Breast lumps medical therapy: Difference between revisions
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Management of breast lumps: | Management of [[breast lumps]]: | ||
*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> | *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 | **Diagnostic mammography is considered as the first step | ||
| Line 10: | Line 10: | ||
**No further evaluation is needed in case of clearly benign mass in mammography | **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 | **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 | ***[[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> | *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 or mammography is suggested for initial management of women aged between 30 to 39 years | ||
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*If ultrasound results become suspicious | *If ultrasound results become suspicious | ||
**Considered as BI-RADS 4 or 5, then core needle biopsy is required | **Considered as BI-RADS 4 or 5, then core needle biopsy is required | ||
Management of breast lumps determined by core needle biopsy | Management of breast lumps determined by [[core needle biopsy]]<ref name="pmid25341156" />: | ||
*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 | ||
*Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ | *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 | **Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually | ||
*Flat epithelial atypia | *Flat [[epithelial]] [[atypia]] | ||
**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, radical scar | *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 | ||
**If papillomas excised; follow-up with annual clinical breast examination and mammography is required | **If papillomas excised; follow-up with annual clinical breast examination and mammography is required | ||
*Fibroadenoma | *[[Fibroadenoma]] | ||
**If accompanied with atypia and enlarging size, surgical consultation is required | **If accompanied with atypia and enlarging size, surgical consultation is required | ||
**Follow-up with annual clinical breast examination and mammography | **Follow-up with annual clinical breast examination and mammography | ||
*Complex fibroadenoma | *Complex [[fibroadenoma]] | ||
**Observation and follow-up with clinical breast examination and mammography annually | **Observation and follow-up with clinical breast examination and mammography annually | ||
*Sclerosing adenosis | *[[Sclerosing adenosis]] | ||
**Observation and follow-up with clinical breast examination and mammography annually | **Observation and follow-up with clinical breast examination and mammography annually | ||
*Fat necrosis | *[[Fat necrosis]] | ||
**Observation and follow-up with clinical breast examination and mammography annually | **Observation and follow-up with clinical breast examination and mammography annually | ||
*Columnar cell hyperplasia | *Columnar [[cell]] [[hyperplasia]] | ||
**Observation and follow-up with clinical breast examination and mammography annually | **Observation and follow-up with clinical breast examination and mammography annually | ||
*Phyllodes tumor | *[[Phyllodes tumor]] | ||
**Surgical consultation is required with follow-up with clinical breast examination and mammography annually | **Surgical consultation is required with follow-up with clinical breast examination and mammography annually | ||
*Desmoid tumor and mammary fibromatosis | *[[Desmoid tumor]] and [[mammary]] [[fibromatosis]] | ||
**Surgical consultation is required with follow-up with clinical breast examination and mammography annually | **Surgical consultation is required with follow-up with clinical breast examination and mammography annually | ||
*Pseudoangiomatous stromal hyperplasia | *Pseudoangiomatous [[stromal]] [[hyperplasia]] | ||
*In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up | *In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up | ||
*Apocrine metaplasia | *[[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 | **In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually | ||
Revision as of 16:08, 13 December 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]
Management of breast lumps:
- women aged>40 years with palpable mass[1]
- 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[2] [3]
- 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[1] :
- If mammographic results become negative,the next step is targeted ultrasound
- Negative ultrasound results considered as 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[1]:
- If ultrasound results become negative, there are two approaches:
- Considered as BI-RADS 1, then clinical follow-up is required
- 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
Management of breast lumps determined by core needle biopsy[2]:
- 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
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 2.0 2.1 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.
- ↑ 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.