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The Palpable Breast Mass Women should be strongly encouraged to examine their breasts monthly. A potentially flawed study from China has suggested that BSE does not alter survival, but given its safety, the procedure should still be encouraged. At worst, this practice increases the likelihood of detecting a mass at a smaller size when it can be treated with more limited surgery. Breast examination by the physician should be performed in good light so as to see retractions and other skin changes. The nipple and areolae should be inspected, and an attempt should be made to elicit nipple discharge | Chapter 086. Breast Cancer Part 3 The Palpable Breast Mass Women should be strongly encouraged to examine their breasts monthly. A potentially flawed study from China has suggested that BSE does not alter survival but given its safety the procedure should still be encouraged. At worst this practice increases the likelihood of detecting a mass at a smaller size when it can be treated with more limited surgery. Breast examination by the physician should be performed in good light so as to see retractions and other skin changes. The nipple and areolae should be inspected and an attempt should be made to elicit nipple discharge. All regional lymph node groups should be examined and any lesions should be measured. Physical examination alone cannot exclude malignancy. Lesions with certain features are more likely to be cancerous hard irregular tethered or fixed or painless lesions . A negative mammogram in the presence of a persistent lump in the breast does not exclude malignancy. Palpable lesions require additional diagnostic procedures including biopsy. In premenopausal women lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2-4 weeks during the follicular phase of the menstrual cycle. Days 5-7 of the cycle are the best time for breast examination. A dominant mass in a postmenopausal woman or a dominant mass that persists through a menstrual cycle in a premenopausal woman should be aspirated by fine-needle biopsy or referred to a surgeon. If nonbloody fluid is aspirated the diagnosis cyst and therapy have been accomplished together. Solid lesions that are persistent recurrent complex or bloody cysts require mammography and biopsy although in selected patients the so-called triple diagnostic techniques palpation mammography aspiration can be used to avoid biopsy Figs. 86-1 86-2 and 86-3 . Ultrasound can be used in place of fine-needle aspiration to distinguish cysts from solid lesions. Not all solid masses are detected .
