|
Breast Disorders |
|
乳房疾病 |
|
Breast symptoms (eg, pain, lumps, nipple discharge) are common, accounting for > 15 million physician visits/yr. Although > 90% of symptoms have benign causes, breast cancer is always a concern. Because breast cancer is common and may mimic benign disorders, the approach to all breast symptoms and findings is to conclusively exclude cancer. |
乳房癥狀（如乳房痛、腫塊、乳頭排泄物)很普遍，每年就診者>1500萬。雖然>90%癥狀為良性，但乳腺癌始終是人們的一大擔(dān)心。乳腺癌很常見，其癥狀也與許多良性乳房疾病相仿，因此，分析乳房癥狀及化驗結(jié)果就是要完全排除乳腺癌。 | |
|
History includes duration of symptoms; relation of symptoms to menses and pregnancy; presence and type of pain, discharge, and skin changes; use of drugs, including hormone therapy; personal and family history of breast cancer; and date and results of last mammogram. |
病史詢問包括癥狀持續(xù)時間，癥狀與月經(jīng)和妊娠的關(guān)系，是否疼痛、有排泄物、皮膚變化及類型，用藥（包括激素)情況、個人及家庭乳腺癌史、最后一次乳房拍片時間及結(jié)果等。 | |
|
Breast examination: Principles of examination are similar for physician and patient. Breasts are inspected for asymmetry in shape, nipple inversion, bulging, and dimpling (see Fig. 1: Breast Disorders: Breast Cancer Risks A and B). Although size differential is common, each breast should have a regular contour. An underlying cancer is sometimes detected by having the patient press both hands against the hips or the palms together in front of the forehead (see Fig. 1: Breast Disorders: Breast Cancer Risks C and D). In these positions, the pectoral muscles are contracted, and a subtle dimpling of the skin may appear if a growing tumor has entrapped a Cooper's ligament.醫(yī)學(xué)全在線www.med126.com |
乳房檢查：醫(yī)生檢查和病人自己檢查的原則類似。應(yīng)檢查乳房大小是否對稱、乳頭是否內(nèi)翻、膨出、凹陷（見圖1：乳房疾�。喝榉课ｋUA、B)。乳房通常會在大小，但輪廓應(yīng)規(guī)則，病人雙手壓在髖部或兩手掌在額前相壓有時就可檢查出潛在的乳癌（見圖1：乳房疾�。喝榉课ｋUC、D)。在這些位置時，胸部肌肉是收縮的，如果在庫柏韌帶陷有一生長腫瘤，皮膚就會微微的凹陷。 | |
|
The axillary and supraclavicular lymph nodes are most easily examined with the patient seated or standing (see Fig. 1: Breast Disorders: Breast Cancer Risks E). Supporting the patient's arm during the axillary examination allows the arm to be fully relaxed so that nodes deep within the axilla can be palpated. |
病人坐位或站位時最易檢查腋下和鎖骨上淋巴結(jié)（見圖1：乳房疾�。喝榉课ｋUE)。腋下檢查時，支撐病人手臂，使其充分放松，這樣就可以摸到腋窩深處的淋巴結(jié)。 | |
|
The breast is palpated with the patient seated and again with the patient supine, the ipsilateral arm above the head, and a pillow under the ipsilateral shoulder (see Fig. 1: Breast Disorders: Breast Cancer Risks F). The latter position is also used for breast self-examination; the patient examines the breast with her contralateral hand. Having the patient roll to one side, so that the breast on the examined side falls medially, may help differentiate breast and chest wall tenderness because the chest wall can be palpated separately from breast tissue. |
捫診病人乳房時，病人取坐位。也可取仰臥位，此時，受檢乳房同側(cè)胳膊上舉過頭，同側(cè)肩下墊一枕頭（見圖1：乳房疾�。喝榉课ｋUF)。此位置也可用于乳房自我檢查，檢查乳房時病人使用對側(cè)手。病人轉(zhuǎn)向一側(cè)，受檢乳房向內(nèi)側(cè)靠攏，因為觸摸時胸壁和乳房組織分離，故此位有助于鑒別乳房和胸壁觸痛。 | |
|
The breast should be palpated with the palmar surfaces of the 2nd, 3rd, and 4th fingers, moving systematically in a small circular pattern from the nipple to the outer edges (see Fig. 1: Breast Disorders: Breast Cancer Risks G). Precise location and size (measured with a caliper) of any abnormality should be noted on a drawing of the breast, which becomes part of the patient's record. A written description of the consistency of the abnormality and degree to which it can be distinguished from surrounding breast tissue should also be included. Detection of abnormalities during physical examination largely determines whether a biopsy is needed, even if a subsequent mammogram shows no abnormalities. |
檢查乳房用第2、3、4指的掌面捫由乳頭向外作環(huán)形有序移動（見圖1：乳房疾�。喝榉课ｋUG)。任何異常的準(zhǔn)確位置和尺寸（用測徑規(guī)測量)應(yīng)記錄于乳房說明圖上，并成為病人醫(yī)療記錄的一部分。應(yīng)書面說明異常的變化情況及與周圍乳房組織的差異程度。發(fā)現(xiàn)異物在很大程度上決定是否要作組織活檢，即使后續(xù)乳房X線檢查未顯示異物時也是如此。 | |
|
Testing: Imaging tests are used for screening and for evaluation of breast abnormalities. Annual screening mammography is recommended for women ≥ 50 yr and sometimes for women 40 to 50 yr. Mammography is more effective in older women because with aging, fibroglandular tissue in breasts tends to be replaced with fatty tissue, which can be more easily distinguished from abnormal tissue. Low-dose x-rays of both breasts are taken in 1 (oblique) or 2 views (oblique and craniocaudal). Only about 10% of abnormalities detected result from cancer. Accuracy of mammography depends partly on the techniques used and experience of the mammographer; false-negative results may exceed 15%. Some centers use computer analysis of digitized mammography images to help in diagnosis. Such systems are not recommended for stand-alone diagnosis, but they appear to improve sensitivity for detecting small cancers by radiologists. |
檢驗：影像檢查用于篩查和乳房異物的評估。≥50歲，或40－50歲婦女，每年應(yīng)作乳房影像篩查。乳房X線檢查對老年婦女較有效，因為隨著年齡增長，乳房中的纖維腺體往往會被脂肪組織所替代，與異常組織鑒別更容易。檢查乳房時采小劑量射線，一個（側(cè)位)或兩個（側(cè)位及軸位)投照位置。在檢測到的異物中，只有10%是由癌癥引起的。乳房X線照相準(zhǔn)確度部分取決于所用技術(shù)及X光師經(jīng)驗，假陰性率超過15%。有些影像中心采用數(shù)字照像圖像電腦分析技術(shù)幫助診斷。這些系統(tǒng)在單獨診斷時不建議使用，但可以提高放射科醫(yī)師發(fā)現(xiàn)小型癌癥的敏感度。 | |
|
Mammography is also used diagnostically to evaluate lumps, pain, and nipple discharge. It can determine size and location of a lesion and provide images of surrounding tissues and lymph nodes. Diagnostic mammography requires more views than screening mammography. For biopsy of a lesion seen on a mammogram but not detectable during physical examination, 2 needles or wires can be inserted via radiologic guidance to localize the lesion. The excised specimen should be x-rayed, and the x-ray compared with the prebiopsy mammogram to determine whether the lesion has been removed. Mammography is repeated when the breast is no longer tender, usually 6 to 12 wk after biopsy, to confirm removal of the lesion. |
乳房X線照相術(shù)也可用于診斷評估腫塊、乳痛和乳頭排泄物。它可以確定某個病灶部位的大小與位置，提供周圍組織和淋巴結(jié)的圖像。診斷性照相術(shù)所需投照位置應(yīng)多于篩查性乳房X線照相。給照相時發(fā)現(xiàn)、體檢又未曾查出的病灶作活檢時，可在放射線指導(dǎo)下，插入兩個針頭或?qū)Ь�進(jìn)行定位。切除的標(biāo)本須拍X線片，并將其與活檢前X片作比較，以確定此病灶已被切除。乳房不再觸痛時再行乳房X線片檢查，通常在活檢后6－12周進(jìn)行，以確認(rèn)病灶已經(jīng)清除。 | |
|
MRI is thought to be more accurate than clinical breast examination or mammography for screening women with a high (eg, > 15%) risk of breast cancer, such as those with a BRCA gene mutation. It is not considered appropriate for screening women with average or slightly increased risk. Because MRI can accurately determine tumor size, chest wall involvement, and presence of multiple tumors, it is often used in evaluation after breast cancer is diagnosed. Use of MRI to identify axillary node involvement is under study. |
在篩查乳腺癌高危婦女（如> 15%)時，如BRCA基因突變者，磁共振成像準(zhǔn)確度應(yīng)高于門診乳房檢查或乳房X線照相檢查。但不適合危險性一般或略高的女性。由于磁共振成像可準(zhǔn)確確定腫瘤大小、胸壁受累程度及是否有多發(fā)性腫瘤存在，它常被用于乳腺癌確診后的評估。目前人們正在研究使用磁共振成像鑒別腋下淋巴結(jié)受累情況。 |
