Breast lumps surgery: Difference between revisions

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| style="background:#DCDCDC;" align="center" + |'''Atypical ductal [[hyperplasia]]'''
| style="background:#DCDCDC;" align="center" + |'''Atypical ductal [[hyperplasia]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
*Excision of lump by surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]'''
| style="background:#DCDCDC;" align="center" + |'''Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
*Surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Flat [[epithelial]] [[atypia]]'''
| style="background:#DCDCDC;" align="center" + |'''Flat [[epithelial]] [[atypia]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
*Surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Papillomas]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Papillomas]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Multiple, peripheral [[papillomas]], lesions with [[atypia]], and size >10 mm require surgical consultation and follow-up with clinical breast examination every 12 months and mammography, annually.
*Multiple, peripheral [[papillomas]], lesions with [[atypia]], and size >10 mm require surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 12 months and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Complex sclerosing lesion, radical scar'''
| style="background:#DCDCDC;" align="center" + |'''Complex sclerosing lesion, radical scar'''
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*If the size < 10mm and adequately sampled: observation.
*If the size < 10mm and adequately sampled: observation.
*If the size > 10mm: surgical consultation is required.
*If the size > 10mm: surgical consultation is required.
*If papilloma is excised: follow-up with annual clinical breast examination and mammography.
*If papilloma is excised: follow-up with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]].
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Fibroadenoma]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Fibroadenoma]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*If accompanied with atypia and enlarging size, surgical consultation is required.
*If accompanied with atypia and enlarging size, surgical consultation is required.
*Follow-up with annual clinical breast examination and mammography.
*Follow-up with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and mammography.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Complex [[fibroadenoma]]'''
| style="background:#DCDCDC;" align="center" + |'''Complex [[fibroadenoma]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Sclerosing adenosis]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Sclerosing adenosis]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Fat necrosis]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Fat necrosis]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Columnar [[cell]] [[hyperplasia]]'''
| style="background:#DCDCDC;" align="center" + |'''Columnar [[cell]] [[hyperplasia]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Phyllodes tumor]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Phyllodes tumor]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
*Surgical consultation is required with follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Desmoid tumor]] and [[mammary]] [[fibromatosis]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Desmoid tumor]] and [[mammary]] [[fibromatosis]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
*Surgical consultation is required with follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Pseudoangiomatous [[stromal]] [[hyperplasia]]:'''
| style="background:#DCDCDC;" align="center" + |'''Pseudoangiomatous [[stromal]] [[hyperplasia]]:'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
*In symptomatic and large lesions, surgical consultation is required with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]] follow-up.
|-
|-
| style="background:#DCDCDC;" align="center" + |'''[[Apocrine]] [[metaplasia]]'''
| style="background:#DCDCDC;" align="center" + |'''[[Apocrine]] [[metaplasia]]'''
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually.
*In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]] annually.
|}
|}


The final decision for excisional [[biopsy]] is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathologic findings which help to reach the best possible management for patient care.
The final decision for excisional [[biopsy]] is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathological findings which help to reach the best possible management for patient care.


==References==
==References==

Revision as of 16:24, 9 January 2019

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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]

Overview

Surgical management of breast lumps depends on the type of masses based on core-needle biopsy. Atypical ductal hyperplasia, atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ, flat epithelial atypia. Multiple, peripheral and atypic papillomas, large sclerosing adenosis and radical scar >10mm, atypic and enlargic fibroadenomas, desmoid tumor, mammary fibromatosis, phyllodes tumor, symptomatic and large pseudoangiomatous stromal hyperplasia requires surgical consultation and excision. The rest of breast lumps require observation and follow-up. The final decision for excisional biopsy is based on recommendations from pathologist, radiologist, and surgeons.

Surgery

Management of breast lumps after confirmation on the basis of core needle biopsy:[1]

Breast lump Surgical management
Atypical ductal hyperplasia
Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ
Flat epithelial atypia
Papillomas
Complex sclerosing lesion, radical scar
  • If the size < 10mm and adequately sampled: observation.
  • If the size > 10mm: surgical consultation is required.
  • If papilloma is excised: follow-up with annual clinical breast examination and mammography.
Fibroadenoma
  • If accompanied with atypia and enlarging size, surgical consultation is required.
  • Follow-up with annual clinical breast examination and mammography.
Complex fibroadenoma
Sclerosing adenosis
Fat necrosis
Columnar cell hyperplasia
Phyllodes tumor
Desmoid tumor and mammary fibromatosis
Pseudoangiomatous stromal hyperplasia:
Apocrine metaplasia

The final decision for excisional biopsy is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathological findings which help to reach the best possible management for patient care.

References

  1. 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.


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