Topic: Palpable Breast Masses

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Jul 30, 2017 04:24AM

Posted on: Jul 30, 2017 04:24AM

djmammo wrote:

from the American College of Radiology

"Breast cancer is the most common female malignancy and the second leading cause of female cancer death in the United States. It is estimated that 249,260 new cases of breast cancer will be diagnosed in 2016 [1]. Although the majority of palpable lumps are benign, a new palpable breast mass is a common presenting sign of breast cancer.

A palpable breast mass may become evident during breast self-examination or clinical breast examination. Breast cancer may present as a palpable mass in women not undergoing regular screening mammography because of young or advanced age or personal choice. Breast cancer may also present as a palpable mass in between mammographic screens (interval cancer).

In general, cancers detected symptomatically tend to be more aggressive than screen-detected cancers and to have a poorer prognosis [2-5]. Determining if a mass is present by physical examination can be difficult, as all breasts have variable combinations of glandular tissue, fibrosis, and fat. True masses are generally asymmetrical in relation to the other breast, distinct from the surrounding tissues, and three-dimensional. A typical cancer may be firm, have indistinct borders, and have attachments to the skin or deep fascia with dimpling or nipple retraction.Palpable breast thickening, defined as greater firmness of an area of the breast compared with the other breast or other quadrants of the same breast, may also be associated with breast cancer in about 5% of women.

Benign masses typically are mobile and have discrete, well-defined margins and a soft or rubbery texture. Cysts cannot reliably be distinguished from solid breast masses by palpation. In 1 study, only 58% of 66 palpable cysts were correctly identified by physical examination [7]. Significant disagreement among experienced examiners may occur. In another study, 4 surgeons performed physical examinations independently and agreed on the need for biopsy of only 73% of 15 masses subsequently proven malignant.

Because many breast masses may not exhibit distinctive physical findings, imaging evaluation is necessary in almost all cases to characterize the palpable lesion. Any woman presenting with a palpable lesion should have a thorough clinical breast examination, usually by the referring clinician or by a specialist breast clinician, but the radiologist must also be able to establish concordance between an imaging finding and a clinically detected mass

When a suspicious finding is identified, image-guided biopsy is indicated. It is preferable for imaging to occur before biopsy, as changes related to the biopsy may confuse, alter, obscure, and/or limit image interpretation.

The negative predictive value of mammography with ultrasound (US) in the context of a palpable mass ranges from 97.4% to 100%.

Nevertheless, negative imaging evaluation should never overrule a strongly suspicious finding on physical examination or vice versa. Any highly suspicious breast mass detected by imaging or palpation should undergo biopsy unless there are exceptional clinical circumstances such as the patient having significant comorbid factors.

Overview of Imaging Modalities Recommended imaging options in the context of a palpable mass include diagnostic mammography and targeted breast US and are dependent on patient age and degree of radiologic suspicion.

There is little role for advanced technologies such as magnetic resonance imaging (MRI), positron emission mammography with fluorine-18-2- fluoro-2-deoxy-D-glucose (FDG-PEM), or Tc-99m sestamibi molecular breast imaging (MBI) in the evaluation of a palpable mass. "

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 14, 2018 11:25AM MKBRENNEN wrote:

I found a lump in my right breast last year and was sent or an ultra sound of it they Dr. stated it was a fat Lobule, and that is was benign, but they would watch it and make sure to get my annual mammograms, I also have dense breast tissue. I have noticed this lobule has gotten bigger and now hurts. I'm worried about it! Can I ask for a biopsy? I want to be certain.

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Feb 14, 2018 11:36AM Outfield wrote:

MKBRENNAN, you can always ask for something, but it ultimately will be the doctor's decision whether or not they think the risk that your lump is something serious is enough to do a biopsy. Biopsies themselves carry some risk (albeit very small), and they also utilize limited resources (mainly time). That second may seem crass, but it truly is a concern. There would not be resources to biopsy every single lump, and if all lumps were biopsied, including all those that really looked/felt benign, there would be net harm.

But that says nothing about your lump in particular, only that the asking won't necessarily lead to a biopsy - it will lead to a thought process. If you are concerned, that's good enough reason to ask, and if they say "no" just ask for an explanation and make sure it's one that satisfies you.

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Feb 14, 2018 11:37AM veeder14 wrote:

You could request an MRI as that shows more detail. My cancer would never have been found until it was large if I hadn't had an MRI. Mammograms seem to not show much for people with dense breasts until the lumps are large.

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 3/7/2018 Hormonal Therapy 2/28/2019 Hormonal Therapy
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Feb 14, 2018 02:12PM djmammo wrote:

MKBRENNEN

Since you have noticed a clinical change in the lump, ask to have it scanned again to see if there is a change in either size that can be measured, or if its appearance has changed when compared to prior. If they find either of these to be true, they would probably suggest a biopsy themselves. If there has been no change in either, you may have a tough time convincing them to biopsy it. You could ask for an MRI but ins may not pay for it unless the next US report recommends it. Let us know how it goes.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Apr 5, 2018 10:57AM zephyr35 wrote:

Hi there, I am 35 years old and felt a pea sized mass in my right breast at the 9 o’clock position. My GP has ordered an U/S and mammogram. It’s 8 days away and I am worried sick. I have myself convinced it’s breast cancer. The waiting process has me sick and thinking I have more symptoms. The lump-is hard and rubbery and doesn’t elicit pain when palpated. Anyone else experience this and get good results? Also how long can I expect to wait for results

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Apr 5, 2018 11:14AM kbeee wrote:

Zephyr, sorry you are dealing with this worry. You might start a new thread, which would get you more responses. Hoping all comes back benign!

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 8/25/2013 Mastectomy; Mastectomy (Left); Mastectomy (Right) Chemotherapy 9/19/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/11/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/22/2014 Reconstruction (Left); Reconstruction (Right) Surgery 1/28/2015 Lumpectomy; Lumpectomy (Right) Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- Surgery 2/24/2015 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel, Underarm/Axillary Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- Chemotherapy 3/30/2015 AC + T (Taxol) Radiation Therapy 8/24/2015 Whole breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Apr 5, 2018 11:25AM bravepoint wrote:

Zephyr - After my U/S and mammogram, a radiologist came and spoke to me right away. He told me that I needed a biopsy of the lump. Quick resuts in terms of next steps but then of course I had to wait another week and a half for the biopsy and then another week for the results of that.

Gail Radiation Therapy 4/17/2016 Whole breast: Breast, Lymph nodes, Chest wall Dx 8/8/2016, IDC, Right, 1cm, Stage IIA, Grade 3, 1/5 nodes, ER+/PR-, HER2- Surgery 8/28/2016 Chemotherapy 10/6/2016 AC + T (Taxol)
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Apr 5, 2018 12:06PM - edited Apr 5, 2018 12:10PM by Lexica

The negative predictive value of mammography with ultrasound (US) in the context of a palpable mass ranges from 97.4% to 100%.

Wow. This was me. Not only am I in the 5% that get breast cancer under 40, I am now also in the 2.6% that had a negative US and Mammo for a palpable lump that (8 months later) was biopsied and malignant. I'm not accepting the 'that's really rare' excuse any more. Wonder if this was influenced by dense breast tissue?

zephyr - you should be able to speak with the radiologist (or at least get the report) the day of your scans. hoping the best for you!

Diagnosed at 34. 2 years of Ibrance via PALLAS trial (ends 4/2020) Dx 7/2017, IDC, Left, Stage IIIC, Grade 2, ER+/PR+, HER2-, Surgery 12/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right Dx 12/27/2017, DCIS/IDC, Left, 6cm+, Stage IIIA, Grade 3, 5/11 nodes, ER+/PR+, HER2-, Radiation Therapy 1/15/2018 Whole breast: Breast, Lymph nodes, Chest wall Chemotherapy AC + T (Taxol) Hormonal Therapy Aromasin (exemestane)
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Oct 22, 2018 09:39AM lkpage wrote:

I recently found a small lump in my right breast following several days of nipple sensitivity, swelling, and clear fluid discharge. I also noticed a lymph node in my right armpit that seemed larger. I have since had a mammogram and ultrasound which revealed nothing, but did state that I have dense breast tissue. I was referred to a general surgeon who sent me to have an mri with and w/o contrast. I was told the lump looked similar to scans from two years ago and was likely just a lymph node and probably nothing to worry about. I have an appointment to go back in three months but I'm concerned that I should seek out a second opinion from a breast specialist. I have read about false positive mri but not a lot about false negative. Should I seek out a specialist or wait and watch?

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Oct 22, 2018 11:19AM djmammo wrote:

lkpage

Can you post the MRI report?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

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