Breast Lump

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DEFINITION
Discrete mass within the breast that may be benign, such as associated with hormonal changes within the breast, or malignant.
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EPIDEMIOLOGY
Nost breast masses are benign in pre-menopausal years.

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AETIOLOGY

Benign breast lumps

Fibroadenoma
Most common.
Formed from both fibrous and glandular tissue.
Peak age 20-30 years.

Lipomas

Fibrocystic change

Intraductal papilloma.


Somewhere In-between

Phyllodes

Malignancy

Breast cancer

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BIOLOGICAL BEHAVIOUR

As per individual diseases

Palpable masses > 7mm can be reliably investigated by FNA and core biopsy in the clinic
- cysts will resolve with aspiration
- if mass is too small then may need an excision biopsy

Non-palpable masses can be evalauted by radiologically-guided core biopsy
- USS preferred
- if not visible on USS then need stereotactic (mammography-guided) core biopsy

May need a needle-localized excisional breast biopsy if:
- deep in chest wall
- behind nipple
- small breast compressing to <3cm in thickness

What about vague densities not easy to stick a needle in?
Repeat exam.
Persisting or increasing size --> consider incisional biopsy.

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MANIFESTATIONS

Breast history & exam.

Fibrocystic
- vague thickening of rubbery
- ill defined mass

Fibroadenoma
- smooth margins
- highly mobile

Lipma
- smooth, soft, mobile

Cancer
- discrete solid mass
- irregular edges

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INVESTIGATIONS

Triple assessment
1. Clinical history & examination
2. Mammography / USS
3. FNA

Histological examination
Core biopsy with core-cutting needles, often under radiological guidance.


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MANAGEMENT

As per individual diseases
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REFERENCES
Sabiston 17th
B&L 23rd
Cameron 10th
Browse 4th

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