Clinical Evaluation of Breast Masses

The evaluation of a breast mass at a breast center may be different than at your physician's office. If a patient has had a mammogram, the films are requested and reviewed. If mammography films are not available, a mammogram may be requested, based on the age of the patient (a younger patient may undergo sonography (ultrasound) first, to characterize the lesion).


Sonogram of a cyst


Sonogram of a malignancy

Are there any abnormalities noted on the mammogram? Sonography may be accomplished at this point to determine if the mass is cystic or solid. If the mass is a simple cyst, the evaluation is complete. The mass is a benign process (not cancer). However, if the cyst is tender or quite large, it can be aspirated with relief of these symptoms. 50% of cysts that are aspirated will recur. If however, air in injected into the cyst, only 2% will recur.

Is the fluid retrieved bloody or the cyst incompletely resolved? Injecting air into the cyst and repeating a mammogram may reveal an intracystic lesion (growth inside the cyst). A bloody aspirate or an intracystic lesion indicates the need for a breast biopsy.

If the mass is a solid lesion on sonography or suspicious mammographically, your physician may recommend a breast biopsy. There are several types:

1.

 FNAB-Fine needle aspiration biopsy. A small needle is inserted into the mass and passed in several directions to pick up cells for the pathologist to evaluate under the microscope. If the cells are malignant, that is 100% accurate. If the cells are benign, that is only 64% accurate and close follow-up is warranted. The accuracy of a FNAB depends not only on the skill and adequacy of the sampling, but the experience of a cytopathologist (pathologist) evaluating the cells.
2. Open surgical biopsy: usually accomplished as an outpatient under local anesthesia, surgical breast biopsy is a minor procedure. If the area of concern is a mammographic lesion, localization will occur prior to biopsy (hook wire localization or needle localization usually done under guidance, mammography or sonography). Usually results in the complete removal of a lesion.
3. Image guided core biopsy
 

a.

Stereotactic core biopsy: computer guided biopsy that samples a lesion.
  b.

Sonography core biopsy: image guidance by sonography to obtain a sample of a lesion.

The pathology report takes several days to return. Remember that 80%-90% of lesions that are detected by clinical examination or mammography are benign.

Quick Facts:

• Mammography can reduce the mortality from breast cancer 30-40%.
• Mammography is 85% accurate in detecting breast cancer.
• Early detection may save not only your life, but also your breast.