to the laboratory.
Incisional biopsies are usually done in the operating room under general anesthesia, and may comprise the entire lesion. Tissue is sent to the laboratory where it is frozen rapidly; very .thin slices containing a good cross-section of tissue are stained with a dye to facilitate microscopic observation.
Sources:
Ramsay DT, Kent JC, Hartmann RA, Hartmann PE (June 2005). “Anatomy of the lactating human breast redefined with ultrasound imaging”. J. Anat.
Gotzsche PC, Nielsen M (2006). “Screening for breast cancer with mammography”. Cochrane Database Syst Rev (4): CD001877
Greenbaum AR, Heslop T, Morris J, Dunn KW (April 2003). “An investigation of the suitability of bra fit in women referred for reduction mammaplasty”. Br J Plast Surg
Introduction to the Human Body, fifth ed. John Wiley & Sons, Inc.: New York, 2001. 560.
