//fpnotebook.com/
Breast Lump
Aka: Breast Lump, Breast Mass- History: Risk Factors Evaluation
- History: Characteristics of Breast Mass
- Mass Location ("Point with one finger to its location")
- Changes in size, pain, swelling
- Nipple Discharge
- Method of discovery
- Duration mass has been present
- Change with Menstrual Cycle (Hormonal influences)
- Tenderness at Breast Mass site
- Etiologies of Discrete Breast Lumps
- Age under 20 years
- Fibroadenoma: 50%
- Benign Breast Mass: 50%
- Age 20 to 29 years
- Fibroadenoma: 35%
- Benign Breast Mass: 52%
- BreastCyst: 10%
- Breast Cancer: 3%
- Age 30 to 39 years
- Fibroadenoma: 18%
- Benign Breast Mass: 62%
- BreastCyst: 10%
- Breast Cancer: 10%
- Age 40 to 55 years
- Fibroadenoma: 9%
- Benign Breast Mass: 31%
- BreastCyst: 25%
- Breast Cancer: 35%
- Age over 55 years
- Benign Breast Mass: 13%
- BreastCyst: 2%
- Breast Cancer: 85%
- Age under 20 years
- Types
- BreastCyst
- Fibroadenoma
- Fibrocystic Breast
- Breast Cancer
- Exam
- See Breast Exam
- Document patient identified Breast Mass location
- Patient points to the lump with one finger
- Dominant mass
- Three dimensional lesion that is distinct from surrounding tissue
- Asymmetric when compared with opposite side
- Document position of lesion on clock-face and distance from the nipple
- Correlate palpable mass on exam with patient reported location
- Diagnostics
- Breast Ultrasound
- Mammogram in mass evaluation
- Not used to evaluate palpable mass
- Used to evaluate for other concurrent lesions
- Delay Mammogram 2 weeks after aspiration
- Aspiration may cause hematoma
- Wait time avoids false positives
- Breast aspiration, fine needle aspirate or core biopsy
- Excisional Breast biopsy
- Triple Test Score
- Evaluation: Initial
- History and Exam as above
- Consider suspicious findings (for urgency of evaluation, but does not obviate need for Breast imaging)
- Hard, immobile lesion
- Breast Mass immobile, fixed to surrounding tissue
- Poorly defined margins
- Overlying skin changes may be present
- Dominant Breast Mass identified
- See evaluation protocols below based on either Ultrasound or FNA
- Diagnostic Mammogram in age over 30 years (or all ages with Breast Cancer Risk Factors)
- Consider early Breast surgeon rerferral if Breast Cancer Risk Factors or suspicious exam findings
- No Dominant Breast Mass identified
- Mammogram in age 40 years or older if not performed in last 12 months
- Repeat examination in 1-2 months,
- Consider early Breast surgeon rerferral if Breast Cancer Risk Factors or suspicious exam findings
- Evaluation: Protocol 1 based on starting with Ultrasound
- Start with breast Ultrasound
- Ultrasound shows simple cyst
- Aspirate and
- Repeat Clinical Breast Exam in 4-6 weeks
- Ultrasound shows complex cyst or solid lesion
- Mammogram and
- Fine needle aspirate or core-needle biopsy
- Ultrasound does not reveal lesion
- Mammogram and
- Fine needle aspirate or core-needle biopsy
- Evaluation: Protocol 2 based on starting with FNA
- Start with fine-needle aspirate of Breast Mass
- Breat mass is cystic
- No residual cyst after aspiration
- Age over 40: Mammogram or core needle biopsy
- Age under 40: Ultrasound or core needle biopsy
- Residual cyst or bloody fluid aspirated
- Repeat Clinical Breast Exam in 6 weeks
- No residual cyst after aspiration
- Breast Mass is solid
- FNA malignant: Treat
- FNA Suspicious: Core-needle or Excisional Biopsy
- FNA non-diagnostic
- Age over 40: Mammogram or core needle biopsy
- Age under 40: Ultrasound or core needle biopsy
- FNA benign
- Obtain Mammogram
- If Mammogram positive
- Ultrasound or
- Core-needle biopsy
- If Mammogram negative
- Repeat Clinical Breast Exam in 6 weeks
- Evaluation: Protocol 3 Basic Approach based on age
- Precautions
- Do not discount Breast Masses in younger patients
- Premenopausal asymmetrical palpable mass
- Reexamine during days 5-10 of Menstrual Cycle
- Mammogram if age over 30 years
- Breast Ultrasound if difficult localization
- Attempt aspiration of Breast lesion
- Postmenopausal asymmetrical palpable mass
- Precautions
- References