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| __NOTOC__ | | __NOTOC__ |
| {{Breast lumps}} | | {{Breast lumps}} |
| {{CMG}} {{AE}} {{S.M}} | | {{CMG}}; {{AE}} {{S.M}} |
| | | ==Overview== |
| | | There is no specific medical therapy for breast lump. However, there are certain medications that may be used prophylactically to reduce the risk of transformation of breast lump into breast carcinoma. |
| Management of breast lumps:
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| *women aged>40 years with palpable mass<ref name="pmid27814822">{{cite journal| author=Harvey JA, Mahoney MC, Newell MS, Bailey L, Barke LD, D'Orsi C et al.| title=ACR Appropriateness Criteria Palpable Breast Masses. | journal=J Am Coll Radiol | year= 2016 | volume= 13 | issue= 11S | pages= e31-e42 | pmid=27814822 | doi=10.1016/j.jacr.2016.09.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27814822 }} </ref>
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| **Diagnostic mammography is considered as the first step
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| **If the last screening test is related to more than previous 6 months, both breast mammography is required to rule out occult malignancy
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| **No further evaluation is needed in case of clearly benign mass in mammography
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| **Ultrasound imaging is required for the rest of cases appeared in mammography
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| ***Stereotactic biopsy is recommended in negative ultrasound findings addition to suspicious mammographic results
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| *Women aged<40 years with palpable mass<ref name="pmid25341156">{{cite journal| author=Lehman CD, Lee AY, Lee CI| title=Imaging management of palpable breast abnormalities. | journal=AJR Am J Roentgenol | year= 2014 | volume= 203 | issue= 5 | pages= 1142-53 | pmid=25341156 | doi=10.2214/AJR.14.12725 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25341156 }} </ref> <ref name="pmid21098212">{{cite journal| author=Loving VA, DeMartini WB, Eby PR, Gutierrez RL, Peacock S, Lehman CD| title=Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. | journal=AJR Am J Roentgenol | year= 2010 | volume= 195 | issue= 6 | pages= 1472-7 | pmid=21098212 | doi=10.2214/AJR.10.4396 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21098212 }} </ref>
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| **Ultrasound or mammography is suggested for initial management of women aged between 30 to 39 years
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| **Ultrasound is the first step for women< 30 years presenting with palpable mass
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| Approach to breast lumps in women aged >40 years based on mammographic results<ref name="pmid27814822" /> :
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| *If mammographic results become negative,the next step is targeted ultrasound
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| **Negative ultrasound results considered as BI-RADS 1, then clinical follow-up is needed
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| **Benign ultrasound results considered as BI-RADS 2, then clinical follow-up is needed
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| **Probably benign results considered as BI-RADS 3, then ultrasound short interval follow-up is needed
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| **Suspicious ultrasound results considered as BI-RADS 4 or 5, then core-needle biopsy is needed
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| *If mammographic results show only fatty tissue
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| ** considered as BI-RADS 1, then clinical follow-up is needed
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| *If mammographic results show benign mass
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| ** considered as BI-RADS 2, then clinical follow-up
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| *If mammographic results are in favor of probably benign lumps, the next step is targeted ultrasound
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| **Negative ultrasound results considered as BI-RADS 3,then mammographic short interval follow-up is required
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| **Benign ultrasound results considered as BI-RADS 2, then clinical follow-up is required
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| **Probably benign ultrasound results considered as BI-RADS 3, then ultrasound short interval follow-up
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| **Suspicious ultrasound results is considered as BI-RADS 4 or 5,then core needle biopsy is required
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| *If mammographic result is in favor of suspicious lesion, the next step is ultrasound to determine biopsy plan
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| **Considered as BI-RADS 4 or 5, then core needle biopsy is required
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| Approach to breast lumps in women aged <40 years based on targeted ultrasound findings<ref name="pmid27814822" />:
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| *If ultrasound results become negative, there are two approaches:
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| **Considered as BI-RADS 1, then clinical follow-up is required
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| **Perform diagnostic mammography
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| ***Negative results are in favor of BI-RADS 1, then clinical follow-up is required
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| ***Benign results are considered as BI-RADS 2,then clinical follow-up is required
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| ***Probably benign results considered as BI-RADS 3, Mammographic short interval follow-up is required
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| ***Suspicious results considered as BI-RADS 4 or 5, then core needle biopsy is required
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| *If ultrasound results show benign findings
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| **Considered as BI-RADS 2, then clinical follow-up is required
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| *If ultrasound results show probably benign findings
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| **Considered as BI-RADS 3, then short interval follow-up is required
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| *If ultrasound results become suspicious
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| **Considered as BI-RADS 4 or 5, then core needle biopsy is required
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| Management of breast lumps determined by core needle biopsy
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| *Atypical ductal hyperplasia
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| **Excision of lump by surgical consultation and follow-up with clinical breast examination for every 6-12 months accompanied with mammography annually
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| *Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ
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| **Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually
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| *Flat epithelial atypia
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| **Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually
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| *Papillomas
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| **Multiple, peripheral papillomas,lesions with atypia, and size >10 mm require surgical consultation and Follow-up with clinical breast examination every 12 months and mammography annually
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| *Complex sclerosing lesion, radical scar
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| **If the size<10mm and adequately sampled, observation would be enough
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| **If the size>10mm; surgical consultation is require
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| **If papillomas excised; follow-up with annual clinical breast examination and mammography is required
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| *Fibroadenoma
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| **If accompanied with atypia and enlarging size, surgical consultation is required
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| **Follow-up with annual clinical breast examination and mammography
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| *Complex fibroadenoma
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| **Observation and follow-up with clinical breast examination and mammography annually
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| *Sclerosing adenosis
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| **Observation and follow-up with clinical breast examination and mammography annually
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| *Fat necrosis
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| **Observation and follow-up with clinical breast examination and mammography annually
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| *Columnar cell hyperplasia
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| **Observation and follow-up with clinical breast examination and mammography annually
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| *Phyllodes tumor
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| **Surgical consultation is required with follow-up with clinical breast examination and mammography annually
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| *Desmoid tumor and mammary fibromatosis
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| **Surgical consultation is required with follow-up with clinical breast examination and mammography annually
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| *Pseudoangiomatous stromal hyperplasia
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| *In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up
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| *Apocrine metaplasia
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| **In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually
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| | ==Breast lumps medical therapy== |
| | * There is no specific medical therapy for breast lump. |
| | * However, there are certain medications that may be used prophylactically to reduce the risk of transformation of breast lump into breast carcinoma. For more information, [[Breast lumps secondary prevention|click here]]. |
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| ==References== | | ==References== |
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| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
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| [[Category:primary care]]
| | [[Category:Up-To-Date]] |
| [[Category:Disease]]
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| [[Category:Musculoskeletal Disease]]
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| [[Category:Physical examination]]
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| [[Category:Needs content]]
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| [[Category:Up-To-Date]]
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| [[Category:Oncology]] | | [[Category:Oncology]] |
| [[Category:Medicine]]
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| [[Category:Gynecology]] | | [[Category:Gynecology]] |
| [[Category:Surgery]] | | [[Category:Surgery]] |