7.2: Palpable Breast Mass
- Page ID
- 14820
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)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.
Breast/Axillary Ultrasound
ODIN Link for Images 7.5A and B: mistr.usask.ca/odin/?caseID=20150707195257929
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.