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7.2: Palpable Breast Mass

  • Page ID
    14820
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    ACR – Palpable Breast Mass

    Case: Palpable Breast Mass

    Clinical:

    • History: This 51 year old, female, patient discovered a left breast lump while in the shower. It was not present on her last physical examination one year ago. She had a family history of breast cancer in her maternal grandmother and her maternal aunt.
    • Symptoms: She felt a lump in the left breast above the nipple.
    • Signs: No evidence of skin thickening or nipple retraction. A hard, but slightly mobile, tumor was felt with lobulated margins. No lymph nodes palpable.

    DDx:

    • Variant of anatomy
    • Benign breast tumor – cyst, fibroadenoma, fibrocystic change, fat necrosis, radial scar, abscess.
    • Malignant breast tumor
    • Metastatic disease to the breast

    Imaging Recommendation

    Palpable breast mass, Woman 40 year of age, or older, initial evaluation, Variant 1.

    Mammography

    The evaluation of a palpable abnormality most often begins with mammography and/or breast tomosynthesis. Imaging analysis of the lesion features will lead to a recommendation for further management based upon the ACR, Breast Imaging Reporting and Data System (BI-RADS).

    If mammography is suspicious for malignancy the next examination would usually be an ultrasound of the mass and the ipsilateral axilla.

    ACR Recommendation for Palpable breast mass. Woman 40 years of age, or older. Mammography findings suspicious for malignancy. Next examination to perform. Variant 2

    Breast/Axillary Ultrasound

    ODIN Link for Images 7.5A and B: mistr.usask.ca/odin/?caseID=20150707195257929

    breast-case-1-3-1.jpg
    Figure 7.5A Mammography image of a breast mass.
    breast-case-1-4-1024x687.jpg
    Figure 7.5B Ultrasound image of a breast mass.

    Imaging Assessment

    Findings:

    Left Mammography

    There was a 1.5 – 2 cm lobulated, spiculated, mass, with minimal architectural distortion, in the left breast at the 2 o’clock location roughly 2.5 – 3 cm cranial to the nipple. The mass does not efface with targeted, focal compression, imaging. Ultrasound of the breast was recommended. No skin abnormalities identified.

    Left Breast Ultrasound

    A lobulated, spiculated, mass was detected 2 cm from the nipple at the 2 o’clock location. It was taller than wide and demonstrated acoustic shadowing. No satellite lesions seen. The left axillary images were normal.

    Interpretation:

    The mass in the left breast had malignant features on mammography and breast ultrasound.

    BI-RADS 5, high suspicion for malignancy, tissue diagnosis was recommended.

    Diagnosis:

    Breast mass with malignant features

    Pathology:

    Ultrasound Guided Core Biopsy of the mass was performed.

    Invasive Ductal Carcinoma was diagnosed on microscopic assessment.

    Discussion:

    Breast cancer is the most common female malignancy and the second leading cause of female cancer death. Between 20,000 – 25,000 new cases of breast cancer will be diagnosed in Canada a year. Most palpable breast lumps are benign, but a new palpable breast mass is a common presenting sign of breast cancer. These masses may be detected by patient self-examination or during a physical examination carried out by a health professional.

    Mammographic findings may include:

    • Atypical breast calcification(s)
    • Visible soft tissue mass(es)
    • Tissue architectural distortion
    • Skin thickening
    • Skin retraction
    • Nipple retraction
    • Asymmetry in breast size

    Attributions

    Figure 7.5A Mammography image of a breast mass by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.

    Figure 7.5B Ultrasound image of a breast mass by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.


    This page titled 7.2: Palpable Breast Mass is shared under a CC BY-NC-SA 4.0 license and was authored, remixed, and/or curated by Brent Burbridge and Evan Mah via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request.