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Palpable Lump or Thickening
Regina J. Hooley, MD; Wendie A. Berg, MD, PhD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Clinically firm mass or area of breast different from surrounding tissue, noted by patient, healthcare provider [clinical breast exam (CBE)], partner, or other
            • CBE: Optional formal physical examination of breasts by qualified practitioner, usually annually or biennially
            • Distinguish interval palpable cancers detected after prior negative screening mammogram, but before next recommended screen (e.g., 1-2 years) from those never or infrequently screened

          IMAGING

          • Mammographic Findings

            • Ultrasonographic Findings

              • Imaging Recommendations

                • Image-Guided Biopsy

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Brennan SB et al: Positive predictive value of biopsy of palpable masses following mastectomy. Breast J. 24(5):789-797, 2018
                                    2. Brown AL et al: Clinical value of mammography in the evaluation of palpable breast lumps in women 30 years old and older. AJR Am J Roentgenol. 1-8, 2017
                                    3. Moy L et al: ACR Appropriateness Criteria® Palpable Breast Masses. J Am Coll Radiol. 14(5S):S203-S224, 2017
                                    4. Leung SE et al: New palpable breast lump with recent negative mammogram: Is repeat mammography necessary? AJR Am J Roentgenol. 207(1):200-4, 2016
                                    5. Ha R et al: Ultrasonographic features and clinical implications of benign palpable breast lesions in young women. Ultrasonography. 34(1):66-70, 2015
                                    6. Lehman CD et al: Imaging management of palpable breast abnormalities. AJR Am J Roentgenol. 203(5):1142-53, 2014
                                    7. Vanier A et al: Are prognostic factors more favorable for breast cancer detected by organized screening than by opportunistic screening or clinical diagnosis? A study in Loire-Atlantique (France). Cancer Epidemiol. 37(5):683-7, 2013
                                    8. Giess CS et al: Risk of malignancy in palpable solid breast masses considered probably benign or low suspicion: implications for management. J Ultrasound Med. 31(12):1943-9, 2012
                                    9. Gumus H et al: Clinically palpable breast abnormalities with normal imaging: is clinically guided biopsy still required? Clin Radiol. 67(5):437-40, 2012
                                    10. Lehman CD et al: Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012
                                    11. Ma I et al: Clinical and self breast examination remain important in the era of modern screening. Ann Surg Oncol. 19(5):1484-90, 2012
                                    12. Malmgren JA et al: Impact of mammography detection on the course of breast cancer in women aged 40-49 years. Radiology. 262(3):797-806, 2012
                                    13. Roth MY et al: Self-detection remains a key method of breast cancer detection for U.S. women. J Womens Health (Larchmt). 20(8):1135-9, 2011
                                    14. Haakinson DJ et al: A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J Surg. 200(6):712-7; discussion 717-8, 2010
                                    15. Loving VA et al: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 195(6):1472-7, 2010
                                    16. Mathis KL et al: Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 210(3):314-8, 2010
                                    17. Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
                                    18. Sihto H et al: Molecular subtypes of breast cancers detected in mammography screening and outside of screening. Clin Cancer Res. 14(13):4103-10, 2008
                                    19. Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
                                    20. Bancej C et al: Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen. 10(1):16-21, 2003
                                    21. Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
                                    22. Kösters JP et al: Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. (2):CD003373, 2003
                                    23. Kaiser JS et al: Palpable breast thickening: role of mammography and US in cancer detection. Radiology. 223(3):839-44, 2002
                                    24. Barton MB et al: Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med. 130(8):651-7, 1999
                                    25. Porter PL et al: Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 91(23):2020-8, 1999
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Definitions

                                              • Clinically firm mass or area of breast different from surrounding tissue, noted by patient, healthcare provider [clinical breast exam (CBE)], partner, or other
                                              • CBE: Optional formal physical examination of breasts by qualified practitioner, usually annually or biennially
                                              • Distinguish interval palpable cancers detected after prior negative screening mammogram, but before next recommended screen (e.g., 1-2 years) from those never or infrequently screened

                                            IMAGING

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  • Image-Guided Biopsy

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • Staging, Grading, & Classification

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Brennan SB et al: Positive predictive value of biopsy of palpable masses following mastectomy. Breast J. 24(5):789-797, 2018
                                                                      2. Brown AL et al: Clinical value of mammography in the evaluation of palpable breast lumps in women 30 years old and older. AJR Am J Roentgenol. 1-8, 2017
                                                                      3. Moy L et al: ACR Appropriateness Criteria® Palpable Breast Masses. J Am Coll Radiol. 14(5S):S203-S224, 2017
                                                                      4. Leung SE et al: New palpable breast lump with recent negative mammogram: Is repeat mammography necessary? AJR Am J Roentgenol. 207(1):200-4, 2016
                                                                      5. Ha R et al: Ultrasonographic features and clinical implications of benign palpable breast lesions in young women. Ultrasonography. 34(1):66-70, 2015
                                                                      6. Lehman CD et al: Imaging management of palpable breast abnormalities. AJR Am J Roentgenol. 203(5):1142-53, 2014
                                                                      7. Vanier A et al: Are prognostic factors more favorable for breast cancer detected by organized screening than by opportunistic screening or clinical diagnosis? A study in Loire-Atlantique (France). Cancer Epidemiol. 37(5):683-7, 2013
                                                                      8. Giess CS et al: Risk of malignancy in palpable solid breast masses considered probably benign or low suspicion: implications for management. J Ultrasound Med. 31(12):1943-9, 2012
                                                                      9. Gumus H et al: Clinically palpable breast abnormalities with normal imaging: is clinically guided biopsy still required? Clin Radiol. 67(5):437-40, 2012
                                                                      10. Lehman CD et al: Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012
                                                                      11. Ma I et al: Clinical and self breast examination remain important in the era of modern screening. Ann Surg Oncol. 19(5):1484-90, 2012
                                                                      12. Malmgren JA et al: Impact of mammography detection on the course of breast cancer in women aged 40-49 years. Radiology. 262(3):797-806, 2012
                                                                      13. Roth MY et al: Self-detection remains a key method of breast cancer detection for U.S. women. J Womens Health (Larchmt). 20(8):1135-9, 2011
                                                                      14. Haakinson DJ et al: A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J Surg. 200(6):712-7; discussion 717-8, 2010
                                                                      15. Loving VA et al: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 195(6):1472-7, 2010
                                                                      16. Mathis KL et al: Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 210(3):314-8, 2010
                                                                      17. Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
                                                                      18. Sihto H et al: Molecular subtypes of breast cancers detected in mammography screening and outside of screening. Clin Cancer Res. 14(13):4103-10, 2008
                                                                      19. Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
                                                                      20. Bancej C et al: Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen. 10(1):16-21, 2003
                                                                      21. Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
                                                                      22. Kösters JP et al: Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. (2):CD003373, 2003
                                                                      23. Kaiser JS et al: Palpable breast thickening: role of mammography and US in cancer detection. Radiology. 223(3):839-44, 2002
                                                                      24. Barton MB et al: Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med. 130(8):651-7, 1999
                                                                      25. Porter PL et al: Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 91(23):2020-8, 1999