Examinations for breast diseases

This is the 5040th article of Da Yi Xiao Hu

Breast disease is a major threat to women's health, and breast cancer is the most common malignant tumor, so early detection and diagnosis are crucial. However, do you know the main methods for checking breast disease? Let me introduce the methods for checking breast disease.

01

Breast Ultrasound

This is a radiation-free examination method suitable for breast examination of any population, especially patients who cannot undergo mammography, such as young patients, pregnant women, and breastfeeding women. It can observe the location, size, boundary, edge, shape, internal and posterior echo, calcification and surrounding tissue of breast lumps, including changes in structures such as skin, pectoral muscles and ligaments, etc., especially for dense breasts. However, it has limitations in distinguishing subtle calcification foci.

02

Mammography (Breast X-ray)

This method can clearly show the various layers of breast tissue and calcification foci, and has a high sensitivity for early breast cancer screening. However, it has a certain amount of radiation and is less capable of diagnosing dense breasts, so it may need to be combined with other examination methods, such as ultrasound and nuclear magnetic resonance.

03

Breast MRI

MRI has the advantages of no radiation and high resolution, and is particularly suitable for highly sensitive examinations of breast lesions, especially for breast cancer diagnosis. However, breast MRI is not suitable for pregnant women, people with metal foreign bodies in the body, or people with claustrophobia, and the cost is relatively high.

04

Ductoscopy

If the patient has nipple discharge, ductoscopy can be used, especially if there is bloody discharge from the nipple. For diseases such as intraductal papilloma, ductoscopy has a high diagnostic rate and little pain, but cross-infection needs to be prevented.

05

Pathological examination

It is suitable for cases with suspicious breast mammography and B-ultrasound examinations, including cytopathology and histopathology, and is an essential basis for clinical diagnosis of breast cancer. Cytopathology is to puncture the tumor under ultrasound guidance and remove a small amount of tumor tissue for pathological examination. Histopathology is to remove the tumor together with the surrounding breast tissue for histopathology examination.

① Fine needle aspiration cytology (FNA)

The diagnosis of clinically palpable breast lumps has a history of half a century, and its diagnostic sensitivity is 72% to 99%, and its specificity is 99% to 100%. The advantages of FNA are easy and simple to operate, safe, less traumatic, and no need for anesthesia. However, FNA can only provide cytological diagnosis, so it is impossible to distinguish infiltration from carcinoma in situ. When the lump is too small, too deep or unclearly demarcated with the surrounding tissue, puncture has difficulties, which can cause missed diagnosis and misdiagnosis.

② Core needle biopsy (CNB)

Using a thicker cutting needle, a cylindrical tissue specimen is obtained in one cut, which is suitable for histological diagnosis. The main difference from FNA is the different diameters of the puncture needles they use. The advantage of CNB is that it can be used for pathological section examination, to clarify the pathological type, and to determine whether it is carcinoma in situ or invasive cancer. However, the false negative rate of CNB is relatively high and has certain limitations. Core needle biopsy may also lead to the complete removal of micro-breast tumor lesions, which may affect the positioning of further surgery and the determination of the lesion margins during breast-conserving surgery.

In summary, factors such as the patient's age, health status, and family history should be considered when choosing an examination method. For example, for young women or women during pregnancy and lactation, ultrasound examination may be the first choice because their breasts are denser. For women over 40 years old, mammography is an effective screening method and has been proven to reduce the mortality rate of breast cancer. For high-risk groups or patients with suspected cases, MRI can be used as a supplementary examination method. Nipple discharge can be diagnosed by ductoscopy. Pathological examination is an essential basis for clinical diagnosis of breast cancer. In short, different breast examination methods have their own advantages and limitations. Choosing the right examination method is crucial for early detection and treatment of breast cancer. It is recommended to choose the most appropriate examination method according to personal circumstances under the guidance of a doctor.

Author: Li Yujin, Shanghai Fifth People's Hospital, Fudan University