Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Clinical manifestations and diagnosis of a palpable breast mass

Michael S Sabel, MD
Section Editor
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD


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 "Screening for breast cancer: Strategies and recommendations".)

(See "Overview of benign breast disease".)

(See "Breast pain".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Apr 24, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. 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).
  2. Singh H, Sethi S, Raber M, Petersen LA. Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol 2007; 25:5009.
  3. 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.
  4. Morrow M. The evaluation of common breast problems. Am Fam Physician 2000; 61:2371.
  5. 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).
  6. Santen RJ, Mansel R. Benign breast disorders. N Engl J Med 2005; 353:275.
  7. Morrow M, Wong S, Venta L. The evaluation of breast masses in women younger than forty years of age. Surgery 1998; 124:634.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. Saunders KJ, Pilgrim CA, Pennypacker HS. Increased proficiency of search in breast self-examination. Cancer 1986; 58:2531.
  14. Hall DC, Goldstein MK, Stein GH. Progress in manual breast examination. Cancer 1977; 40:364.
  15. 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.
  16. 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.
  17. Orel S. Who should have breast magnetic resonance imaging evaluation? J Clin Oncol 2008; 26:703.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. Klein S. Evaluation of palpable breast masses. Am Fam Physician 2005; 71:1731.
  23. Schoonjans JM, Brem RF. Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 2001; 20:967.
  24. 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.
  25. 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.
  26. 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.
  27. Majedah S, Alhabshi I, Salim S. Granulomatous reaction secondary to intramammary silicone injection. BMJ Case Rep 2013; 2013.
  28. Lewin R, Göransson M, Elander A, et al. Risk factors for complications after breast reduction surgery. J Plast Surg Hand Surg 2014; 48:10.
  29. Wagner IJ, Tong WM, Halvorson EG. A classification system for fat necrosis in autologous breast reconstruction. Ann Plast Surg 2013; 70:553.
  30. Meric F, Buchholz TA, Mirza NQ, et al. Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol 2002; 9:543.
  31. 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.