Diagnostic Tests for Breast Masses
|
Adapted from Osuch JR: Breast health and disorders over
the life phases. In: Wallis LA, editor: Textbook of
women's health, Philadelphia, 1998, Lippincott-Raven.
|
The workup of a palpable breast mass detected by a woman or
by clinical breast examination (CBE) must include further diagnostic
tests. This evaluation may include bilateral mammography, ultrasonography, or breast aspiration.
A woman under age 30 to 35 should not have bilateral mammography
unless she has a strong family history of premenopausal breast
cancer, previous history of breast cancer, or highly suspect
findings on physical examination. Breast cancer is uncommon
in this age group, and mammography is less effective in young
women because of their increased breast density (Cady).
The most important diagnostic step is to distinguish
between a cyst and a solid mass. This is effectively done with
either ultrasonography or fine needle aspiration (FNA). FNA
has the following advantages:
- If the mass is cystic, drainage will be diagnostic and therapeutic.
- FNA may relieve tenderness associated with a cyst.
- Fluid may be sent for cytologic evaluation, if necessary
(Osuch).
|
Adapted from Osuch JR: Breast health and disorders over
the life phases. In: Wallis LA, editor: Textbook of
women's health, Philadelphia, 1998, Lippincott-Raven.
|
Click here for information
on how to do fine needle aspiration.
If the mass is a cyst, drainage with FNA should eliminate it.
If the fluid aspirated is clear and the mass disappears, the
fluid can be discarded. The woman should return for repeat CBE
in 4 to 6 weeks to make sure the cyst has not recurred. If cysts
are found at this visit, the patient should be referred to a
surgeon for further evaluation.
Referral to a surgeon should also occur if the aspirated fluid
is bloody or the mass does not completely disappear on aspiration.
At this time, the fluid should be sent for cytologic evaluation.
The exact site of the aspiration must be documented so that
the surgeon knows precisely where to perform the biopsy.
Any woman over age 30 (or younger if she has a strong family
history of premenopausal breast cancer in a first-degree relative)
who has an FNA that does not produce fluid should have bilateral
mammography. Not only will a mammogram better describe the
palpable mass (for example, whether calcifications are present
within the mass), but also it will help screen the rest of the
breast tissue for suspect lesions. Any dominant, solid, persistent
mass in a woman over 30 should be evaluated by a surgeon, even
if the mammogram is normal. A normal mammogram does not rule
out a cancer diagnosis in a woman with a suspect mass.
|
Send
to a friend
Printer
friendly page
Get
PDF
