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==Surgery==
==Surgery==
Management of breast lumps after confirmation on the basis of core needle biopsy:<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>
Management of breast lumps after confirmation on the basis of core needle biopsy:<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>
*'''Atypical ductal [[hyperplasia]]:'''
 
**Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
{|
*'''Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]:'''
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Breast lump
**Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Surgical management
*'''Flat [[epithelial]] [[atypia]]:'''
|-
**Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
| style="background:#DCDCDC;" align="center" + |'''Atypical ductal [[hyperplasia]]'''
*'''[[Papillomas]]:'''
| 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.
*Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
*'''Complex sclerosing lesion, radical scar:'''
|-
**If the size < 10mm and adequately sampled: observation.
| style="background:#DCDCDC;" align="center" + |'''Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]'''
**If the size > 10mm: surgical consultation is required.
| style="background:#F5F5F5;" + |
**If papilloma is excised: follow-up with annual clinical breast examination and mammography.
*Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
*'''[[Fibroadenoma]]:'''
|-
**If accompanied with atypia and enlarging size, surgical consultation is required.
| style="background:#DCDCDC;" align="center" + |'''Flat [[epithelial]] [[atypia]]'''
**Follow-up with annual clinical breast examination and mammography.
| style="background:#F5F5F5;" + |
*'''Complex [[fibroadenoma]]:'''
*Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
**Observation and follow-up with clinical breast examination and mammography, annually.
|-
*'''[[Sclerosing adenosis]]:'''
| style="background:#DCDCDC;" align="center" + |'''[[Papillomas]]'''
**Observation and follow-up with clinical breast examination and mammography, annually.
| style="background:#F5F5F5;" + |
*'''[[Fat necrosis]]:'''
*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.
**Observation and follow-up with clinical breast examination and mammography, annually.
|-
*'''Columnar [[cell]] [[hyperplasia]]:'''
| style="background:#DCDCDC;" align="center" + |'''Complex sclerosing lesion, radical scar'''
**Observation and follow-up with clinical breast examination and mammography, annually.
| style="background:#F5F5F5;" + |
*'''[[Phyllodes tumor]]:'''
*If the size < 10mm and adequately sampled: observation.
**Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
*If the size > 10mm: surgical consultation is required.
*'''[[Desmoid tumor]] and [[mammary]] [[fibromatosis]]:'''
*If papilloma is excised: follow-up with annual clinical breast examination and mammography.
**Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
|-
*'''Pseudoangiomatous [[stromal]] [[hyperplasia]]:'''
| style="background:#DCDCDC;" align="center" + |'''[[Fibroadenoma]]'''
**In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
| style="background:#F5F5F5;" + |
*'''[[Apocrine]] [[metaplasia]]:'''
*If accompanied with atypia and enlarging size, surgical consultation is required.
**In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually.
*Follow-up with annual clinical breast examination and mammography.
|-
| style="background:#DCDCDC;" align="center" + |'''Complex [[fibroadenoma]]'''
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
|-
| style="background:#DCDCDC;" align="center" + |'''[[Sclerosing adenosis]]'''
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
|-
| style="background:#DCDCDC;" align="center" + |'''[[Fat necrosis]]'''
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
|-
| style="background:#DCDCDC;" align="center" + |'''Columnar [[cell]] [[hyperplasia]]'''
| style="background:#F5F5F5;" + |
*Observation and follow-up with clinical breast examination and mammography, annually.
|-
| style="background:#DCDCDC;" align="center" + |'''[[Phyllodes tumor]]'''
| style="background:#F5F5F5;" + |
*Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
|-
| style="background:#DCDCDC;" align="center" + |'''[[Desmoid tumor]] and [[mammary]] [[fibromatosis]]'''
| style="background:#F5F5F5;" + |
*Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
|-
| style="background:#DCDCDC;" align="center" + |'''Pseudoangiomatous [[stromal]] [[hyperplasia]]:'''
| style="background:#F5F5F5;" + |
*In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
|-
| style="background:#DCDCDC;" align="center" + |'''[[Apocrine]] [[metaplasia]]'''
| 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.
|}


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 pathologic findings which help to reach the best possible management for patient care.

Revision as of 16:19, 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
  • Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ
  • Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Flat epithelial atypia
  • Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Papillomas
  • 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.
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
  • Observation and follow-up with clinical breast examination and mammography, annually.
Sclerosing adenosis
  • Observation and follow-up with clinical breast examination and mammography, annually.
Fat necrosis
  • Observation and follow-up with clinical breast examination and mammography, annually.
Columnar cell hyperplasia
  • Observation and follow-up with clinical breast examination and mammography, annually.
Phyllodes tumor
  • Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
Desmoid tumor and mammary fibromatosis
  • Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
Pseudoangiomatous stromal hyperplasia:
  • In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
Apocrine metaplasia
  • In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with 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.

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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