Breast lumps diagnostic study of choice: Difference between revisions
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== Overview == | == Overview == | ||
[[Mammography]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged >40 years old. [[Ultrasound]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged <40 years old. Management and medical therapy of [[breast lumps]] depends on women's age (age> 40 or age <40) and [[mammography]] results in women aged > 40 years. In women aged > 40 years; no further evaluation is needed in case of clearly [[benign]] mass in [[mammography]]; however, [[ultrasound]] imaging is required for the rest of the findings [[mammography]]. Approach to breast lumps in women >40 years is depended on breast imaging reporting and data systems (BI-RADS) stages. Medical therapy of breast lumps in women< 40 years is depended on [[ultrasound]] results and BI-RADS categories. | |||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
=== | === Gold Standard === | ||
==== Mammography ==== | |||
[[Mammography]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged >40 years old.<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> | |||
*If the patient had positive history of [[bilateral]] [[mammography]] within past 6 months, only [[ipsilateral]] [[mammography]] is needed. | |||
* | |||
==== The comparison of various diagnostic studies for [ | ==== Ultrasound ==== | ||
[[Ultrasound]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged <40 years old.<ref name="pmid25341156" /> | |||
The comparison of various diagnostic studies for [[breast lumps]]:<ref name="pmid25241817">{{cite journal| author=Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI et al.| title=The comparative accuracy of ultrasound and mammography in the detection of breast cancer. | journal=Med J Malaysia | year= 2014 | volume= 69 | issue= 2 | pages= 79-85 | pmid=25241817 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25241817 }} </ref> | |||
{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity | ||
|- | |- | ||
! style="background: #696969; color: #FFFFFF; text-align: center;" | | ! style="background: #696969; color: #FFFFFF; text-align: center;" |Ultrasound | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |82% | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |84% | ||
|- | |- | ||
! style="background: #696969; color: #FFFFFF; text-align: center;" | | ! style="background: #696969; color: #FFFFFF; text-align: center;" |Mammography | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |49% | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |89% | ||
|} | |} | ||
<small> [ | <small> Breast ultrasound has higher sensitivity and mammography has higher specificity. The accuracy of ultrasound reported as 84% and accuracy of mammography reported as 81% .<ref name="pmid25241817" /></small> | ||
=== Diagnostic Approach to Breast Lump === | |||
Diagnostic approach for breast lump: | |||
*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> | |||
**Diagnostic [[mammography]] is considered as the first step. | |||
**If the last [[screening test]] is related to more than previous 6 months, both breast [[mammography]] is required to rule out occult [[malignancy]]. | |||
**No further evaluation is needed in case of clearly [[benign]] mass in [[mammography]]. | |||
**[[Ultrasound]] imaging is required for the rest of cases appeared in [[mammography]]. | |||
***[[Stereotactic]] [[biopsy]] is recommended in negative [[ultrasound]] findings addition to suspicious mammographic results. | |||
*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> | |||
**[[Ultrasound]] or [[mammography]] is suggested for initial management of women aged between 30 to 39 years. | |||
**[[Ultrasound]] is the first step for women < 30 years presenting with palpable mass. | |||
Approach to [[breast lumps]] in women aged > 40 years based on mammographic results:<ref name="pmid27814822" /> | |||
*If mammographic results become negative, the next step is targeted [[ultrasound|ultrasound.]] | |||
**Negative [[ultrasound]] results considered as '''breast imaging reporting and data system''' (BI-RADS) 1, then clinical follow-up is needed. | |||
**Benign [[ultrasound]] results considered as BI-RADS 2, then clinical follow-up is needed. | |||
**Probably benign results considered as BI-RADS 3, then ultrasound short interval follow-up is needed. | |||
**Suspicious [[ultrasound]] results considered as BI-RADS 4 or 5, then core-needle biopsy is needed. | |||
*If mammographic results show only fatty tissue: | |||
** Considered as BI-RADS 1, then clinical follow-up is needed. | |||
*If mammographic results show benign mass: | |||
** Considered as BI-RADS 2, then clinical follow-up | |||
*If mammographic results are in favor of probably [[benign]] lumps, the next step is targeted [[ultrasound|ultrasound.]] | |||
**Negative [[ultrasound]] results considered as BI-RADS 3, then mammographic short interval follow-up is required. | |||
**[[Benign]] [[ultrasound]] results considered as BI-RADS 2, then clinical follow-up is required. | |||
**Probably [[benign]] [[ultrasound]] results considered as BI-RADS 3, then [[ultrasound]] short interval follow-up. | |||
**Suspicious [[ultrasound]] results is considered as BI-RADS 4 or 5, then core needle biopsy is required. | |||
*If mammographic result is in favor of suspicious lesion, the next step is [[ultrasound]] to determine [[biopsy]] plan. | |||
**Considered as BI-RADS 4 or 5, then core needle biopsy is required. | |||
Approach to breast lumps in women aged <40 years based on targeted [[ultrasound]] findings:<ref name="pmid27814822" /> | |||
*If [[ultrasound]] results become negative, there are two approaches: | |||
**Considered as BI-RADS 1, then clinical follow-up is required ( if no palpable dominant suspicious mass found at clinical examination) | |||
**Perform diagnostic [[mammography]]: | |||
***Negative results are in favor of BI-RADS 1, then clinical follow-up is required. | |||
***Benign results are considered as BI-RADS 2, then clinical follow-up is required. | |||
***Probably benign results considered as BI-RADS 3, Mammographic short interval follow-up is required. | |||
***Suspicious results considered as BI-RADS 4 or 5, then core needle biopsy is required. | |||
*If [[ultrasound]] results show benign findings: | |||
**Considered as BI-RADS 2, then clinical follow-up is required. | |||
*If [[ultrasound]] results show probably benign findings: | |||
**Considered as BI-RADS 3, then short interval follow-up is required. | |||
*If [[ultrasound]] results become suspicious: | |||
**Considered as BI-RADS 4 or 5, then core needle biopsy is required. | |||
'''''For more information on breast imaging reporting and data system (BI-RADS) system, [[Breast lumps other imaging findings#Mammography|click here]].''''' | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | A01 | | | | | |A01=Women age > 40 years}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | B01 | | | | | |B01=Mammographic findings}} | |||
{{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|-|.|}} | |||
{{familytree | | C01 | | C02 | | C03 | | C04 | | | C05 | |C01=Negative|C02=Fatty tissue|C03=Benign|C04=Probably benign|C05=Suspicious }} | |||
{{familytree | | |!| | | |!| | | |!| | | |!| | | | |!| }} | |||
{{familytree | | C06 | | C07 | | C08 | | C09 | | | C10 |C06=Ultrasound|C07=BI-RADS 1, then clinical follow-up|C08=BI-RADS 2, then clinical follow-up|C09=Ultrasound|C10=Ultrasound for biopsy plan determination}} | |||
{{familytree | | |!| | | | | | | | | | | |!| | | | |!| |}} | |||
{{familytree | | |!| | | | | | | | | | | |!| | | | C19 | C19=BI-RADS 4 or 5, then core needle biopsy}} | |||
{{familytree | | |!| | | | | | | | | | | |!| | | | | | |}} | |||
{{familytree | | |!| | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}} | |||
{{familytree | | |!| | | | | |!| | | |!| | | |!| | | |!|}} | |||
{{familytree | | |!| | | | | C11 | | C12 | | C13 | | C14 |C11=Negative|C12=Benign|C13=Probably benign|C14=Suspicious}} | |||
{{familytree | | |!| | | | | |!| | | |!| | | |!| | | |!|}} | |||
{{familytree | | |!| | | | | C15 | | C16 | | C17 | | C18 | C15=BI-RADS 3, then mammographic short interval follow-up|C16=BI-RADS 2, then clinical follow-up|C17=BI-RADS 3, then ultrasound short interval follow-up|C18=BI-RADS 4 or 5, then core needle biopsy}} | |||
{{familytree | | |!| | | | | | | | | | | | | | | | | | |}} | |||
{{familytree | | |)|-|-|-|v|-|-|-|v|-|-|-|.|}} | |||
{{familytree | | |!| | | |!| | | |!| | | |!|}} | |||
{{familytree | | D01 | | D02 | | D03 | | D04 | | |D01=Negative results|D02=Benign|D03=Probably benign|D04=Suspicious}} | |||
{{familytree | | |!| | | |!| | | |!| | | |!| | | | }} | |||
{{familytree | | E01 | | E02 | | E03 | | E04 | | |E01=BI-RADS 1, then clinical follow-up|E02=BI-RADS 2, then clinical follow-up|E03=BI-RADS 3, then ultrasound short interval follow-up|E04= BI-RADS 4 or 5, then core needle biopsy}} | |||
{{familytree/end}} | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | A01 | | | | | |A01=Women age < 40 years}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | B01 | | | | | |B01=Targeted ultrasound}} | |||
{{familytree | | |,|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|.|}} | |||
{{familytree | | C01 | | C02 | | | | | | C03 | | C04 | | | |C01=Negative|C02=Benign|C03=Probably benign|C04=Suspicious}} | |||
{{familytree | | |!| | | |!| | | | | | | |!| | | |!| }} | |||
{{familytree | | |!| | | C015| | | | | | C016| | C017|C015=BI-RADS 2, then clinical follow-up|C016=BI-RADS 3, then short interval follow-up|C017=BI-RADS 4 or 5, then core needle biopsy}} | |||
{{familytree | | |!| | | | | | |}} | |||
{{familytree | | |)|-|-|-|-|.| |}} | |||
{{familytree | | |!| | | | |!|}} | |||
{{familytree | | C05 | | | C06|C05=BI-RADS 1, then clinical follow-up|C06=Perform diagnostic mammography}} | |||
{{familytree | | | | | | | |!| }} | |||
{{familytree | | | | | | | |)|-|-|-|v|-|-|-|-|v|-|-|-|.|}} | |||
{{familytree | | | | | | | C07 | | C08 | | | C09 | | C010| |C07=Negative|C08=Benign|C09=Probably benign|C010=Suspicious}} | |||
{{familytree | | | | | | | |!| | | |!| | | | |!| | | |!|}} | |||
{{familytree | | | | | | | C011| | C012| | | C013| | C014|C011=BI-RADS 1, then clinical follow-up|C012=BI-RADS 2, then clinical follow-up|C013=BI-RADS 3, Mammographic short interval follow-up|C014=BI-RADS 4 or 5, then core needle biopsy}} | |||
{{familytree/end}} | |||
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Latest revision as of 20:42, 29 July 2020
Breast lumps Microchapters |
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Breast lumps diagnostic study of choice On the Web |
American Roentgen Ray Society Images of Breast lumps diagnostic study of choice |
Risk calculators and risk factors for Breast lumps diagnostic study of choice |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]
Overview
Mammography is the gold standard test for the diagnosis of breast lumps in women aged >40 years old. Ultrasound is the gold standard test for the diagnosis of breast lumps in women aged <40 years old. Management and medical therapy of breast lumps depends on women's age (age> 40 or age <40) and mammography results in women aged > 40 years. In women aged > 40 years; no further evaluation is needed in case of clearly benign mass in mammography; however, ultrasound imaging is required for the rest of the findings mammography. Approach to breast lumps in women >40 years is depended on breast imaging reporting and data systems (BI-RADS) stages. Medical therapy of breast lumps in women< 40 years is depended on ultrasound results and BI-RADS categories.
Diagnostic Study of Choice
Gold Standard
Mammography
Mammography is the gold standard test for the diagnosis of breast lumps in women aged >40 years old.[1]
- If the patient had positive history of bilateral mammography within past 6 months, only ipsilateral mammography is needed.
Ultrasound
Ultrasound is the gold standard test for the diagnosis of breast lumps in women aged <40 years old.[1]
The comparison of various diagnostic studies for breast lumps:[2]
Sensitivity | Specificity | |
---|---|---|
Ultrasound | 82% | 84% |
Mammography | 49% | 89% |
Breast ultrasound has higher sensitivity and mammography has higher specificity. The accuracy of ultrasound reported as 84% and accuracy of mammography reported as 81% .[2]
Diagnostic Approach to Breast Lump
Diagnostic approach for breast lump:
- Women aged >40 years with palpable mass:[3]
- Diagnostic mammography is considered as the first step.
- If the last screening test is related to more than previous 6 months, both breast mammography is required to rule out occult malignancy.
- No further evaluation is needed in case of clearly benign mass in mammography.
- Ultrasound imaging is required for the rest of cases appeared in mammography.
- Stereotactic biopsy is recommended in negative ultrasound findings addition to suspicious mammographic results.
- Women aged< 40 years with palpable mass:[1][4]
- Ultrasound or mammography is suggested for initial management of women aged between 30 to 39 years.
- Ultrasound is the first step for women < 30 years presenting with palpable mass.
Approach to breast lumps in women aged > 40 years based on mammographic results:[3]
- If mammographic results become negative, the next step is targeted ultrasound.
- Negative ultrasound results considered as breast imaging reporting and data system (BI-RADS) 1, then clinical follow-up is needed.
- Benign ultrasound results considered as BI-RADS 2, then clinical follow-up is needed.
- Probably benign results considered as BI-RADS 3, then ultrasound short interval follow-up is needed.
- Suspicious ultrasound results considered as BI-RADS 4 or 5, then core-needle biopsy is needed.
- If mammographic results show only fatty tissue:
- Considered as BI-RADS 1, then clinical follow-up is needed.
- If mammographic results show benign mass:
- Considered as BI-RADS 2, then clinical follow-up
- If mammographic results are in favor of probably benign lumps, the next step is targeted ultrasound.
- Negative ultrasound results considered as BI-RADS 3, then mammographic short interval follow-up is required.
- Benign ultrasound results considered as BI-RADS 2, then clinical follow-up is required.
- Probably benign ultrasound results considered as BI-RADS 3, then ultrasound short interval follow-up.
- Suspicious ultrasound results is considered as BI-RADS 4 or 5, then core needle biopsy is required.
- If mammographic result is in favor of suspicious lesion, the next step is ultrasound to determine biopsy plan.
- Considered as BI-RADS 4 or 5, then core needle biopsy is required.
Approach to breast lumps in women aged <40 years based on targeted ultrasound findings:[3]
- If ultrasound results become negative, there are two approaches:
- Considered as BI-RADS 1, then clinical follow-up is required ( if no palpable dominant suspicious mass found at clinical examination)
- Perform diagnostic mammography:
- Negative results are in favor of BI-RADS 1, then clinical follow-up is required.
- Benign results are considered as BI-RADS 2, then clinical follow-up is required.
- Probably benign results considered as BI-RADS 3, Mammographic short interval follow-up is required.
- Suspicious results considered as BI-RADS 4 or 5, then core needle biopsy is required.
- If ultrasound results show benign findings:
- Considered as BI-RADS 2, then clinical follow-up is required.
- If ultrasound results show probably benign findings:
- Considered as BI-RADS 3, then short interval follow-up is required.
- If ultrasound results become suspicious:
- Considered as BI-RADS 4 or 5, then core needle biopsy is required.
For more information on breast imaging reporting and data system (BI-RADS) system, click here.
Women age > 40 years | |||||||||||||||||||||||||||||||||||||||||||
Mammographic findings | |||||||||||||||||||||||||||||||||||||||||||
Negative | Fatty tissue | Benign | Probably benign | Suspicious | |||||||||||||||||||||||||||||||||||||||
Ultrasound | BI-RADS 1, then clinical follow-up | BI-RADS 2, then clinical follow-up | Ultrasound | Ultrasound for biopsy plan determination | |||||||||||||||||||||||||||||||||||||||
BI-RADS 4 or 5, then core needle biopsy | |||||||||||||||||||||||||||||||||||||||||||
Negative | Benign | Probably benign | Suspicious | ||||||||||||||||||||||||||||||||||||||||
BI-RADS 3, then mammographic short interval follow-up | BI-RADS 2, then clinical follow-up | BI-RADS 3, then ultrasound short interval follow-up | BI-RADS 4 or 5, then core needle biopsy | ||||||||||||||||||||||||||||||||||||||||
Negative results | Benign | Probably benign | Suspicious | ||||||||||||||||||||||||||||||||||||||||
BI-RADS 1, then clinical follow-up | BI-RADS 2, then clinical follow-up | BI-RADS 3, then ultrasound short interval follow-up | BI-RADS 4 or 5, then core needle biopsy | ||||||||||||||||||||||||||||||||||||||||
Women age < 40 years | |||||||||||||||||||||||||||||||||||||||||||||
Targeted ultrasound | |||||||||||||||||||||||||||||||||||||||||||||
Negative | Benign | Probably benign | Suspicious | ||||||||||||||||||||||||||||||||||||||||||
BI-RADS 2, then clinical follow-up | BI-RADS 3, then short interval follow-up | BI-RADS 4 or 5, then core needle biopsy | |||||||||||||||||||||||||||||||||||||||||||
BI-RADS 1, then clinical follow-up | Perform diagnostic mammography | ||||||||||||||||||||||||||||||||||||||||||||
Negative | Benign | Probably benign | Suspicious | ||||||||||||||||||||||||||||||||||||||||||
BI-RADS 1, then clinical follow-up | BI-RADS 2, then clinical follow-up | BI-RADS 3, Mammographic short interval follow-up | BI-RADS 4 or 5, then core needle biopsy | ||||||||||||||||||||||||||||||||||||||||||
References
- ↑ 1.0 1.1 1.2 Lehman CD, Lee AY, Lee CI (2014). "Imaging management of palpable breast abnormalities". AJR Am J Roentgenol. 203 (5): 1142–53. doi:10.2214/AJR.14.12725. PMID 25341156.
- ↑ 2.0 2.1 Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI; et al. (2014). "The comparative accuracy of ultrasound and mammography in the detection of breast cancer". Med J Malaysia. 69 (2): 79–85. PMID 25241817.
- ↑ 3.0 3.1 3.2 Harvey JA, Mahoney MC, Newell MS, Bailey L, Barke LD, D'Orsi C; et al. (2016). "ACR Appropriateness Criteria Palpable Breast Masses". J Am Coll Radiol. 13 (11S): e31–e42. doi:10.1016/j.jacr.2016.09.022. PMID 27814822.
- ↑ Loving VA, DeMartini WB, Eby PR, Gutierrez RL, Peacock S, Lehman CD (2010). "Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications". AJR Am J Roentgenol. 195 (6): 1472–7. doi:10.2214/AJR.10.4396. PMID 21098212.