Work-up of Palpable Breast Mass

1. Work-up of Palpable Breast Mass Courtney Riley Radiology August 28, 2007

2. Palpable Breast Mass in the Non-Pregnant Female • Examine patient • If mass is round, well defined and mobile: • <20 yo f/u in 2-6 wks with U/S if persists • 20-25yo f/u 2-6 wks with U/S +/- mammogram • >25yo cautiously f/u 2-6 wks with mammogram +/- U/S Courtesy of Dr. J Fulton

3. Palpable Breast Mass in Non-Pregnant Female • Hard, Fixed mass: • <20 yo → ultrasound • 20-25 yo → if negative family history and low suspicion cautious f/u in 2-6 weeks; if strong family history and high suspicion U/S +/- mammogram • >25 yo → mammogram + U/S → if cystic w/u complete; if complex cyst or solid mass → biopsy Courtesy of Dr. J Fulton

4. For cystic mass: Painful → aspirate Nontender → work up complete For complex cyst or solid mass: Biopsy Palpable Breast Mass in Pregnant Patient Ultrasound first Courtesy of Dr. J Fulton

5. Interpretation of Mammogram ~ Note any asymmetry between breast & density of tissue ~ Calcifications: - Normal with age → round, > 2mm in diameter, or calcifications in vessel walls - Suspicious → fine (<1mm) sandlike, microcalcifications ~ Note signs associated with malignancy: - Focal skin thickening or dimpling, unilateral nipple retraction, vascular asymmetry ~Compare findings to old films Mettler: Essentials of Radiology, 2nd ed.

6. Density

8. Non-palpable Mass Noted on Mammogram for Palpable Breast Mass

9. Spiculated Mass • Differential diagnosis for a spiculated mass visible on mammogram includes malignancy, post-surgical scar, radial scar, hematoma, or past trauma tothe breast.

10. Inflammatory Carcinoma

11. Traumatic Fat Necrosis

12. Solid vs. Cystic Mass on Ultrasound

13. Fibroadenoma

14. Compare with Old Films