Suspicious breast lesion

Principles

• Any suspicious palpable breast mass requires additional imaging and diagnostic biopsy
• Triple test - the combination of clinical, radiological and pathological evaluation of a breast lump
  • Should be used for all solid breast lumps or asymmetric localised nodularity
  • Clinical history and examination, mammogram (if >40yo) and USS, non-excisional biopsy (usually core)
  • Sensitivity of 99.6% for cancer
  • Companion recommends scoring all components of the assessment 1-5 to allow easy perception of discordance
  • So you end up with E1-E5, R1-R5, U1-U5, B1-B5
• See BI-RADS definitions under 'screening/imaging'

History/examination

• See separate topic

Differential diagnosis for breast lump

• Benign breast lesion (separate topic)
• Malignant breast lesion
• Most likely diagnosis
  • <30yo - fibroadenoma
  • 40-50yo - cyst
  • >50yo - cancer

Differential diagnosis for axillary lump

• Lymph nodes - explore recent local or systemic infections
• Skin lesions
• Accessory breast tissue

Non-palpable:

• Imaging findings triggering workup:
  • Use BI-RADS
  • See separate 'imaging' topic
• Choice of biopsy approach
  • See separate 'biopsy technique' topic
  • Imaging-guided CNB generally best first option
  • Then consider excisional biopsy based on indications on 'biopsy technique' topic
• Prognosis
  • 75-80% of patients with indicated biopsy for non-palpable breast lesion ultimately have benign findings

Palpable

• Choice of biopsy approach
  • As above