Breast lumps medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Surgery

Recommendations

• Women < age 35

• If no distinct lump found or primary care physician (PCP) unsure: refer to breast specialist for 2nd opinion
• If non-suspicious lump on exam

• • Reassess 3-10 days after onset of next menses
  • If lump regresses, no further evaluation needed

• If lump remains palpable and feels cystic

• • Fine needle aspiration (FNA)
  • Management of bloody vs. non-bloody fluid as above

• If lump does not feel cystic

• • Ultrasound
  • If solid mass: FNAB, core biopsy or excisional biopsy
  • If cyst, FNA as above
  • If non-suspicious solid mass < 1 cm: likely fibroadenoma
  • Can follow by physical examination every 3-6 months

• Mammography generally not helpful in this age group

• Women age 35 and over

• Mammography and ultrasonography (note: mammography has 10-20% false-negative rate)
• Cystic mass

  • FNA with mgmt of bloody vs. non-bloody fluid as above

• Solid mass

• • Core biopsy, FNAB or excisional biopsy if no suspicious features
  • Excisional biopsy recommended if mass is suspicious by exam or mammogram

• No specific findings on mammogram and ultrasound: refer to surgeon for likely excision

References

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