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| ==Breast lumps medical therapy== | | ==Breast lumps medical therapy== |
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| 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|ultrasound.]]
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| **Negative [[ultrasound]] results considered as '''breast imaging reporting and data system''' (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|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 ( if no palpable dominant suspicious mass found at clinical examination)
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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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| '''''For more information on breast imaging reporting and data system (BI-RADS) system, [[Breast lumps other imaging findings#Mammography|click here]].'''''
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | A01 | | | | | |A01=Women age > 40 years}}
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| {{familytree | | | | | | | | | | |!| | | | | | | | }}
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| {{familytree | | | | | | | | | | B01 | | | | | |B01=Mammographic findings}}
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| {{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|-|.|}}
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| {{familytree | | C01 | | C02 | | C03 | | C04 | | | C05 | |C01=Negative|C02=Fatty tissue|C03=Benign|C04=Probably benign|C05=Suspicious }}
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| {{familytree | | |!| | | |!| | | |!| | | |!| | | | |!| }}
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| {{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}}
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| {{familytree | | |!| | | | | | | | | | | |!| | | | |!| |}}
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| {{familytree | | |!| | | | | | | | | | | |!| | | | C19 | C19=BI-RADS 4 or 5, then core needle biopsy}}
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| {{familytree | | |!| | | | | | | | | | | |!| | | | | | |}}
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| {{familytree | | |!| | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}}
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| {{familytree | | |!| | | | | |!| | | |!| | | |!| | | |!|}}
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| {{familytree | | |!| | | | | C11 | | C12 | | C13 | | C14 |C11=Negative|C12=Benign|C13=Probably benign|C14=Suspicious}}
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| {{familytree | | |!| | | | | |!| | | |!| | | |!| | | |!|}}
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| {{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}}
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| {{familytree | | |!| | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | |)|-|-|-|v|-|-|-|v|-|-|-|.|}}
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| {{familytree | | |!| | | |!| | | |!| | | |!|}}
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| {{familytree | | D01 | | D02 | | D03 | | D04 | | |D01=Negative results|D02=Benign|D03=Probably benign|D04=Suspicious}}
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| {{familytree | | |!| | | |!| | | |!| | | |!| | | | }}
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| {{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}}
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| {{familytree/end}}
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | A01 | | | | | |A01=Women age < 40 years}}
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| {{familytree | | | | | | | | | | |!| | | | | | | | }}
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| {{familytree | | | | | | | | | | B01 | | | | | |B01=Targeted ultrasound}}
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| {{familytree | | |,|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|.|}}
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| {{familytree | | C01 | | C02 | | | | | | C03 | | C04 | | | |C01=Negative|C02=Benign|C03=Probably benign|C04=Suspicious}}
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| {{familytree | | |!| | | |!| | | | | | | |!| | | |!| }}
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| {{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}}
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| {{familytree | | |!| | | | | | |}}
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| {{familytree | | |)|-|-|-|-|.| |}}
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| {{familytree | | |!| | | | |!|}}
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| {{familytree | | C05 | | | C06|C05=BI-RADS 1, then clinical follow-up|C06=Perform diagnostic mammography}}
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| {{familytree | | | | | | | |!| }}
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| {{familytree | | | | | | | |)|-|-|-|v|-|-|-|-|v|-|-|-|.|}}
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| {{familytree | | | | | | | C07 | | C08 | | | C09 | | C010| |C07=Negative|C08=Benign|C09=Probably benign|C010=Suspicious}}
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| {{familytree | | | | | | | |!| | | |!| | | | |!| | | |!|}}
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| {{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}}
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| {{familytree/end}}
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| ==References== | | ==References== |