Breast cancer diagnosis

March. 09,2021

The early symptoms of most breast cancer patients are not obvious, and it is easy to be ignored and fail to seek medical attention in time. Therefore, high-risk groups should pay attention to breast cancer screening, and conduct regular breast self-examinations and clinical physical examinations. Once breast lumps, nipple discharge, axillary lymphadenopathy and other abnormal signs are found, attention should be paid and a professional doctor should be asked to do it. Further judge.

Most people seek medical treatment with breast lumps as the first symptom. The routine diagnosis process is as follows:

The doctor will collect the medical history according to the patient's personal situation, which may include: when the lump appeared, how fast the lump grew, whether it was painful, and other accompanying symptoms.

The doctor will then perform a physical examination of the patient. If the doctor has any abnormal signs, he will ask the patient to do further auxiliary examinations, such as breast ultrasound, mammography, etc.

Finally, the doctor will make the diagnosis and differential diagnosis of breast cancer based on the patient's clinical manifestations, physical examination, imaging examination, and histopathological examination. When the patient is diagnosed with breast cancer, the doctor will judge the type of the disease based on the results of histopathological examination, and integrate other auxiliary examination methods to stage breast cancer and guide later treatment.

Doctors generally stage breast cancer based on the TNM system. The TNM system has high clinical value for predicting tumor recurrence and metastasis, and it is also a relatively mature risk assessment index.

The TNM system is used to describe the size of the primary tumor and its spread to nearby lymph nodes or other parts of the body.

Tumor (T): the size and location of the tumor;

Lymph node (N): the size and location of the lymph node where the cancer has spread;

Metastasis (M): The cancer has spread to other parts of the body.

Primary tumor (T)

Tx: The primary tumor cannot be assessed.

T0: No evidence of primary tumor.

Tis: Carcinoma in situ.

T1: The maximum diameter of the tumor is less than or equal to 20mm.

T2: The maximum diameter of the tumor is >20mm and ≤50mm.

T3: The maximum diameter of the tumor>50mm.

T4: Regardless of the size of the tumor, it directly invades the chest wall and/or skin (ulcers or skin nodules). Only dermal infiltration does not include the T4 category.

Regional lymph nodes (N)

Clinical stage:

Nx: Regional lymph nodes cannot be assessed (if they have been removed).

N0: No regional lymph node metastasis.

N1: Metastasis of axillary lymph nodes at the level I and II on the same side, movable.

N2: Axillary lymph node metastasis at the ipsilateral level I and II, fixed or fused; or clinical signs of ipsilateral internal mammary lymph node metastasis, no clinical signs of axillary lymph node metastasis.

N3: Metastasis of ipsilateral subclavian lymph nodes (level III axillary lymph nodes), with or without involvement of level I and II axillary lymph nodes; or clinical signs of ipsilateral internal mammary lymph node metastasis, accompanied by metastases of level I and II axillary lymph nodes ; Or have ipsilateral supraclavicular lymph node metastasis, with or without axillary or internal mammary lymph node involvement.

Pathological staging (pN)

pNx: Regional lymph nodes cannot be assessed (if they have been removed, or have not been removed due to pathological studies).

pN0: No regional lymph node metastasis in histological examination.

pN1: micrometastasis; or 1 to 3 axillary lymph node metastases; and (or) sentinel lymph node biopsy found internal mammary lymph node metastasis, but no clinical signs.

pN2: 4-9 axillary lymph node metastasis; or no axillary lymph node metastasis, but internal mammary lymph node metastasis (with clinical signs).

pN3: ≥10 axillary lymph node metastasis; or subclavian lymph node (Ⅲ level axillary lymph node) metastasis; or ipsilateral internal mammary lymph node metastasis (with clinical signs), and ≥1 level Ⅰ, Ⅱ axillary lymph node metastasis; or >3 Axillary lymph node metastasis, and sentinel lymph node biopsy found micrometastasis or macrometastasis in internal mammary lymph nodes, but no clinical signs; or metastasis to ipsilateral supraclavicular lymph node.

Distant transfer (M)

M0: No clinical or imaging evidence of distant metastasis.

M1: Distant metastasis found by traditional clinical and imaging methods, and/or histologically confirmed distant metastasis exceeding 0.2mm.

Clinical stage:

Issue 0: TisN0M0

Phase IA: T1bN0M0

Stage IB: T0N1miM0 T1N1miM0

Phase ⅡA: T0N1cM0  T1N1M0 T2N0M0

Phase ⅡB: T2N1M0 T3N0M0

Phase IIIA: T0N2M0 T1N2M0 T2N2M0  T3N1M0 T3N2M0

Phase III B: T4N0M0 T4N1M0 T4N2M0

Phase III C: Any TN3M0

Phase IV: Any T   Any NM1

Breast cancer needs to be differentiated from benign diseases such as breast fibroadenoma, cystic hyperplasia of the breast, and plasma cell mastitis.

Breast fibroadenoma

A benign tumor composed of a mixture of two components of glandular epithelium and fibrous tissue tends to occur in young women. Except for breast lumps, there are often no other symptoms. The lump is hard, elastic, like a rubber ball, with a smooth surface and easy to push. Histopathological examination helps to distinguish.

Cystic Hyperplasia of Breast

Also known as lobular hyperplasia of the breast, fibrocystic disease, etc., it refers to the benign disease of breast duct and acinar epithelial hyperplasia accompanied by cyst formation, which is common in middle-aged women. Its typical symptoms are periodic breast tenderness and breast lumps on one or both sides, which are obvious before menstruation and relieved after menstruation. Mammography and ultrasonography can help in the identification.

Plasma cell mastitis

Also known as mammary duct dilatation, it is a chronic non-bacterial inflammation of the breast. It is more common in non-lactating women between 30 and 40 years old. The lumps are often located around the areola, tough or hard, with unclear boundaries, and no adhesion to the chest wall. The breast skin has varying degrees of redness, swelling, heat, and pain, and the systemic inflammatory reaction is mild. It is often differentiated from breast cancer by breast puncture cytology.