Clinical manifestations and diagnosis of a palpable breast mass
- Michael S Sabel, MD
Michael S Sabel, MD
- Associate Professor of Surgery
- University of Michigan Medical School
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Evaluation of a palpable breast mass requires a systematic approach to the history, physical examination, and radiographic imaging studies to ensure a correct diagnosis. A missed diagnosis of breast cancer is one of the most frequent causes of malpractice claims in the United States [1-3].
The clinical manifestations and diagnostic evaluation of women with a palpable breast mass are reviewed here. Screening and epidemiology of breast cancer, benign breast disease, breast pain, nipple discharge, breast cysts, and breast cancer are reviewed separately.
●(See "Breast pain".)
- Physician Insurers Association of America. Breast cancer study, 3rd edition, Physician Insurers Association of America, Rockville 2002. http://www.neomatrix.com/pdfs/PIAAStudy.pdf (Accessed on January 11, 2012).
- Singh H, Sethi S, Raber M, Petersen LA. Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol 2007; 25:5009.
- Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 2006; 145:488.
- Morrow M. The evaluation of common breast problems. Am Fam Physician 2000; 61:2371.
- Cady, B, Steele, GD, Morrow, M, et al. Evaluation of Common Breast Problems: A Primer for Primary Care Providers; prepared by the Society of Surgical Oncology and the Commission on Cancer of the American College of Surgeons for the Centers for Disease Control and Prevention, Publication no. 633-001/20900, US Department of Health and Human Services, 1998. www.utmb.edu/Surgery/clerks/primer.htm (Accessed on August 08, 2008).
- Santen RJ, Mansel R. Benign breast disorders. N Engl J Med 2005; 353:275.
- Morrow M, Wong S, Venta L. The evaluation of breast masses in women younger than forty years of age. Surgery 1998; 124:634.
- The palpable breast lump: information and recommendations to assist decision-making when a breast lump is detected. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Association of Radiation Oncologists. CMAJ 1998; 158 Suppl 3:S3.
- Rimsten A, Stenkvist B, Johanson H, Lindgren A. The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions: report on a prospective study in 1244 women with symptoms. Ann Surg 1975; 182:1.
- van Dam PA, Van Goethem ML, Kersschot E, et al. Palpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions. Radiology 1988; 166:435.
- Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 1999; 282:1270.
- Morrow, M. Physical examination of the breast. In: Breast diseases, 3rd edition, Harris, JR, et al (Eds), Lippincott, Williams, and Wilkins, Philadelphia 2004. p.29.
- Saunders KJ, Pilgrim CA, Pennypacker HS. Increased proficiency of search in breast self-examination. Cancer 1986; 58:2531.
- Hall DC, Goldstein MK, Stein GH. Progress in manual breast examination. Cancer 1977; 40:364.
- Moy L, Slanetz PJ, Moore R, et al. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review. Radiology 2002; 225:176.
- Wang LE, Han CH, Xiong P, et al. Gamma-ray-induced mutagen sensitivity and risk of sporadic breast cancer in young women: a case-control study. Breast Cancer Res Treat 2012; 132:1147.
- Orel S. Who should have breast magnetic resonance imaging evaluation? J Clin Oncol 2008; 26:703.
- Clarke D, Sudhakaran N, Gateley CA. Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer. Ann R Coll Surg Engl 2001; 83:110.
- Johnson JM, Johnson AK, O'Meara ES, et al. Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology 2015; 275:54.
- Salkowski LR, Fowler AM, Burnside ES, Sisney GA. Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology 2011; 258:380.
- Shaylor SD, Heller SL, Melsaether AN, et al. Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy--is it worthwhile? Eur Radiol 2014; 24:1176.
- Klein S. Evaluation of palpable breast masses. Am Fam Physician 2005; 71:1731.
- Schoonjans JM, Brem RF. Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 2001; 20:967.
- Elmore JG, Barton MB, Moceri VM, et al. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med 1998; 338:1089.
- de Blacam C, Momoh AO, Colakoglu S, et al. Evaluation of clinical outcomes and aesthetic results after autologous fat grafting for contour deformities of the reconstructed breast. Plast Reconstr Surg 2011; 128:411e.
- Erguvan-Dogan B, Yang WT. Direct injection of paraffin into the breast: mammographic, sonographic, and MRI features of early complications. AJR Am J Roentgenol 2006; 186:888.
- Majedah S, Alhabshi I, Salim S. Granulomatous reaction secondary to intramammary silicone injection. BMJ Case Rep 2013; 2013.
- Lewin R, Göransson M, Elander A, et al. Risk factors for complications after breast reduction surgery. J Plast Surg Hand Surg 2014; 48:10.
- Wagner IJ, Tong WM, Halvorson EG. A classification system for fat necrosis in autologous breast reconstruction. Ann Plast Surg 2013; 70:553.
- Meric F, Buchholz TA, Mirza NQ, et al. Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol 2002; 9:543.
- Piroth MD, Fischedick K, Wein B, et al. Fat necrosis and parenchymal scarring after breast-conserving surgery and radiotherapy with an intraoperative electron or fractionated, percutaneous boost: a retrospective comparison. Breast Cancer 2014; 21:409.
- CLINICAL FEATURES
- Clinical manifestations
- - Clinical presentation
- - Physical examination
- Imaging studies
- Presenting symptoms
- Risk factors for the development of breast cancer
- Physical examination
- - Inspection
- - Palpation
- - Documentation
- Diagnostic imaging
- - Mammography
- - Ultrasonography
- - MRI
- DIFFERENTIAL DIAGNOSIS
- RADIOGRAPHICALLY IDENTIFIED MASSES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS