Referring Physicians >> Newsletters >> June 2011 Breast Newsletter >> Evaluation of the Palpable Breast Mass
Evaluation of the Palpable Breast Mass
A palpable breast mass remains one of the most common problems that a general surgeon will encounter in daily practice. Ultimately, the goal of a breast mass evaluation is to make sure that it is not a cancer that requires further surgery and adjuvant treatments.
The recommended steps for evaluating a breast mass include the following:
A breast history should include the patient’s parity, age of first full-term pregnancy, year of onset of her menstrual cycle and menopause if applicable, family history of breast and/or ovarian cancer as well as her use of oral contraceptives and hormone replacement therapy. In addition, the patient’s prior history of breast cancer or pre-malignant lesions is important to include in this evaluation.
Currently, the Gail Model Risk is the most widely used risk calculator to assist the physician in defining the patient’s risk for breast malignancy. UW Health has a dedicated clinic for patients at high risk for the development of breast cancer (greater than 20% lifetime risk of breast cancer, known BRCA mutation carrier, and/or history of chest wall radiation). The PATHS Clinic (Prevention, Assessment and Tailored Health Screening and treatment) offers same-day imaging evaluation with both MRI and mammograms, on-site genetic counselors, and evaluation by an array of providers based on the patient’s needs (medical oncologists, gynecologic oncologists, nurse practitioners, breast surgical oncologists, and plastic surgeons). Through tailored risk assessment, patients can better understand their risk of developing cancer in the future, develop individualized screening plans and understand the options for risk reduction.
A focused breast examination commonly includes evaluation of the supraclavicular, cervical and axillary nodes as well as full characterization of the mass: location, size, margin irregularity, relationship to the chest wall and general density of the breast tissue. Evaluation of the skin overlying the mass and nipple are also important characteristics to note.
Once the patient has been evaluated, breast imaging should be obtained. A palpable mass can be evaluated with a unilateral diagnostic mammography and ultrasound of the mass. An ultrasound should always be performed in the setting of a new palpable abnormality to help differentiate the benign cyst from a benign or malignant solid mass.
For any mass which is not identified as a simple cyst on ultrasound, core needle biopsy should be performed using image guidance to ensure adequate localization of the mass and placement of a localizing clip for future identification of the mass if required for surgical intervention.
For more information on UW Health’s Breast Care Services please click here.