Palpable breast masses

Palpable breast masses are common among biologic females, including pregnant and lactating women.

Most palpable breast masses are benign.

As many as 10-15% of palpable breast cancers will not be visualized on mammography.

Physical examination, breast imaging, and tissue biopsy are a key diagnostic tools.

For patients younger than 30 years, lactating, or pregnant, the initial valuation includes ultrasound, whereas mammogram with ultrasound is recommended for individuals 30 years or older.

Tissue biopsy is necessary to evaluate a clinically suspicious mass.

A normal mammogram and/or ultrasound examination doe not eliminate the need for a biopsy or a palpable solid mass.

Vague areas of thickness in a premenopausal women should be reexamined after 1-2 menstrual cycles.

Triple negative-benign feeling lesion, benign mammogram and benign needle aspiration suggest no further work-up needed.

Medical history includes: time frame of symptom on set, mass size and location, associated pain, skin changes, nipple changes, and the presence of nipple discharge.

Physical examination includes breast evaluation for a symmetry, swelling, messages, nipple changes, and skin changes.

Physical examination includes breast evaluation for asymmetry, swelling, masses, nipple changes, and skin changes.

Examination should be in the upright position, and the patient should place their hands behind their head, position elbow slightly back, and bringing the chest forward.

Patients should ultimately be in the supine position with hands behind their head with the same physical examination of the axilla and breast.

In patients with asymptomatic breast mass, it should be palpated in the systematic fashion of all four quadrants using the flat palm surfaces of the hand.

If a mass is palpated the location should be documented using clockwise orientation and distance from the nipple, size, and borders, and consistency should be noted.

Any lymphadenopathy should be noted as its size and consistency and fixation.

Any mass characterized by firmness, poorly defined borders, immobility, with or without skin and nipple changes, bloody nipple discharge, and or lymphadenopathy should be considered suspicious.

Mammogram and ultrasound for the key imaging techniques to evaluate a palpable mass.

A negative finding, BI-RADS 1 in the setting of the clinically suspicious mass, always necessitates further work up.

BI-RADS 2 is benign and suggests 0% risk of malignancy and routine screening.

BI-RADS 3is probably benign and carries 0 to 2% risk of malignancy and requires close follow up with imaging at six, 12, and 24 months.

BI-RADS 4 has three subclassifications with cancer risk, 2 to 10%, 10% to 50% and 50 to 95%.

BI-RADS 5 is highly suspicious for cancer risk of greater than 95%.

BI-RADS 4 and 5 require tissue biopsy.

Ultrasound is preferred as the initial evaluation of a palpable mass in patients younger than 30 years of age.

All solid masses and complex cysts require tissue biopsy.

Diagnostic mammogram with ultrasound is recommended for patients age 30 years or older.

Ultrasound is the preferred imaging modality in pregnant and lactating patients.

Diagnostic mammogram is safe and considered, although sensitivity may be limited due to increase breast density.






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