Breast lumps diagnostic study of choice: Difference between revisions

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Latest revision as of 20:42, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Mammography is the gold standard test for the diagnosis of breast lumps in women aged >40 years old. Ultrasound is the gold standard test for the diagnosis of breast lumps in women aged <40 years old. 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 the findings 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.

Diagnostic Study of Choice

Gold Standard

Mammography

Mammography is the gold standard test for the diagnosis of breast lumps in women aged >40 years old.^[1]

If the patient had positive history of bilateral mammography within past 6 months, only ipsilateral mammography is needed.

Ultrasound

Ultrasound is the gold standard test for the diagnosis of breast lumps in women aged <40 years old.^[1]

The comparison of various diagnostic studies for breast lumps:^[2]

	Sensitivity	Specificity
Ultrasound	82%	84%
Mammography	49%	89%

Breast ultrasound has higher sensitivity and mammography has higher specificity. The accuracy of ultrasound reported as 84% and accuracy of mammography reported as 81% .^[2]

Diagnostic Approach to Breast Lump

Diagnostic approach for breast lump:

Women aged >40 years with palpable mass:^[3]
- 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:^[1]^[4]
- 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:^[3]

If mammographic results become negative, the next step is targeted ultrasound.
- Negative ultrasound results considered as breast imaging 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:^[3]

If ultrasound results become negative, there are two approaches:
- Considered as BI-RADS 1, then clinical follow-up is required ( if no palpable dominant suspicious mass found at clinical examination)
- 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.

For more information on breast imaging reporting and data system (BI-RADS) system, click here.

Women age > 40 years

Mammographic findings

Negative

Fatty tissue

Benign

Probably benign

Suspicious

Ultrasound

BI-RADS 1, then clinical follow-up

BI-RADS 2, then clinical follow-up

Ultrasound

Ultrasound for biopsy plan determination

BI-RADS 4 or 5, then core needle biopsy

Negative

Benign

Probably benign

Suspicious

BI-RADS 3, then mammographic short interval follow-up

BI-RADS 2, then clinical follow-up

BI-RADS 3, then ultrasound short interval follow-up

BI-RADS 4 or 5, then core needle biopsy

Negative results

Benign

Probably benign

Suspicious

BI-RADS 1, then clinical follow-up

BI-RADS 2, then clinical follow-up

BI-RADS 3, then ultrasound short interval follow-up

BI-RADS 4 or 5, then core needle biopsy

Women age < 40 years

Targeted ultrasound

Negative

Benign

Probably benign

Suspicious

BI-RADS 2, then clinical follow-up

BI-RADS 3, then short interval follow-up

BI-RADS 4 or 5, then core needle biopsy

BI-RADS 1, then clinical follow-up

Perform diagnostic mammography

Negative

Benign

Probably benign

Suspicious

BI-RADS 1, then clinical follow-up

BI-RADS 2, then clinical follow-up

BI-RADS 3, Mammographic short interval follow-up

BI-RADS 4 or 5, then core needle biopsy

References

↑ ^1.0 ^1.1 ^1.2 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.
↑ ^2.0 ^2.1 Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI; et al. (2014). "The comparative accuracy of ultrasound and mammography in the detection of breast cancer". Med J Malaysia. 69 (2): 79–85. PMID 25241817.
↑ ^3.0 ^3.1 ^3.2 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.
↑ 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.

Template:WikiDoc Sources

[pmid25341156-1] 1.0 ^1.1 ^1.2 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.

[pmid25241817-2] 2.0 ^2.1 Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI; et al. (2014). "The comparative accuracy of ultrasound and mammography in the detection of breast cancer". Med J Malaysia. 69 (2): 79–85. PMID 25241817.

[pmid27814822-3] 3.0 ^3.1 ^3.2 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.

[pmid21098212-4] 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.

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Breast lumps}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}}{{S.M}}
 == Overview ==
+[[Mammography]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged >40 years old. [[Ultrasound]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged <40 years old. 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 the findings [[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.
 == Diagnostic Study of Choice ==
-=== Study of choice ===
+=== Gold Standard ===
-[[Mammography]] is the gold standard test for the diagnosis of breast lumps in women aged>40 years old<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>
-*If the patient had positive history of bilateral mammography,therefore; only ipsilateral [[mammography]] is needed
-[[Ultrasound]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged<40 years old.
-The comparison of various diagnostic studies for breast lumps <ref name="pmid25241817">{{cite journal| author=Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI et al.| title=The comparative accuracy of ultrasound and mammography in the detection of breast cancer. | journal=Med J Malaysia | year= 2014 | volume= 69 | issue= 2 | pages= 79-85 | pmid=25241817 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25241817  }} </ref>
+==== Mammography ====
+[[Mammography]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged >40 years old.<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>
+*If the patient had positive history of [[bilateral]] [[mammography]] within past 6 months, only [[ipsilateral]] [[mammography]] is needed.
+==== Ultrasound ====
+[[Ultrasound]] is the gold standard test for the diagnosis of [[breast lumps]] in women aged <40 years old.<ref name="pmid25341156" />
+The comparison of various diagnostic studies for [[breast lumps]]:<ref name="pmid25241817">{{cite journal| author=Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI et al.| title=The comparative accuracy of ultrasound and mammography in the detection of breast cancer. | journal=Med J Malaysia | year= 2014 | volume= 69 | issue= 2 | pages= 79-85 | pmid=25241817 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25241817  }} </ref>
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 26: / Line 31: @@
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |89%
 |}
-<small> Breast ultrasound has higher sensitivity and mammography has higher specificity. The accuracy of ultrasound reported as 84% and accuracy of mammography reported as 81% <ref name="pmid25241817" /></small>.
+<small> Breast ultrasound has higher sensitivity and mammography has higher specificity. The accuracy of ultrasound reported as 84% and accuracy of mammography reported as 81% .<ref name="pmid25241817" /></small>
+=== Diagnostic Approach to Breast Lump ===
+Diagnostic approach for breast lump:
+*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.
+**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:<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]] 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" />
+*If mammographic results become negative, the next step is targeted [[ultrasound|ultrasound.]]
+**Negative [[ultrasound]] results considered as '''breast imaging 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|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:<ref name="pmid27814822" />
+*If [[ultrasound]] results become negative, there are two approaches:
+**Considered as BI-RADS 1, then clinical follow-up is required ( if no palpable dominant suspicious mass found at clinical examination)
+**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.
+'''''For more information on breast imaging reporting and data system (BI-RADS) system, [[Breast lumps other imaging findings#Mammography|click here]].'''''
+{{familytree/start}}
+{{familytree | | | | | | | | | | A01 | | | | | |A01=Women age > 40 years}}
+{{familytree | | | | | | | | | | |!| | | | | | | | }}
+{{familytree | | | | | | | | | | B01 | | | | | |B01=Mammographic findings}}
+{{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|-|.|}}
+{{familytree | | C01 | | C02 | | C03 | | C04 | | | C05 | |C01=Negative|C02=Fatty tissue|C03=Benign|C04=Probably benign|C05=Suspicious }}
+{{familytree | | |!| | | |!| | | |!| | | |!| | | | |!| }}
+{{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}}
+{{familytree | | |!| | | | | | | | | | | |!| | | | |!| |}}
+{{familytree | | |!| | | | | | | | | | | |!| | | | C19 | C19=BI-RADS 4 or 5, then core needle biopsy}}
+{{familytree | | |!| | | | | | | | | | | |!| | | | | | |}}
+{{familytree | | |!| | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}}
+{{familytree | | |!| | | | | |!| | | |!| | | |!| | | |!|}}
+{{familytree | | |!| | | | | C11 | | C12 | | C13 | | C14 |C11=Negative|C12=Benign|C13=Probably benign|C14=Suspicious}}
+{{familytree | | |!| | | | | |!| | | |!| | | |!| | | |!|}}
+{{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}}
+{{familytree | | |!| | | | | | | | | | | | | | | | | | |}}
+{{familytree | | |)|-|-|-|v|-|-|-|v|-|-|-|.|}}
+{{familytree | | |!| | | |!| | | |!| | | |!|}}
+{{familytree | | D01 | | D02 | | D03 | | D04 | | |D01=Negative results|D02=Benign|D03=Probably benign|D04=Suspicious}}
+{{familytree | | |!| | | |!| | | |!| | | |!| | | | }}
+{{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}}
+{{familytree/end}}
+{{familytree/start}}
+{{familytree | | | | | | | | | | A01 | | | | | |A01=Women age < 40 years}}
+{{familytree | | | | | | | | | | |!| | | | | | | | }}
+{{familytree | | | | | | | | | | B01 | | | | | |B01=Targeted ultrasound}}
+{{familytree | | |,|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|.|}}
+{{familytree | | C01 | | C02 | | | | | | C03 | | C04 | | | |C01=Negative|C02=Benign|C03=Probably benign|C04=Suspicious}}
+{{familytree | | |!| | | |!| | | | | | | |!| | | |!| }}
+{{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}}
+{{familytree | | |!| | | | | | |}}
+{{familytree | | |)|-|-|-|-|.| |}}
+{{familytree | | |!| | | | |!|}}
+{{familytree | | C05 | | | C06|C05=BI-RADS 1, then clinical follow-up|C06=Perform diagnostic mammography}}
+{{familytree | | | | | | | |!| }}
+{{familytree | | | | | | | |)|-|-|-|v|-|-|-|-|v|-|-|-|.|}}
+{{familytree | | | | | | | C07 | | C08 | | | C09 | | C010| |C07=Negative|C08=Benign|C09=Probably benign|C010=Suspicious}}
+{{familytree | | | | | | | |!| | | |!| | | | |!| | | |!|}}
+{{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}}
+{{familytree/end}}
 ==References==
 {{Reflist|2}}
-{{WH}}
-{{WS}}
+{{WikiDoc Help Menu}}
+{{WikiDoc Sources}}
+[[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Gynecology]]
+[[Category:Surgery]]

Breast lumps diagnostic study of choice: Difference between revisions

Latest revision as of 20:42, 29 July 2020

Overview

Diagnostic Study of Choice

Gold Standard

Mammography

Ultrasound

Diagnostic Approach to Breast Lump

References

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