The general check of mammary gland is divided into history collection and clinical check of disease to diagnose two fractions;The latter includes inspection and Men to diagnose.While face check should in the ray bright place, Zhu patient seat regular, untie blouse, double arm ptosis, make a pair of sides mamma, breasts well rear, so that the contrast observe.
(A)the history of disease collect
Because of the universal publicity of the family Pu sanitation knowledge, the sufferer discovers mammary gland abnormality’s circumstance cure to obviously increase by himself[herself], check sufferer the mammary gland before collects a disease history very necessary.
The sufferer’s age, multiparity circumstance, feed history, Menopause history and kindred history etc. all very important.Another according to recent years domestic and international research report, the outbreak rate of breast carcinoma year by year and obviously rises to absorb quantity increment with fat to contain direct relation within the scope of world, past Diet habit and composition are in the history of the disease the collection as well important day by day.A lot of pathological changeses of mammary glands express the proptosis obvious variety in the menstrual cycle, so the understanding menarche age and menstruation circumstance is very important currently.
Collect the history of disease in, have in response to the special attention inquiry mammary gland have no swollen thing or lump and whether the swelling of the ache, course of illness length, mammary gland and the change circumstance of the heavy feeling, trauma history, menstruation size, and since go toward have without alike circumstance etc..When the mammary gland has a swollen thing, should inquire it to grow speed, axillary fossa have already had no lump, the skin surface once denied the inflammation or the color change.Should also ask and the nipple hasn’t overflowed a liquid and overflow the property, number of times of liquid how much and course of illness length.The sufferer uses a medicine history in, specially should notice the usage circumstance of hormone;Involve take of contraceptive, should in detail understanding use a medicine for time of length, drug name, dose and operation method, and end time the date which check mammary gland.
(Two)clinical check
1.Inspection:The meticulous inspection can acquire very the ketone body of have the diagnosis meaning advertise for.
(1)The outline form observe:Double size, position and outline form of the side mamma, breast generally in response to is symmetry, otherwise then hint probably sick mutation existence.While there is bigger lump inside mamma, breast, its outline form can show localized swell up;The tumor infringes upon Cooper surname ligament in the mammary gland deep layer and make of contraction but creation should correspond the skin depression, line of dependency or skin contraction of part phenomenon.Observe skin depression hour let the patient take seat, double arm chiasma in neck empress or ex- Fu first half main part of root and short rhizome, or by hand jack up the whole mamma, breast more obvious.Observe the skin hollow is importance, so species the ketone body advertise for in the positive pathological changes and in addition to fat necrosis, seldom see.Sometimes can also discover don’t arrive small breast cancer of lump in the clinical last Men.Single side mamma, breast shallow form venous dilatation is later period breast cancer or mammary gland sarcoma to advertise for elephant.Pregnancy, lactation or jugular root iliac vein are press(for example get a retrosternal thyroid cyst hour) and can also cause the mamma, breast shallow form venous dilatation, but the latter be often a pair of side.
(2)Nipple:The nipple double of the normal mamma, breast side symmetry, its direction direction front combine slightly and outwardly next.If its neighborhood have the cancer the swollen or chronic inflammation, nipple can to the focus deviation, for example the nipple has cancer cyst above and then is lead long up but manifestation double side nipple Gao Di be different, if cancer cyst Be located on a nipple deep part, the nipple then is lead long but invagination.Nipple retraction, crater nipple may also because of development poor but occurrence of Sir’s blemish, but the nipple retraction, crater nipple then needs a high vigilance in the short run.Primipara lactation period can appear because the infant sucks up or bites open nipple erosion and rupture, but don’t breast feed to expect women nipple an erosion to take off scraps, areola mammae surroundings the Eczema be a then likely to be eczematoid carcinoma, namely Paget surname disease of performance.
(3)Mamma, breast skin:The skin has already deny red, cyst, heat, pain?Mamma, breast skin swollen and inflamed, should consider the purulent inflammation disease of mamma, breast first, but scope extensive skin redness.The congestion edena should watch out for whether special type breast cancer, then blaze the possibility of sex breast cancer.The cancer cell irruptive mamma, breast shallow form lymphatic vessel causes cancer emblism, can cause lymphedema but make the mamma, breast skin present “Mandarin bark kind” change.
2.Palpation:The important point of palpation is understand a mamma, breast have already had no lump and lump of property;The district lymph node has already greatly has no cyst.Palpation the doctor sit a side a square at the sufferer, or the Zhu sufferer calm lie and the shoulder descends pad one small Zhen.When Men checked mamma, breast seamy side half Zhu the sufferer raised an arm, Zhu for Men to check lateral half sufferer arm ptosis the side of the main part of root and short rhizome.Correct palpation skill with the palm of hand is in the mamma, breast the top depend on up, outside up(include a coda), outside under, inside bottom, central(nipple, areola mammae) in proper order and lightly the Men press the mamma, breast.Hate to by hand point to grasp to knead a mamma, breast, the in order to prevent mistake thinks the mamma, breast lump to the normal ceruminous gland ketone body tissue.(Diagram 2-8, 2-9)the central region lump not easy Men of sterigma arrive, can start to give a mamma, breast with the left hand, check with the right hand Men, more and easily discover.The mamma, breast inferior part lump is often cover up because of mastoptosis;Can start to give a mamma, breast or make the patient even to lie to raise an arm, then carry on Men to check.Lump if Men of the mamma, breast deep part can not understand, can Zhu patient ex- Fu top main part of root and short rhizome again the Men check it.The empress of the mamma, breast palpation, have to the Men check a district lymph node.
(1)Mamma, breast lump:Whether ex- thoracic lump comes from a mamma, breast or not should notice an identification first.The lump(like costal chondritis, costal tumor, thoracic cavity wall tuberculosis…etc.) from ex- thoracic cavity wall while change mamma, breast, the lump will not move because of the fluctuation of mamma, breast position.When the Men arrives an explicit mamma, breast lump, should notice its size, position, number, texture, have already denied a tenderness, outline form whether orderliness, edge whether know, whether surface is smooth or not, organize with surroundings like skin, pectoralis major, serratus anterior…etc. whether glue connect etc. circumstance.The light and soft Nian rises a lump surface skin, can have learned that whether lump has with skin or not have never glue connect;If glued to connect but have no inflammation performance, then should watch out for the possibility of breast cancer particularly.The Men checks a lump whether glues with deep part tissue to connect, first distinguish in the level direction and the perpendicular direction test a lump of movable degree, then adopt a pectoralis major contraction indol test:The Zhu sufferer makes an effort by suffering from side upper limbs to stand with arms akimbo, borrow with the nervous pectoralis major and make a same test again.Lump’s movable degree in pectoralis major surface while more and twice testing can know whether lump glues with pectoralis major iliac fascia, pectoralis to connect or not.Probably have already exceeded a pectoralis major inferior border because of it when the Men checks a mamma, breast to outside descend a quadrant lump, can adopt a serratus anterior contraction indol test:The Zhu sufferer will suffer from side upper limbs to make an effort to press to press Examiner shoulder and borrow with nervous serratus anterior, compare method together ex-.
(2)Axillary fossa lymph node:In addition to nasty and chronic inflammation, the general mammary gland positive pathological changes will not cause an axillary fossa swelling of lymph node.While checking the axillary fossa lymph nodes, the doctor faces a patient, check sufferer left Yi to the right the hand Men and check a sufferer right Yi by left hand Men.First the Zhu sufferer raises check side upper limbs, the Examiner hand stretches into the axillary fossa to the tallest, namely the Yi lymphoid and sharp cluster, the fingers palmar side faces sufferer thoracic cavity wall, again let the patient let go of upper limbs, put off on the forearm of Examiner, one by one in order the Men check the Yi cupula, Yi anterior wall, Yi posterior wall, latissimus dorsi ex- seamy side.Have already had no swollen lymph node on clavicular bottom and clavicle.Check to fully suffer from a side, return should check to the side.Notice when Men arrived a swollen lymph node its position, number, size, texture, touch pain and translation degree.
Two, special check
Mammary gland paroxysm the special check be cardinal to is a physical image enzymology check and cytopathology to check two major types.The former mainly in order to and gradually sieves sex check and the latter useds to finally confirm sex check.
(A)physical image enzymology check, this method recent years makes progress more and quickly, currently adopt at most, and some effectses be better.
The in common use method of the 1. X line check includes a Mu target the X line to photograph, do the epiphyseal plate photograph, calculator ketone body the stratum, story scan(CT) etc..
(1)The Mu target X line photographs the demulcent therapy, reconciliation trunks(selenium) epiphyseal plate static electricity to photograph.The penetrability of the Mu target X line is weaker, past easy to differentiation the tissue of various density inside the mamma, breast, can discover smaller lump and more and clearly observe its appearance and structure.Positive lump inside the mamma, breast, piece shadow the density be even, the surroundings often has a permease the brightness higher fat turn;If see a calcification shadow, often more bulky and divergence, the surroundings tissue was subjected to change phenomenon;The piece shadow of the malignant pathological changes is much irregular or presents the leaf, frond form in cent, center region the density be higher and some edges of lumps present a hair spine a form;If there is calcification shadow, much small but the density be higher combine it is thus clear that at the tumor scope outside of tissue in;Lump surroundings tissue can because the tumor invade moistening but distort a deformity, close to the skin can have already increased thick depression etc..Do the epiphyseal plate static electricity photograph see advertise for elephant and the Mu target X line performance basic homology, but it has special”the edge accentuate effect” but makes picture clearer;Weakness’ ising the meticulous structure of the lump has already lost true phenomenon.Above-mentioned two specieseses’ photographing currently a method is extensively applied at the census of breast cancer.
(2)The calculator ketone body stratum, story scan(CT):Jejunum resolving power and density resolving power that the CT scan are all higher and be advantageous to discovering small cancer cooking stove;Because it belong to break a stratum, story check, can expel close together structure’s interference for focus, especially to the fine type mammary gland or obvious ceruminous gland ketone body hyperplasis, proper make a CT check.In addition, CT is fair clear to show a breast carcinoma, the sufferer has already had no armpit swelling of lymph node, can also judge have already have no to transfer inside the mammary ridge lymph node;On the image, it with the Mu target X line slice top see same alike, because of close by structure of overlap, various image is clearer and clear.The weakness is equipments and operation complications, the expenses expensive etc..
(3)The mammary gland catheter builds a shadow:Show to the nipple discharge or the X line even slice suspicious lump and companion catheter correspond to obviously increase a thick sufferer and choose to use the stimulative more and smallly contains an iodine contrast medium(if be suffused with shadow Pu an amine) to go the X line of mammary gland catheter to build a shadow and have certain value to the diagnosis pathological changes inside the catheter or lump property inside the mammary gland.
2.The super voice check:The applied B is super to check a mamma, breast pathological changes of the biggest advantage’s being the property that can quickly and accurately distinguish a mammary gland lump is solid or capsule.Diagnose the mammary gland cyst, abscess and the disease of capsule hyperplasis a better than other check.The weakness is an operation as well opposite more complicated, wrap a piece to smaller solid of good, malignancy discretion for more difficult often hold.
3.The hot diagram check:Applied picture shows a shell temperature distribution, by with carry on diagnosis.
(1)The liquid crystal hot diagram:Make use of the principle that the Dan Zi type liquid crystal has intelligent temperature effect, examine the distribution of skin temperature, help diagnosis;Adopt microcapsule liquid crystal more currently shell membrane.This method low price and operation are simple, diagnosis fast, used for census sieving more.
(2)Infrared hot diagram:Can measure a distribution of show different temperature of the mammary gland skin, such as tumor partial bark warm the high proptosis be 0.8~1.5 ? , have a malignancy may.But distinguish the accurate standard of picture because of lack, with the result that same picture can get proptosis different diagnosis effect;And the part of heat abnormality often doesn’t is correspond in tumor position, particularly match a rate to the diagnosis of the small cancer cooking stove still disregard to think.
4.The near infrared line mammary gland scans a check:This method originate inventive at the beginning of this century the mammary gland”the light deeply shines on” check technique;After improving for several years make into permease to shine on to photograph an instrument, make use of the cold light source output near infrared line is absorb by the hemoglobin of the property become a picture and carry on the mammary gland whole visual fieldses to scan to observe and diagnose.Recent years again the assistance picture of the gave birth to computer process of new red and outside scanner, can carry on enlarge, accentuate, pulling to stretch, take to be like an etc. processing to the image, raised diagnosis to match a rate thus.In the near future report 90% already is or so.Its diagnosis principle is mainly the strength which makes use of red outside light to pass a mamma, breast dissimilarity but manifestation permease light, dark and bright and various different sh degree shadow, show thus the mamma, breast swollen thing shadow.The in addition red outside light is stronger to the sensitive degree of hemoglobin and make mamma, breast afferent develop clearer, cause to the breast carcinoma of partial blood luck increment, neighborhood blood vessel increase thick, not in a row etc.s all include better picture to show, can also show to the small illness cooking stove with 0.5 cms.This method operation simple, diagnosis quick, the picture keep a view and clear, have no injury and have no to the human body pain and sufferings, in keeping with carry on mammary gland census to the each age section women(include a pregnancy and breast feed women), can also avoid the women whom the sufferer has a mammary gland disease again and again accept a radiography check of have the damage.So, it is the ideal method of census and the positive pathological changes of the sieving mammary gland and malignant tumor currently.
(Two)the cytopathology check
1.The nipple discharge check:Arrange a direction according to mammary ridge palatine canal in proper order again and again and lightly press an areola mammae region, understanding include have no nipple discharge and overflow a liquid to come from which mammary ridge palatine canal.The nipple discharge is mostly rational for disease.The observation overflows the property of liquid to contribute to the property which predicts a focus.Fresh and red guts’ overflowing a liquid is see in intraductal papilloma more and the minority sees at the mammary ridge cancer inside the palatine canal;Palm tree’s ising brown to overflow a liquid hint blood ever be evertaken care of at the mammary ridge by the Zu inside do not eject in time, much is see in to have mammary ridge palatine canal the intraductal papilloma of the obstruction or have the mamma, breast cystic hyperplasia of mamillary body formation because of epithelium hyperplasis.Yellow or grass green color’s overflowing a liquid is often the mamma, breast capsule the performance of the hyperplasis, occasionally also is see in breast cancer.The ivory overflows a liquid it is thus clear that at the normal menstrual phase, earlier period pregnancy or the cystic hyperplasia.According to the covariance, in variously overflow the liquid, the guts overflows a liquid to share to amount 50~70% around;The one who have to overflow a liquid, 9 ? 14% patients get breast cancer.Overflow the liquid smear looks for a cancer cell to contribute to the occurrence reason which makes sure to overflow a liquid, but the feminine gender can’t completely expel the possibility of breast cancer.
2.The needle absorbs cytology and biopsy to check:The needle absorbs a cell with thin needle(No.7~8 needle) empty needle, the direct puncture of the surface skin of the mammary gland lump that is after disinfection go into lump inside, return to pull needle to bolt, result in negative press, revolve toward different direction several times, keep negative press under the circumstance quickly proptosis needle;Will draw out a thing immediately in addition to the slice dye, the microscope descends an observation to look for oncocyte.This method is simple to easily go, injury and pain and sufferings are opposite smaller, but have 10 the ?s be 20% false feminine gender rates and have 1 the ? be 3% false masculine gender rates.Biopsy check is mammary gland lump the cutting makes a pathology biopsy microscopic examination after take part of or whole pieces the excision and diagnose accuracy tallest;But to mammary gland malignant tumor sufferer, easily result in the cancer cell transfer because of squeezing or remaining.Currently more steady way, is through various above check sieving and highly doubt for the malignant tumor, slice to take or cut off a lump to soon send to keep a pathologic biopsy check in deep freeze in the surgical operation, generally can acquire a microscopic examination effect within 20~30 minutes, by this determination surgical operation method.
