DIAGNOSTIC INVESTIGATIONS OF THE BREAST
To improve our survival:
1. Early detection
2. Accurate diagnosis
3. Timely treatment, is a must.
The National Comprehensive Cancer Network for breast cancer
screening offer specific guidance for older women with serious
health problems and women at increased risk.
DIAGNOSTIC INVESTIGATIONS OF THE
BREAST
Several techniques are used to screen for breast disease or
to provide a diagnosis of a suspicious physical finding.
The diagnostic investigations on breast is mainly divided
into:
1. Non- Invasive Techniques
2. Invasive Techniques
DIAGNOSTIC INVESTIGATIONS OF THE
BREAST
• NON-INVASIVE TECHNIQUES
1. Breast Examination
2. Mammography
3. Thermography
4. Ultrasonography
DIAGNOSTIC INVESTIGATIONS OF THE
BREAST
• INVASIVE TECHNIQUES
1. Needle Biopsy
2. Incisional Biopsy
3. Excisional Biopsy
BREAST EXAMINATION TECHNIQUE
• Clinical breast examination is required every 3
years. For women between ages 20 & 30 and every
year for women beginning at the age 40.
• Breast-self examination is an option for women
starting at age 20.
• Women should report any breast changes promptly
to their health care provider.
BREAST EXAMINATION TECHNIQUE
BREAST EXAMINATION TECHNIQUE
• Breast Self examination should include information
about:
1. Potential benefits
2. Limitations
3. Harm ( chance of a false- positive result)
FREQUENCY OF BREAST EXAMINATION
1. For women who are having regular menses,
breast self examination is best carried out right
after menstruation when the breast is less lumpy
and tender.
2. If menses are irregular, breast self examination is
carried out in the same day of each month.
FREQUENCY OF BREAST EXAMINATION
3. For women taking oral contraceptives, the first
day of the new package may be a helpful reminder.
4. Post menopausal women and women who
underwent hysterectomy, they usually chose one
specific date and first day of each month for breast
self examination.
MAMMOGRAPHY OF THE BREAST
• Mammography is a method used to visualised the
internal structure of the breast using X-rays.
– This procedure can detect findings that cannot be
felt.
– Recent imaging technology has also reduced the
radiation that accompanies mammography.
– Mammography may follow screening procedures,
such as ultrasonography or thermography.
MAMMOGRAPHY OF THE BREAST
USES OF MAMMOGRAPHY
Mammogram is mainly used for:
1. Screening mammogram
2. Diagnostic mammogram
SCREENING MAMMOGRAM
• Screening mammogram is used to screen for
unsuspected breast cancer in women with no
signs/symptoms.
SCREENING MAMMOGRAM
• It usually involves X-rays images of each breast to
detect tumours /small calcifications within the
breast tissue.
• Calcifications are the most easily recognised
mammogram abnormalities.
• These deposits of calcium crystals form in the
breast for many reasons, such as inflammation,
trauma and aging.
SCREENING MAMMOGRAM
DIAGNOSTIC MAMMOGRAM
Diagnostic mammogram is used to diagnose breast
cancer in a patient with a suspicious lump or other
signs such as breast pain, nipple discharge, thickening
of breast skin or sudden change in the breast shape or
size.
DIAGNOSTIC MAMMOGRAM
However, it is also utilised to examine breast
abnormalities found during a SCREENING
MAMMOGRAM, such as in cases for patients with
breast implants. This is so because it provides more
detailed X-ray of the breast than in screening
mammogram.
Although mammography can detect 90-95% of the
breast cancers, this test produces many falsepositive results.
INDICATION OF MAMMOGRAPHY
• Mammography is generally indicated to:
1. Differentiate between benign breast disease and
breast cancer.
2. Investigate breast pain, nipple retraction, nipple
discharge.
3. Evaluate palpable and impalpable breast masses.
4. Screen for malignant breast tumours.
5. Monitor effectiveness of breast radiation therapy.
6. Evaluate opposite breast following mastectomy.
CONTRAINDICATION OF MAMMOGRAPHY
• Mammography is generally not indicated to:
1. Pregnant women, unless the potential benefits
of a procedure using radiation outweigh the
risks of maternal and fetal damage.
2. Patients younger than 25years or with very
dense breast tissue.
INTERFERING FACTORS
These are factors/ conditions that may change the
outcome of the study:
1. Application of substances such as antiperspirants,
talcum powder, lotions or creams to the
underarm and breast area that may interfere with
the accuracy of the results.
2. Failure to remove metallic objects and clothing.
INTERFERING FACTORS
3.Previous breast surgery, active lactation and
glandular breast (common in women age 30 and
below), which can affect the quality of the image.
4.Breast implants which
visualization of the breast.
may
prevent
full
5.Inability to cooperate or remain still during the
procedure due to age, health condition or mental
status.
RESPONSIBILITIES OF NURSES BEFORE
MAMMOGRAPHY
The responsibilities of nurses when assisting patients before
mammography are:
1. Explain the procedure and what to expect after.
2. Allow the patient to express concerns and fears about
the procedure.
3. Remove interfering factors.
4. Schedule a senior technologist for the with breast
implants.
5. Prepare the patient (give gown open in front, remove
jewelleries)
RESPONSIBILITIES OF NURSES DURING
MAMMOGRAPHY
• The responsibilities of nurses when assisting patients
during mammography are:
1. Assist with the positioning.
2. Tell the patient that some discomfort can be felt.
3. Advise the patient to cooperate completely and
follow directions.
RESPONSIBILITIES OF NURSES AFTER
MAMMOGRAPHY
The responsibilities of nurses when assisting patients after
mammography are:
1. Provide information about the availability of the
results.
2. Reinforce the information given by the patient’s
doctor.
THERMOGRAPHY
Thermography is a non-invasive and painless test that
doctors sometimes use to monitor for early breast
changes that could indicate breast cancer.
✓ It works by detecting increases in temperature.
✓It does not involve radiation. Instead, it uses an ultrasensitive camera to produce high-resolution, infrared
photographs, heat images of the breast.
THERMOGRAPHY
✓This infrared imaging technique can detect changes
in breast tissue and produce a high resolution
image of the breast skin temperature.
✓The image can be analysed using thermal vascular
mapping for skin temperature and changes, even
the slightest change.
THERMOGRAPHY
According to the American College of Clinical
Thermology, thermography can detect changes that
may indicate various conditions, such as:
✓Cancer
✓Fibrocystic disease
✓An infection
✓Vascular disease
The test cannot confirm that cancer is present. It can
only show that there are changes that may need
further investigation.
THERMOGRAPHY
This technique cannot detect a lump, it will show
changes in body and skin temperature, which may
be a sign of increased metabolic activity or blood
flow in one particular area. This changes happen as
the cancer cells try to maintain themselves and
grow.
BENEFITS OF THERMOGRAPHY
As a screening option of the breast cancer,
thermography has advantages such as:
✓It is not painful
✓It is not invasive
✓It does not involve radiation
RISKS OF THERMOGRAPHY
The risk of thermography is that:
✓It can give inaccurate results
✓It can give misleading information
ULTRASONOGRAPHY
Ultrasonography uses high frequency sound waves to create a
black and white image of breast tissues and structures.
This test is usually required to assess the size and shape of
breast lumps and to determine whether they could be
tumorous growths or fluid filled cysts.
ULTRASONOGRAPHY
• Unlike CT scans and X-rays, an ultrasound does not use
ionizing radiation.
• Individuals who are not candidates for radiation-based
imaging techniques, the Doctors advised for ultrasound.
• However, people who should avoid radiation include:
– Pregnant or breastfeeding woman
– People under 25 years
– Have breast implants
A doctor may also use an ultrasound to help guide a biopsy
needle to collect tissue from a lump for testing.
INDICATION FOR BREAST ULTRASONOGRAPHY
Doctors may request for breast ultrasound in cases
like:
1. Assessing unusual nipple discharge
2. Evaluating cases of mastitis, which is the
inflammation of the mammary tissues
INDICATION FOR BREAST ULTRASONOGRAPHY
3. Assessing symptoms like breast pain, redness and
swelling.
4.Examining skin changes such as discoloration
5.Monitoring existing benign breast lumps
6.Verifying the results of other imaging tests, such as
MRI or mammogram
INVASIVE TECHNIQUES
• DEFINITION
It is defines as a medical procedure that enters the body,
usually by cutting or puncturing the skin or by inserting
instruments into the body.
In the context of breast diseases, the THREE invasive
techniques which will be studied are:
1. Needle biopsy
2. Incisional biopsy
3. Excisional biopsy
GROUP WORK PRESENTATION (20 MARKS):HAND
WRITING …PHOTOS CAN BE STICKED OR DRAWN
NEEDLE BIOPSY
INCISIONAL BIOPSY
EXCISIONAL BIOPSY
DEFINITION
DEFINITION
DEFINITION
WHEN IS NEEDLE BIOPSY
USED?/ INDICATION
WHEN IS INCISIONAL BIOPSY WHEN IS EXCISIONAL
USED?/ INDICATION
BIOPSY USED?/ INDICATION
RISKS OF NEEDLE BIOPSY
RISKS OF INCISIONAL BIOPSY RISKS OF EXCISIONAL
BIOPSY
Fine Needle Aspiration (FNA)
Core Needle Biopsy (CNB)
Sample
Removed
Removes only a very small portion of
the lesion
Removes a small portion in most cases,
occasionally removes the entire lesion
Needle Size
22-27 gauge
11-18 gauge
Pathology
Cytopathology
Type
Interpretation
Immediately
Time
Diagnostic
Abilities
Limited ability to specifically
diagnose benign lesions
No ability to differentiate between in
situ and invasive breast cancer
Disadvantages Cannot be used for additional study
Advantages
Inexpensive, quick, readily available,
and very safe
Effectiveness
Sensitivity: 75.8-98.7%
Specificity: 60-100%
Positive Predictive Value: 93.5-100%
Histopathology
Delayed
Strong ability to specifically diagnose
benign lesions.
Some ability to differentiate between in
situ and invasive breast cancer.
More invasive, time consuming,
expensive
Can be used for additional study and
has more specific diagnostic abilities
than FNA
Sensitivity: 91-99.6%%
Specificity: 98-100%
Positive Predictive Value: 100%