Diagnosis of Benign Breast Tumors

Diagnosis

1. Medical history A breast mass is the most common symptom that leads a patient to visit a hospital. The history should determine when the lump first appeared, whether its size changes with the menstrual cycle, whether it is continuing to grow, whether it is accompanied by pain, whether there are any related nipple changes, and whether there is any discharge. If there is breast pain, the degree of distress caused by the pain should be assessed, along with whether there are any changes according to the menstrual cycle. Questions should also be asked about medications or foods that may cause the pain, recent weight gain, and any musculoskeletal or cardiovascular disease. In the case of nipple discharge, information is also needed on whether it comes from one side or both, whether it comes from a single duct, the color of the discharge, and related gastrointestinal medications, blood pressure medications, and nervous system medications.

In addition to the current discomfort, a detailed past medical history is needed to obtain detailed information about menstrual status and breast cancer risk. For all women, the age at menarche, marital status and age at marriage, number of pregnancies, number of deliveries and miscarriages, age at first childbirth, whether they have breastfed and for how long, family history of breast cancer, previous breast surgery, and any history of trauma should be checked. In premenopausal women, the date of the last menstrual period, regularity of the menstrual cycle, and whether oral contraceptives are being taken should be confirmed, and in postmenopausal women, the timing of menopause and whether hormone replacement therapy is being used should be checked.

2. Physical examination Physical examination is performed by inspection and palpation. For inspection, with sufficient time and in a sitting position, observe the size of the breasts, symmetry, skin and nipple retraction, and any masses. Then ask the patient to raise both arms above the head, or to straighten the back and lower both arms to press on the hips, thereby tensing the pectoralis major muscle, and perform the same examination.

For palpation, with the patient lying down, examine the entire breast from the clavicle (collarbone) superiorly to the lower margin of the ribs inferiorly, and from the sternal border medially to the midaxillary line laterally. If a mass is palpable, check its size, shape, location, borders, smoothness of the surface, mobility, hardness, skin changes, and tenderness. Also check for nipple discharge by pressing or gently squeezing the areola. Next, palpate the axillary lymph nodes.

3. Radiologic tests · Mammography Mammography is performed with standard mediolateral oblique and craniocaudal views. Depending on the patient's body type, the image is taken at an angle of about 45 degrees and compressed according to the direction of the pectoral muscle.

· Breast ultrasound Breast ultrasound is a useful test for differentiating the internal components of a breast mass. In the case of cysts, it has a diagnostic rate of over 96%, and it can also efficiently distinguish malignant solid masses from benign masses such as fibroadenomas.

· Other tests Other tests include gamma scan, breast MRI, ductography, and digital mammography. These tests are performed when necessary after evaluation by a specialist.

4. Tissue examination · Fine-needle aspiration cytology This method is used to diagnose firm cysts similar to fibroadenomas. It is relatively simple, highly accurate, has few complications, and causes little discomfort to the patient, so it is widely used. Reported sensitivity ranges from 65% to 98%, and specificity from 34% to 100%. If there is any possibility of cancer, additional tissue examination is required for histologic confirmation.

· Needle biopsy Needle biopsy can obtain an adequate amount of tissue, with a sensitivity of 100% and a specificity of 98%. The procedure is performed under local anesthesia, and bleeding may occur afterward, so hemostasis is important. There are ultrasound-guided automated core needle biopsy using a fine needle and vacuum-assisted biopsy using a thicker needle. Although vacuum-assisted breast biopsy is relatively more expensive, it has the advantage of being able to completely remove small breast lesions.

· Excisional biopsy Excisional biopsy is the complete removal of the lesion together with the surrounding tissue, or of the lesion alone, through surgery. In benign tumors, it is a method that allows complete diagnosis and treatment.

· Incisional biopsy Excisional biopsy is the complete removal of the lesion together with the surrounding tissue, or of the lesion alone, through surgery. In benign tumors, it is a method that allows complete diagnosis and treatment.

· Stereotactic biopsy Stereotactic biopsy is used when examining non-palpable breast masses or calcifications not seen on ultrasound. It is a procedure in which the location of the calcification is tracked through digital mammographic images and a computer program, and then tissue is obtained using an automated gun or vacuum-assisted breast biopsy.

· Image-guided needle localization Among non-palpable breast lesions, when changes seen on mammography cannot exclude malignancy, this method is used for surgical biopsy. Before surgery, the location is tracked using a standard mammography machine, stereotactic device, or ultrasound, and then a needle is inserted.

So far, I have explained the diagnosis of benign breast tumors. In the next installment, we will look at edema, which occurs frequently in modern people.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal