Imaging recommendations of clinically palpable breast lump

Dr Amit Chakraborty, Oct 2021

Introduction:

A palpable breast lump is one of the more common breast conditions that women present with at all ages of their lives. The imaging recommendations can vary, depending on individual presentation and clinical scenario.

A few relevant considerations in the history and clinical examinations are as follows:

  • Breast lump in younger women (up to the age of 35):
    Palpable breast lumps in this age group is most commonly benign. These lumps are usually only incidentally discovered, usually in the preceeding few weeks. They usually appear discrete and relatively mobile and is not associated with pain, nipple or skin changes. Often these breast lumps are solitary and can be present anywhere within the breast.Differential diagnosis: The most common causes of breast lump in this age group are fibroadenoma or simple breast cysts.Imaging recommendation:A breast ultrasound is the most appropriate imaging method in this age group and under these presenting conditions. If there are any suspicious findings in the ultrasound study, a mammogram is then obtained to complete the imaging workup.
  • Palpable breast lump in a middle aged woman with no family history:
    Women above the age of 35 who present with palpable breast lump should be investigated with a mammogram and an ultrasound study. In most centres, a 3D Digital Tomosynthesis mammogram is obtained which has a superior sensitivity and specificity profile.Breast lumps in these age group are often painless, although fluctuation with menstrual cycle is usually observed. In most cases, a solid lesion detected by either mammogram or ultrasound study will require a tissue biopsy.Differential diagnosis:Fibrocystic change, simple cysts, phylloides tumour, breast carcinoma
  • Palpable breast lump, postmenopausal woman:
    Women in these age group usually undergo regular screening mammogram and ultrasound examinations every 2 years. If an interim palpable mass develops, prompt imaging assessment with mammogram and ultrasound examination is recommended. Comparison examination is usually available and often adds invaluable additional information in making a diagnosis.In most cases, solid lesions breast detected in this age group will require tissue biopsy.

Special cases:

  • Younger women with high risk of breast cancer (genetic predisposition or family history): After initial mammogram and ultrasound examination, annual followup of these women is usually performed through serial MRI examinations. The MRI study, although more expensive than a mammogram and ultrasound, has superior sensitivity and specificity, especially in a relatively dense breast. Radiation exposure to the breast at an earlier age is also a concern for younger women.
  • Extremely dense breasts, any age group: Again, MRI breast is the study of choice for surveillance and screening of these women. Dense breasts pose a challenge in lesion visualisation in both mammogram and in ultrasound examinations. An MRI study is the way to go.
  • The post-operative breast: This patient is usually followed up by the surgeons. Mammogram and ultrasound examination are usually obtained for these patients and compared to previous studies. In equivocal cases (if there is a new area of vascularity or parenchymal asymmetry), a tissue sample is readily obtained. An MRI study may often also help.
  • Breast implant: MRI breast is the most sensitive method of imaging the implanted breast. Silicon and saline specific sequences are usually obtained, which can highlight intra or extracapsular implant rupture, silicon granuloma or an abnormal mass which may otherwise be obscured by the implant in a mammographic examination.

How we can help:

Our doctors specialise in women’s imaging and bring years of experience, expertise and training to successful management and investigation of women with breast conditions. Our doctors are always happy to have a clinical discussion with you to formulate a tailored breast imaging and management plan suited to your patient’s individual needs.

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