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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Oct 22, 2018 06:51PM lkpage wrote:

Will post once I get a copy of the report

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Oct 23, 2018 07:54AM djmammo wrote:

lkpage

In the meantime know that the negative predictive value of breast MRI is extremely high, and combined with a neg mammo and a neg US, is even higher.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Oct 23, 2018 10:30AM lkpage wrote:

Thank you, that is reassuring.

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Aug 16, 2019 02:59PM - edited Aug 16, 2019 03:20PM by Olliefitz

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Aug 16, 2019 03:01PM - edited Aug 16, 2019 03:01PM by Olliefitz

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Oct 31, 2019 01:12PM KayLuq wrote:

Hello. My first time here. I am not sure if I am posting correctly. Please advise if I am not. I am a 41 year old woman with a very extensive familial history of various cancers, including breast cancer. I had been noting for quite some time a lump in my left breast and to be honest I was terrified to have it looked at. After noting that it was growing and becoming visible to me, I did have a mammogram and then a biopsy. The mass was benign. This all took place in 2016. This year 2019 I noticed another palpable lump in the same breast and some what same area. I went in for a mammogram and the mass that I felt was detected on the mammogram. I was then ordered for more pics as there was something else visible. After the 2nd set of pics I was sent over for an ultrasound of what they found on the mammogram. I could also see it on the screen. I was told by a tech that this mass was a cyst and that all was well and I would be scheduled for a 6 mo follow up. However, that following week I was called and told that I needed to come in to see the doctor. with no real explanation why. So now I am going crazy with anxiety. Can anyone think of a reason why I would need to go back to see the doctor after being told it was a cyst? Thank you

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Oct 31, 2019 06:27PM MamaAvery wrote:

Kayluq- you should be able to call and ask why

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Nov 1, 2019 07:25AM emilynn wrote:

KayLuq you can also call to ask for a copy of the ultrasound report. Once you get it if it doesn't make it any easier to understand, you can post the report findings here and djmammo may have insight.

My guess would be that the ultrasound images were sent on to a radiologist who reviewed them and decided that there was something that may need to be followed up. Getting their report may give some insight as it will detail what they were seeing on the images.

Try not to panic. I am new to this, but so far every mammo and MRI I have had has needed follow up appointments...all for benign breast conditions. While it is nerve wrecking...it is best to try to relax and just wait until you actually know something. Until then, you can request documents and such...and write down all the questions you may have. I am terrible to not write things down and then forget at my appointments.

Best of luck!

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Aug 13, 2020 08:22AM roller-coasterRide4me wrote:

From October 2020 to the Present-STILL NO ANSWERS (so sorry...long post)

Hello...newby here. I have been on a roller coaster ride since October and still have no answers. Wanna ride with me? Summary of all the bumps below:

Summary of Mammary Concerns:

04/0 6/2019-Blunt trauma to chest with seat belt/airbag. (car accident) 4 fx ribs and dark purple, swollen, "hard as a rock" rt breast. Over time the bruises cleared and the hardness went away except for one lump. In October of 2019, I had a breast exam performed by Dr. Gray who ordered a Mammogram and Ultrasound. (She told me that she did not think the area was of serious concern, so she ordered a Screening Mammogram.) However, when I attempted to schedule this an order was obtained from my PCP for a Diagnostic Mammogram and Ultrasound.

IMPRESSION:

1. Right breast 10:00 4 cm from the nipple 2 cm hypoechoic shadowing region corresponding to that seen mammographically. This may represent sequelae from the patient's recent traumatic event, however, ultrasound guided core biopsy is recommended for definitive tissue diagnosis.

2. Palpable region of concern right 4:00 breast corresponds to a 1.3 cm heterogeneous hypoechoic oblong structure region suggestive of a resolving hematoma. Recommend a 3-4 month follow-up ultrasound to ensure stability. At that time, the other hypoechoic structures in the right breast should also be reassessed likely representing developing oil cysts/complicated cyst.

3. No definite suspicious sonographic findings in the scanned left retroareolar breast. Recommend left routine mammography in one year unless clinical symptoms dictate otherwise.

RECOMMEND: Ultrasound-guided core biopsy right breast 10:00

10/28/2019-Biopsy Report- Granulomatous inflammation and fibrosis. No malignancy seen. BI-RADS Category 3 Probably Benign Finding

04/20/2020-Irregular mass corresponding to a previous benign biopsy site, may be concordant with Granulomatous Mastitis, lobular carcinoma cannot be excluded.

04/29/2020-Breast Surgical Consult: Dr-didn't believe it is Granulomatous Mastitis, didn't believe another biopsy was necessary, said there isn't anything on the Ultrasound of 04/20 that she is "worried about" but suggested an MRI to get a closer look at a "dark" area on the Ultrasound. She said she didn't see that there was "blood flow" in that area, "which is a good thing." (her words)

The MRI was done on 05/14/2020

05/20/2020- Breast Surgeon Dr. called me to discuss the MRI. Now she is saying possibly Granulomatous Mastitis, there might be activity indicating "blood flow". (I have absolutely NO SYMTOMS of Granulomatous Mastitis)

MRI Report: Summary/Impression

There is no axillary or internal mammary lymphadenopathy on either side. There is no skin thickening or tethering and the nipples are not inverted.

IMPRESSION: 3 areas in the right breast with suspicious imaging characteristics. Unfortunately differentiating carcinoma from fat necrosis cannot be made based on MR imaging as their appearances can be indistinguishable.

BI-RADS Category 4 suspicious findings.

She STRONGLY recommends an MRI Guided Biopsy. I told her I needed to think about it. She did not like that answer and I felt "pressed" to schedule it. I told her I was not sure and wanted to think about it. She said she didn't want her staff to waste hours of time to get this all arranged and then I decide I don't want to have it done. She said her staff would call me on Friday the 22nd for my decision. When I asked her what she thought this could be, she said she has no idea. I have not heard from her office again.

I have decided NOT to have another MRI, first of all being in the prone position was very uncomfortable for me (pressure on area of fx ribs) and it was difficult for me to breath. If another biopsy is really necessary, I will agree to an Ultrasound Guided Biopsy.

I requested and was granted a 2nd opinion Breast Surgeon of my choice

*To date: I have not seen any change whatsoever in my right breast. I can palpate several "lumps". One of them the first Breast Surgeon consulted has labeled in the diagram on her written report: Fat Necrosis

*Before I obtained the above report, I had asked Breast Surgeon #1 if the "suspicious areas" could be Fat Necrosis and she said emphatically…"oh, no! Not after all this time. (I looked it up and found that after traumatic injury, sometimes Fat Necrosis can become evident a year or more later.) hmm…why, despite her denial, did she label one of them Fat Necrosis???? I will not return to her!

07/23/2020-Consultation with Breast Surgeon #2. She believes this all could be Fat Necrosis, from the trauma but suggests a 2nd Look Ultrasound to try to pin-point the areas of "suspicion" from the MRI with possibly an Ultrasound Guided Biopsy in the future depending on the results of the Ultrasound. Sounded like a reasonable plan.

08/10/2020-2nd Look Ultrasound done. The radiologist said the Ultrasound was unable to "get close enough" to the 3 suspicious areas seen on the MRI. Her recommendation was to have an MRI-guided Biopsy but to discuss this with the Breast Surgeon on 08/13/2020.


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Aug 13, 2020 10:40AM moderators wrote:

Dear roller-coasterRide4me,

We are sorry you are going through all of this. We are glad that you reached out to our members. It looks like you have an appointment today. Here is a link to some resources that pertain to Imaging Questions. Our volunteer radiologist djmammo ofter responds to these kinds of posts but he is currently on a leave from us. This particular topic has not seen activity in recent months. Once you get more information perhaps you can start a new topic in this forum and pose some questions to our members about next steps. Let us know if we can be of further help. Sounds frustrating.

The Mods

To send a PM to the Mods: community.breastcancer.org/my/...

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