Breast lumps medical therapy
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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:
- 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 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.