How do you palpate breasts for lumps or other anomalies?

From the Guidelines

To properly palpate breasts for lumps or anomalies, lie down with a pillow under your shoulder and place your arm behind your head, then use the pads of your three middle fingers to press firmly in small circular motions, covering the entire breast in a systematic pattern, as recommended by the study published in the Ca-A Cancer Journal for Clinicians 1.

Key Steps for Palpation

• Position: Patients should be lying down for breast palpation, with their ipsilateral hand overhead to flatten the breast tissue on the chest wall, thereby reducing the thickness of the breast tissue being palpated, as described in the study published in the Ca-A Cancer Journal for Clinicians 1.
• Perimeter: All breast tissue falls within a pentagon shape, and the examiner should use the following landmarks to cover all of this area: down the midaxillary line, across the inframammary ridge at the fifth/sixth rib, up the lateral edge of the sternum, across the clavicle, and back to the midaxilla, as outlined in the study published in the Ca-A Cancer Journal for Clinicians 1.
• Pattern of search: The full extent of breast tissue should be searched using a “vertical strip” pattern, as recommended in the study published in the Ca-A Cancer Journal for Clinicians 1.

Additional Recommendations

• The examiner should use the finger pads of the middle three fingers to palpate one breast at a time, as described in the study published in the Ca-A Cancer Journal for Clinicians 1.
• Palpate with overlapping dime-sized circular motions, as recommended in the study published in the Ca-A Cancer Journal for Clinicians 1.
• Tissue at and beneath the nipple should be palpated, not squeezed, as squeezing often results in discharge as well as discomfort, as noted in the study published in the Ca-A Cancer Journal for Clinicians 1.

Importance of Imaging Studies

• Diagnostic mammography or DBT is the initial imaging modality of choice for evaluating a clinically detected palpable breast mass in a woman aged 40 years or older, as recommended in the study published in the Journal of the American College of Radiology 1.
• Breast US is the initial imaging modality of choice for evaluating a clinically detected palpable breast mass in a woman younger than age 30 years, as recommended in the study published in the Journal of the American College of Radiology 1.

Clinical Breast Examination

• A thorough clinical breast examination, usually by the referring clinician or by a specialist breast clinician, is necessary for any woman presenting with a palpable lesion, as noted in the study published in the Journal of the American College of Radiology 1.
• The radiologist must also be able to establish concordance between an imaging finding and a clinically detected mass, as recommended in the study published in the Journal of the American College of Radiology 1.

From the Research

Palpation of Breasts for Lumps or Other Anomalies

To palpate breasts for lumps or other anomalies, a clinical breast examination is typically performed. However, there are no research papers provided that directly discuss the method of palpation for breast lumps.

Imaging Modalities for Breast Cancer Detection

The following imaging modalities are used to detect breast cancer:

• Mammography: considered the "gold standard" in breast cancer screening 2
• Ultrasound: used as an adjunct to mammography to characterize breast lesions 3, 2
• Magnetic Resonance Imaging (MRI): used to detect multifocal, multicentric, or contralateral disease, and to assess the response to neoadjuvant chemotherapy 4, 5
• Other modalities: such as positron emission tomography, 99mTc-sestamibi scintimammography, and electrical impedance tomography (EIT) are also being used 2

Diagnostic Performance of Imaging Modalities

The diagnostic performance of imaging modalities varies:

• MRI: has the highest sensitivity, with an overall sensitivity of 94.6% and specificity of 74.2% 5
• Mammography: has a lower sensitivity, with an overall sensitivity of 54.5% and specificity of 85.5% 5
• Ultrasound: has a sensitivity of 67.2% and specificity of 76.8% 5
• Combining modalities: increases diagnostic ability, with a sensitivity of 97.7% and specificity of 63.3% when combining MRI, mammography, and ultrasound 5