Palpable Breast Masses
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. "
Comments
-
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.
0 -
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.
0 -
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.
0 -
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.
0 -
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
0 -
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!
0 -
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.
0 -
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!
0 -
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?
0 -
Will post once I get a copy of the report
0 -
Thank you, that is reassuring.
0 -
I am 34 years old and 3 months post partum and breastfeeding my baby. I noticed a lump in my right breast a few weeks after she was born and assumed it was a clogged duct. Fast forward to this week and I noticed the lump was still there. I made an appointment with my ob who ordered me to go for Ann ultrasound next week. It feels hard and I can’t tell if it isn’t moveable and close to the skin. Would love some words of wisdom!
0 -
I am 34 years old and 3 months post partum and breastfeeding my baby. I noticed a lump in my right breast a few weeks after she was born and assumed it was a clogged duct. Fast forward to this week and I noticed the lump was still there. I made an appointment with my ob who ordered me to go for Ann ultrasound next week. It feels hard and I can't tell if it isn't moveable and close to the skin. Would love some words of wisdom!
0 -
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
0 -
Kayluq- you should be able to call and ask why
0 -
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!
0 -
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.
0 -
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
0 -
Thank you Moderator, for your response. You hit it right...FRUSTRATING!
0 -
I don’t want to make a mountain out of a mile hole. My mom was first diagnosed with breast cancer at 24 and then again at 29, however she does not have the genetic markers. Recently, I found a large hard lump on my right breast. I went to my OB who sent me for an ultrasound and the radiologist is calling it a complex cyst with a birad of 3 and ordered me to have a rescan in 3 months. My mom wants me to get a second opinion ASAP but I don’t want to make such a big deal out of something that could be nothing. Any opinions on what you would do
0 -
Onlytime - I think you got good answers on the other thread where you posted.
0 -
could someone tell me how a core needle biopsy is done ? really afraid of needles and scared it is going to hurt.
0 -
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)
0 -
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!!
0 -
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
0 -
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.
0
