Breast lumps medical therapy: Difference between revisions
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{{CMG}} {{AE}} {{S.M}} | {{CMG}} {{AE}} {{S.M}} | ||
==Overview== | ==Overview== | ||
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 cases appeared in [[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. | |||
==Breast lumps medical therapy== | ==Breast lumps medical therapy== | ||
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 | ||
**If the last screening test is related to more than previous 6 months, both breast mammography is required to rule out occult malignancy | **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 | **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 | ||
**Ultrasound is the first step for women< 30 years presenting with palpable mass | **[[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" /> | 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 | *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 | **Negative [[ultrasound]] results considered as breast imagaging 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 | **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 | **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 | **Suspicious [[ultrasound]] results considered as BI-RADS 4 or 5, then core-needle biopsy is needed | ||
*If mammographic results show only fatty tissue | *If mammographic results show only fatty tissue | ||
** considered as BI-RADS 1, then clinical follow-up is needed | ** considered as BI-RADS 1, then clinical follow-up is needed | ||
*If mammographic results show benign mass | *If mammographic results show benign mass | ||
** considered as BI-RADS 2, then clinical follow-up | ** 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 | *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 | **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 | **[[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 | **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 | **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 | *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 | **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" />: | 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: | *If [[ultrasound]] results become negative, there are two approaches: | ||
**Considered as BI-RADS 1, then clinical follow-up is required | **Considered as BI-RADS 1, then clinical follow-up is required | ||
**Perform diagnostic mammography | **Perform diagnostic [[mammography]] | ||
***Negative results are in favor of BI-RADS 1, then clinical follow-up is required | ***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 | ***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 | ***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 | ***Suspicious results considered as BI-RADS 4 or 5, then core needle biopsy is required | ||
*If ultrasound results show benign findings | *If [[ultrasound]] results show benign findings | ||
**Considered as BI-RADS 2, then clinical follow-up is required | **Considered as BI-RADS 2, then clinical follow-up is required | ||
*If ultrasound results show probably benign findings | *If [[ultrasound]] results show probably benign findings | ||
**Considered as BI-RADS 3, then short interval follow-up is required | **Considered as BI-RADS 3, then short interval follow-up is required | ||
*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 | ||
Revision as of 16:48, 4 January 2019
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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]
Overview
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 cases appeared in 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.
Breast lumps medical therapy
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 breast imagaging 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[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
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.
- ↑ 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.