II. History: Risk Factors Evaluation

III. History: Characteristics of Breast Mass

  1. Mass Location ("Point with one finger to its location")
  2. Changes in size, pain, swelling
  3. Nipple Discharge
  4. Method of discovery
  5. Duration mass has been present
  6. Change with Menstrual Cycle (Hormonal influences)
  7. Tenderness at Breast Mass site

IV. Etiologies of Discrete Breast Lumps

  1. Age under 20 years
    1. Fibroadenoma: 50%
    2. Benign Breast Mass: 50%
  2. Age 20 to 29 years
    1. Fibroadenoma: 35%
    2. Benign Breast Mass: 52%
    3. BreastCyst: 10%
    4. Breast Cancer: 3%
  3. Age 30 to 39 years
    1. Fibroadenoma: 18%
    2. Benign Breast Mass: 62%
    3. BreastCyst: 10%
    4. Breast Cancer: 10%
  4. Age 40 to 55 years
    1. Fibroadenoma: 9%
    2. Benign Breast Mass: 31%
    3. BreastCyst: 25%
    4. Breast Cancer: 35%
  5. Age over 55 years
    1. Benign Breast Mass: 13%
    2. BreastCyst: 2%
    3. Breast Cancer: 85%

V. Types

  1. Breast Cyst
  2. Fibroadenoma
  3. Fibrocystic Breast
  4. Breast Cancer

VI. Exam

  1. See Breast Exam
  2. Document patient identified Breast Mass location
    1. Patient points to the lump with one finger
  3. Dominant mass
    1. Three dimensional lesion that is distinct from surrounding tissue
    2. Asymmetric when compared with opposite side
  4. Document position of lesion on clock-face and distance from the nipple
    1. Correlate palpable mass on exam with patient reported location

VII. Diagnostics

  1. Breast Ultrasound
  2. Mammogram in mass evaluation
    1. Not used to evaluate palpable mass
    2. Used to evaluate for other concurrent lesions
    3. Delay Mammogram 2 weeks after aspiration
      1. Aspiration may cause hematoma
      2. Wait time avoids false positives
  3. Breast aspiration, fine needle aspirate or core biopsy
  4. Excisional Breast biopsy
  5. Triple Test Score

VIII. Evaluation: Initial

  1. History and Exam as above
  2. Consider suspicious findings (for urgency of evaluation, but does not obviate need for Breast imaging)
    1. Hard, immobile lesion
    2. Breast Mass immobile, fixed to surrounding tissue
    3. Poorly defined margins
    4. Overlying skin changes may be present
  3. Dominant Breast Mass identified
    1. See evaluation protocols below based on either Ultrasound or FNA
    2. Diagnostic Mammogram in age over 30 years (or all ages with Breast Cancer Risk Factors)
    3. Consider early Breast surgeon rerferral if Breast Cancer Risk Factors or suspicious exam findings
  4. No Dominant Breast Mass identified
    1. Mammogram in age 40 years or older if not performed in last 12 months
    2. Repeat examination in 1-2 months,
    3. Consider early Breast surgeon rerferral if Breast Cancer Risk Factors or suspicious exam findings

IX. Evaluation: Protocol 1 based on starting with Ultrasound

  1. Start with breast Ultrasound
  2. Ultrasound shows simple cyst
    1. Aspirate and
      1. See Breast Cyst Aspiration
    2. Repeat Clinical Breast Exam in 4-6 weeks
  3. Ultrasound shows complex cyst or solid lesion
    1. Mammogram and
    2. Fine needle aspirate or core-needle biopsy
      1. See Breast Cyst Aspiration
  4. Ultrasound does not reveal lesion
    1. Mammogram and
    2. Fine needle aspirate or core-needle biopsy
      1. See Breast Cyst Aspiration

X. Evaluation: Protocol 2 based on starting with FNA

  1. Start with fine-needle aspirate of Breast Mass
    1. See Breast Cyst Aspiration
  2. Breat mass is cystic
    1. No residual cyst after aspiration
      1. Age over 40: Mammogram or core needle biopsy
      2. Age under 40: Ultrasound or core needle biopsy
    2. Residual cyst or bloody fluid aspirated
      1. Repeat Clinical Breast Exam in 6 weeks
  3. Breast Mass is solid
    1. FNA malignant: Treat
    2. FNA Suspicious: Core-needle or Excisional Biopsy
    3. FNA non-diagnostic
      1. Age over 40: Mammogram or core needle biopsy
      2. Age under 40: Ultrasound or core needle biopsy
    4. FNA benign
      1. Obtain Mammogram
      2. If Mammogram positive
        1. Ultrasound or
        2. Core-needle biopsy
      3. If Mammogram negative
        1. Repeat Clinical Breast Exam in 6 weeks

XI. Evaluation: Protocol 3 Basic Approach based on age

  1. Precautions
    1. Do not discount Breast Masses in younger patients
  2. Premenopausal asymmetrical palpable mass
    1. Reexamine during days 5-10 of Menstrual Cycle
    2. Mammogram if age over 30 years
    3. Breast Ultrasound if difficult localization
    4. Attempt aspiration of Breast lesion
      1. See Breast Cyst Aspiration
  3. Postmenopausal asymmetrical palpable mass
    1. Exercise high level of suspicion (High Risk)
    2. Mammogram
    3. Attempt aspiration of Breast lesion
      1. See Breast Cyst Aspiration

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Ontology: Mass in breast (C0024103)

Definition (NCI) A mass in the mammary gland, either mobile or immobile. Once the mass has reached the size of a small garden pea, it can be detected by palpation. With mammography a larger number of early breast cancers are being detected since this techniques allows detection prior to the point at which the mass can be felt. Breast masses are not always malignant. Benign fibrocystic breast disease is not uncommon. A fine needle biopsy aspiration can distinguish a cystic mass from a solid one.
Concepts Finding (T033)
ICD9 611.72
ICD10 N63
SnomedCT 89164003, 155958009, 290062006, 163440007, 271940008, 274113005
English Lump in breast, Mass in breast, Unspecified lump in breast, Lump, breast - NOS, lump or mass of breast (diagnosis), lump or mass of breast, Breast lump NOS, Mass breast (NOS), Breast nodule, breast lump or mass, breast nodule, mass in breast, breast mass, breast nodules, lump in breast, nodule breast, breast lump, lumpy breast, lumpy breasts, breast lumps, breasts lumps, breast masses, Breast mass NOS, Lumpy breast (finding), Lump, breast - NOS (disorder), Lump, breast - NOS (finding), LUMPS, BREAST, BREAST LUMPS, Breast lump, Breast irregular nodularity, Lumpy breasts, Lumpy breast, Breast mass, Breast lump (finding), Mammary gland mass, breast; lump, breast; mass, breast; node, lump; breast, mass; breast, node; breast, Lump in Breast, Mass in Breast, Breast Lump, Breast Mass, Breast Nodule, Lump or mass in breast
Italian Massa in sede mammaria, Massa della mammella (NAS), Mammelle nodulari, Nodulo mammario, Nodulo mammario NAS, Massa in sede mammaria NAS, Nodulo o massa nella mammella, Massa della ghiandola mammaria
Dutch knobbel of gezwel in borst, borstkliergezwel, borstgezwel NAO, borstknobbel, borstknobbel NAO, borstnodule, knobbelige borsten, gezwel borst (NAO), knobbel; mamma, mamma; knobbel, mamma; massa, mamma; nodus, massa; mamma, nodus; mamma, Palpabele weerstand in mamma, niet gespecificeerd, borstgezwel
French Nodule mammaire, Masse mammaire, Nodule du sein SAI, Seins nodulaires, Masse mammaire SAI, Masse de la glande mammaire, Nodule ou masse du sein, Masse du sein SAI, Masse du sein
German Raumforderung in der Brust NNB, Brustknoten NNB, Brust mit Knoten, Raumforderung in der Brust (NNB), Brustknoetchen, Knoten oder Raumforderung in der Brust, Brustknoten, Raumforderung der Milchdruese, Nicht naeher bezeichnete Knoten in der Mamma [Brustdruese], Raumforderung im der Brust
Portuguese Nódulo mamário, Massa na glândula mamária, Nódulo mamário NE, Nódulo ou massa mamária, Mamas com nódulos, Massa mamária NE, Mass mamária NE, Massa da mama
Spanish Nódulo o masa en la mama, Nodulo mamario, Nódulo mamario, Masa en mama (NEOM), Tumor en la mama NEOM, Masa mamaria, Nódulo mamario NEOM, Nódulos mamarios, Lump, breast - NOS, bulto mamario, SAI, bulto mamario, SAI (trastorno), bulto mamario, SAI (hallazgo), bulto mamario (hallazgo), bulto mamario, masa mamaria (hallazgo), masa mamaria, tumoración mamaria, Masa en mama
Japanese 乳房腫瘤NOS, 乳房塊, 乳腺腫瘤, 乳房腫瘤, 乳房腫瘤(NOS), 乳房小結節, ニュウセンシュリュウ, ニュウボウショウケッセツ, ニュウボウシュリュウNOS, ニュウボウシュリュウ, ニュウボウカイ
Czech Útvar v prsu (NOS), Útvar v prsu, Útvar v prsní žláze, Bulka v prsu, Bulka v prsu NOS, Uzlinka v prsu, Bulka nebo resistence v prsu, Mnohočetné rezistence v prsu, Rezistence v prsu NOS
Korean 유방의 상세불명의 소괴
Hungarian Emlő térfoglaló folyamata, Emlőmassza (k.m.n.), Emlőpúp k.m.n., Emlőpúp, Emlőcsomó, Mammalis mirigytömeg, Csomós emlők, Emlő térfoglaló folyamata, k.m.n., Csomó vagy térfoglalás az emlőben