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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Aug 13, 2020 12:40PM roller-coasterRide4me wrote:

Thank you Moderator, for your response. You hit it right...FRUSTRATING! Shocked

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Jan 1, 2021 09:52PM - edited Jan 5, 2021 04:56PM by Onlytimewilltell

This Post was deleted by Onlytimewilltell.
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Jan 2, 2021 09:47AM minustwo wrote:

Onlytime - I think you got good answers on the other thread where you posted.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Feb 26, 2021 10:04AM auratba wrote:

could someone tell me how a core needle biopsy is done ? really afraid of needles and scared it is going to hurt.

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Feb 26, 2021 10:18AM beesie.is.out-of-office wrote:

auratba, your same question about core needle biopsies in another thread has already been answered. See the answer here:

Topic: Waiting for biopsy. Bi-rads (4)
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Nov 1, 2021 07:07PM hollyattew wrote:

I’m a 23 y/o female and about 3 weeks ago I accidentally noticed that my right breast had become very tender and felt quite solid on the side closest to my armpit. I have visited my OBGYN who has sent me for an ultrasound (next week). I am very worried about breast cancer, however I have no family history of cancer. I have been taking birth control for six months, but i was also in a severe car accident 3 months ago where my airbag was deployed & my seatbelt severely retrained me. Could the birth control or the chest trauma from the accident have created these lumps? My breast is very solid in the exact area my seatbelt would have been, but I feel so many small lumps in this solid area as well as a larger rubbery lump. Any advise would be very helpful!!

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Nov 2, 2021 04:29AM - edited Nov 2, 2021 04:29AM by moderators

hollyattew - Welcome to Breastcancer.org! We know it can be scary, but benign breast changes at your age are pretty normal. It is very rare for a woman your age to be diagnosed with breast cancer. Anyway it is very important to discuss your concerns with your doctor and ask for an explanation that can help you to understand what is going on. And please, come back to let us know what you learn.

Best wishes,

From the Mods

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Nov 2, 2021 12:32PM salamandra wrote:

Hey Holly,

The body's healing process on the inside can be much more complex (and longer) that we can always see from the outside. I think it's absolutely plausible that your chest could still be healing from the seat belt trauma and that these bumps are related to it. But it's also really good that you're getting it checked out and that your doc is taking your symptoms and pain seriously. Whatever they are (and cancer is technically possible though seems like a less likely scenario) you want to know what they are. Birth control pills and hormones can also cause changes. It could be a combination of things also. The important thing is you're getting it checked out. But I absolutely wouldn't jump to cancer as the most likely suspect. Even in the beginning of this thread, the post states that the majority of lumps are NOT cancer.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/17/2018 Lumpectomy; Lymph node removal Hormonal Therapy 11/1/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 12/2/2018 Whole breast: Breast Hormonal Therapy 12/18/2019 Fareston (toremifene)

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