Clinical meaning
The clinical breast examination (CBE) is a systematic physical assessment of the breast performed by a trained clinician to detect breast abnormalities, complementing mammographic screening. Breast tissue is composed of 15-20 lobes of glandular tissue arranged radially around the nipple, with each lobe containing lobules (milk-producing units) and lactiferous ducts that converge at the nipple. The upper outer quadrant and axillary tail of Spence contain the greatest concentration of glandular tissue and are the most common site for breast malignancies (~50% of cancers). The CBE involves two phases: visual inspection and palpation. Visual inspection is performed with the patient in upright position with arms at sides, arms raised overhead, and hands pressed on hips (pectoralis contraction) — the clinician looks for asymmetry, skin retraction, dimpling, peau d'orange (dermal lymphatic obstruction), erythema, nipple inversion or deviation, and spontaneous nipple discharge. Palpation is performed with the patient supine, ipsilateral arm raised behind the head to flatten the breast against the chest wall. The clinician uses the pads of the three middle fingers in a vertical strip pattern (shown to be more thorough than concentric circles or radial spoke patterns), applying three levels of pressure — light (superficial tissue), medium (mid-tissue), and deep (against the chest wall) — using small dime-sized circular motions at each point. The axillary, supraclavicular, and infraclavicular lymph node regions are systematically palpated. Findings warranting further workup include a dominant mass (hard, fixed, irregular borders), skin dimpling or retraction, nipple retraction of new onset, spontaneous unilateral bloody or serous nipple discharge, and palpable lymphadenopathy. The BI-RADS (Breast Imaging Reporting and Data System) classification standardizes imaging interpretation: 0 = incomplete/needs additional imaging, 1 = negative, 2 = benign, 3 = probably benign (short-interval follow-up), 4 = suspicious (biopsy recommended, subdivided 4A/4B/4C), 5 = highly suggestive of malignancy, 6 = known biopsy-proven malignancy.