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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Mammography is the gold standard test for the diagnosis of breast lumps in women aged >40 years old. Ultrasound is the gold standard test for the diagnosis of breast lumps in women aged <40 years old. Management and medical therapy of breast lumps depends on women's age (age> 40 or age <40) and mammography results in women aged > 40 years. In women aged > 40 years; no further evaluation is needed in case of clearly benign mass in mammography; however, ultrasound imaging is required for the rest of the findings mammography. Approach to breast lumps in women >40 years is depended on breast imaging reporting and data systems (BI-RADS) stages. Medical therapy of breast lumps in women< 40 years is depended on ultrasound results and BI-RADS categories.

Diagnostic Study of Choice

Gold Standard

Mammography

Mammography is the gold standard test for the diagnosis of breast lumps in women aged >40 years old.[1]

Ultrasound

Ultrasound is the gold standard test for the diagnosis of breast lumps in women aged <40 years old.[1]

The comparison of various diagnostic studies for breast lumps:[2]

Sensitivity Specificity
Ultrasound 82% 84%
Mammography 49% 89%

Breast ultrasound has higher sensitivity and mammography has higher specificity. The accuracy of ultrasound reported as 84% and accuracy of mammography reported as 81% .[2]

Diagnostic Approach to Breast Lump

Diagnostic approach for breast lump:

Approach to breast lumps in women aged > 40 years based on mammographic results:[3]

  • If mammographic results become negative, the next step is targeted ultrasound.
    • Negative ultrasound results considered as breast imaging reporting and data system (BI-RADS) 1, then clinical follow-up is needed.
    • Benign ultrasound results considered as BI-RADS 2, then clinical follow-up is needed.
    • Probably benign results considered as BI-RADS 3, then ultrasound short interval follow-up is needed.
    • Suspicious ultrasound results considered as BI-RADS 4 or 5, then core-needle biopsy is needed.
  • If mammographic results show only fatty tissue:
    • Considered as BI-RADS 1, then clinical follow-up is needed.
  • If mammographic results show benign mass:
    • Considered as BI-RADS 2, then clinical follow-up
  • If mammographic results are in favor of probably benign lumps, the next step is targeted ultrasound.
    • Negative ultrasound results considered as BI-RADS 3, then mammographic short interval follow-up is required.
    • Benign ultrasound results considered as BI-RADS 2, then clinical follow-up is required.
    • Probably benign ultrasound results considered as BI-RADS 3, then ultrasound short interval follow-up.
    • Suspicious ultrasound results is considered as BI-RADS 4 or 5, then core needle biopsy is required.
  • If mammographic result is in favor of suspicious lesion, the next step is ultrasound to determine biopsy plan.
    • Considered as BI-RADS 4 or 5, then core needle biopsy is required.

Approach to breast lumps in women aged <40 years based on targeted ultrasound findings:[3]

  • If ultrasound results become negative, there are two approaches:
    • Considered as BI-RADS 1, then clinical follow-up is required ( if no palpable dominant suspicious mass found at clinical examination)
    • Perform diagnostic mammography:
      • Negative results are in favor of BI-RADS 1, then clinical follow-up is required.
      • Benign results are considered as BI-RADS 2, then clinical follow-up is required.
      • Probably benign results considered as BI-RADS 3, Mammographic short interval follow-up is required.
      • Suspicious results considered as BI-RADS 4 or 5, then core needle biopsy is required.
  • If ultrasound results show benign findings:
    • Considered as BI-RADS 2, then clinical follow-up is required.
  • If ultrasound results show probably benign findings:
    • Considered as BI-RADS 3, then short interval follow-up is required.
  • If ultrasound results become suspicious:
    • Considered as BI-RADS 4 or 5, then core needle biopsy is required.

For more information on breast imaging reporting and data system (BI-RADS) system, click here.


 
 
 
 
 
 
 
 
 
Women age > 40 years
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mammographic findings
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative
 
Fatty tissue
 
Benign
 
Probably benign
 
 
Suspicious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ultrasound
 
BI-RADS 1, then clinical follow-up
 
BI-RADS 2, then clinical follow-up
 
Ultrasound
 
 
Ultrasound for biopsy plan determination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BI-RADS 4 or 5, then core needle biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative
 
Benign
 
Probably benign
 
Suspicious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BI-RADS 3, then mammographic short interval follow-up
 
BI-RADS 2, then clinical follow-up
 
BI-RADS 3, then ultrasound short interval follow-up
 
BI-RADS 4 or 5, then core needle biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative results
 
Benign
 
Probably benign
 
Suspicious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BI-RADS 1, then clinical follow-up
 
BI-RADS 2, then clinical follow-up
 
BI-RADS 3, then ultrasound short interval follow-up
 
BI-RADS 4 or 5, then core needle biopsy
 
 


 
 
 
 
 
 
 
 
 
Women age < 40 years
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Targeted ultrasound
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative
 
Benign
 
 
 
 
 
Probably benign
 
Suspicious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BI-RADS 2, then clinical follow-up
 
 
 
 
 
BI-RADS 3, then short interval follow-up
 
BI-RADS 4 or 5, then core needle biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BI-RADS 1, then clinical follow-up
 
 
Perform diagnostic mammography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative
 
Benign
 
 
Probably benign
 
Suspicious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BI-RADS 1, then clinical follow-up
 
BI-RADS 2, then clinical follow-up
 
 
BI-RADS 3, Mammographic short interval follow-up
 
BI-RADS 4 or 5, then core needle biopsy

References

  1. 1.0 1.1 1.2 Lehman CD, Lee AY, Lee CI (2014). "Imaging management of palpable breast abnormalities". AJR Am J Roentgenol. 203 (5): 1142–53. doi:10.2214/AJR.14.12725. PMID 25341156.
  2. 2.0 2.1 Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI; et al. (2014). "The comparative accuracy of ultrasound and mammography in the detection of breast cancer". Med J Malaysia. 69 (2): 79–85. PMID 25241817.
  3. 3.0 3.1 3.2 Harvey JA, Mahoney MC, Newell MS, Bailey L, Barke LD, D'Orsi C; et al. (2016). "ACR Appropriateness Criteria Palpable Breast Masses". J Am Coll Radiol. 13 (11S): e31–e42. doi:10.1016/j.jacr.2016.09.022. PMID 27814822.
  4. Loving VA, DeMartini WB, Eby PR, Gutierrez RL, Peacock S, Lehman CD (2010). "Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications". AJR Am J Roentgenol. 195 (6): 1472–7. doi:10.2214/AJR.10.4396. PMID 21098212.


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