Breast lumps medical therapy: Difference between revisions

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=== Recommendations ===
=== Recommendations ===
* Women < age 35  
* Women < age 35  
:* If no distinct lump found or primary care physician (PCP) unsure:  refer to breast specialist for 2nd opinion
*:* If no distinct lump found or primary care physician (PCP) unsure:  refer to breast specialist for 2nd opinion
:* If non-suspicious lump on exam
*:* If non-suspicious lump on exam
*:* Reassess 3-10 days after onset of next menses  
*:*:* Reassess 3-10 days after onset of next menses  
*:* If lump regresses, no further evaluation needed
*:*:* If lump regresses, no further evaluation needed
:* If lump remains palpable and feels cystic
*:* If lump remains palpable and feels cystic
*:* Fine needle aspiration (FNA)
*:*:* Fine needle aspiration (FNA)
*:* Management of bloody vs. non-bloody fluid as above
*:*:* Management of bloody vs. non-bloody fluid as above
:* If lump does not feel cystic
*:* If lump does not feel cystic
*:* Ultrasound
*:*:* Ultrasound
*:* If solid mass: FNAB, core biopsy or excisional biopsy
*:*:* If solid mass: FNAB, core biopsy or excisional biopsy
*:* If cyst, FNA as above
*:*:* If cyst, FNA as above
*:* If non-suspicious solid mass < 1 cm: likely fibroadenoma
*:*:* If non-suspicious solid mass < 1 cm: likely fibroadenoma
*:* Can follow by physical examination every 3-6 months
*:*:* Can follow by physical examination every 3-6 months
:* Mammography generally not helpful in this age group
*:* Mammography generally not helpful in this age group
* Women age 35 and over
* Women age 35 and over
:* Mammography and ultrasonography (note: mammography has 10-20% false-negative rate)
*:* Mammography and ultrasonography (note: mammography has 10-20% false-negative rate)
:* Cystic mass  
*:* Cystic mass  
:*:* FNA with mgmt of bloody vs. non-bloody fluid as above
*:*:* FNA with mgmt of bloody vs. non-bloody fluid as above
:* Solid mass
*:* Solid mass
*:* Core biopsy, FNAB or excisional biopsy if no suspicious features
*:*:* Core biopsy, FNAB or excisional biopsy if no suspicious features
*:* Excisional biopsy recommended if mass is suspicious by exam or mammogram
*:*:* Excisional biopsy recommended if mass is suspicious by exam or mammogram
:* No specific findings on mammogram and ultrasound:  refer to surgeon for likely excision
*:* No specific findings on mammogram and ultrasound:  refer to surgeon for likely excision
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 14:24, 22 April 2013

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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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