Breast lumps surgery: Difference between revisions
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{{CMG}} {{AE}} {{S.M}} | {{CMG}} {{AE}} {{S.M}} | ||
==Overview== | ==Overview== | ||
Surgical management of breast lumps is related to type of masses based on core-needle biopsy. Atypical ductal [[hyperplasia]], atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]], flat [[epithelial]] [[atypia]] . Multiple, peripheral and atypic [[papillomas]], large [[sclerosing adenosis]] and radical scar >10mm, atypic and enlargic [[fibroadenomas]] ,[[Desmoid tumor]], [[mammary]] [[fibromatosis]], [[phyllodes tumor]], symptomatic and large pseudoangiomatous [[stromal]] [[hyperplasia]] are required surgical consultation and excision. The rest of breast lumps require observation and follow-up. | |||
==Surgery== | ==Surgery== | ||
Management of breast lumps determined by | Management of breast lumps determined by core needle biopsy:<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> | ||
*Atypical ductal [[hyperplasia]] | *Atypical ductal [[hyperplasia]] | ||
**Excision of lump by surgical consultation and follow-up with clinical breast examination for every 6-12 months accompanied with mammography annually | **Excision of lump by surgical consultation and follow-up with clinical breast examination for every 6-12 months accompanied with mammography annually | ||
| Line 12: | Line 14: | ||
**Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually | **Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually | ||
*[[Papillomas]] | *[[Papillomas]] | ||
**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 | **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 | ||
*Complex sclerosing lesion, | *Complex sclerosing lesion, radical scar | ||
**If the size<10mm and adequately sampled, observation would be enough | **If the size<10mm and adequately sampled, observation would be enough | ||
**If the size>10mm; surgical consultation is require | **If the size>10mm; surgical consultation is require | ||
Revision as of 17:12, 4 January 2019
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Breast lumps surgery On the Web |
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American Roentgen Ray Society Images of Breast lumps surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]
Overview
Surgical management of breast lumps is related to type of masses based on core-needle biopsy. Atypical ductal hyperplasia, atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ, flat epithelial atypia . Multiple, peripheral and atypic papillomas, large sclerosing adenosis and radical scar >10mm, atypic and enlargic fibroadenomas ,Desmoid tumor, mammary fibromatosis, phyllodes tumor, symptomatic and large pseudoangiomatous stromal hyperplasia are required surgical consultation and excision. The rest of breast lumps require observation and follow-up.
Surgery
Management of breast lumps determined by core needle biopsy:[1]
- Atypical ductal hyperplasia
- Excision of lump by surgical consultation and follow-up with clinical breast examination for every 6-12 months accompanied with mammography annually
- Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ
- Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually
- Flat epithelial atypia
- Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually
- Papillomas
- 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
- Complex sclerosing lesion, radical scar
- If the size<10mm and adequately sampled, observation would be enough
- If the size>10mm; surgical consultation is require
- If papillomas excised; follow-up with annual clinical breast examination and mammography is required
- Fibroadenoma
- If accompanied with atypia and enlarging size, surgical consultation is required
- Follow-up with annual clinical breast examination and mammography
- Complex fibroadenoma
- Observation and follow-up with clinical breast examination and mammography annually
- Sclerosing adenosis
- Observation and follow-up with clinical breast examination and mammography annually
- Fat necrosis
- Observation and follow-up with clinical breast examination and mammography annually
- Columnar cell hyperplasia
- Observation and follow-up with clinical breast examination and mammography annually
- Phyllodes tumor
- Surgical consultation is required with follow-up with clinical breast examination and mammography annually
- Desmoid tumor and mammary fibromatosis
- Surgical consultation is required with follow-up with clinical breast examination and mammography annually
- Pseudoangiomatous stromal hyperplasia
- In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up
- Apocrine metaplasia
- In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually
The final decision for excisional biopsy is based on recommendations from pathologist,radiologist and surgeons. The decision is made after comprehensive evaluation of clinical,imaging and pathologic findings which help to reach the best possible management for patient care.
References
- ↑ 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.