Proposed systematization of the clinical breast examination: a structured semiological approach

Abstract

Introduction: The clinical breast examination remains fundamental in the diagnostic evaluation of breast diseases, even with advances in imaging methods such as mammography, ultrasonography, and magnetic resonance imaging. In various contexts, the physical examination provides relevant information that supports the indication of imaging tests and complements radiological findings. However, significant heterogeneity is observed in the techniques used, including variations in the examination sequence, physical maneuvers, and reporting of findings, which compromises standardization and hinders the systematic teaching of breast semiology. Objective: To present a proposal for the systematization of the physical breast examination, based on three structured stages of clinical assessment, including the introduction of a simultaneous comparative palpation technique. Methods: A systematized narrative literature review was conducted following PRISMA recommendations, with searches performed in the PubMed/MEDLINE, Scopus, Web of Science, SciELO, and Cochrane Library databases, including publications from 1990 to 2024. Original articles, systematic reviews, clinical guidelines, and classical works addressing inspection, palpation, and lymph node evaluation were selected. The proposal was developed based on a critical analysis of the literature and clinical experience in mastology, with registration in PROSPERO (CRD420261354315). Results: The clinical examination was structured into three stages: static inspection, dynamic inspection, and systematized breast palpation. Palpation comprises eight maneuvers: sliding, fingertip palpation, manual and bimanual compression, expression of the nipple-areolar complex, lymph node assessment, contralateral repetition, simultaneous comparative palpation, and examination in the supine position. Particular emphasis is given to simultaneous comparative palpation, performed with mirror-like circular movements, referred as the Silveira Júnior Maneuver. Conclusion: The proposed systematization may increase the standardization and reproducibility of the clinical breast examination, as well as improve guidance for complementary tests, documentation of findings, and the teaching of breast semiology. The Silveira Júnior Maneuver shows potential utility, and further studies are needed to validate its diagnostic accuracy.