Breast lumps surgery: Difference between revisions

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Revision as of 16:24, 9 January 2019

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

Overview

Surgical management of breast lumps depends on the type of masses based on core-needle biopsy. Atypical ductal hyperplasia, atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ, flat epithelial atypia. Multiple, peripheral and atypic papillomas, large sclerosing adenosis and radical scar >10mm, atypic and enlargic fibroadenomas, desmoid tumor, mammary fibromatosis, phyllodes tumor, symptomatic and large pseudoangiomatous stromal hyperplasia requires surgical consultation and excision. The rest of breast lumps require observation and follow-up. The final decision for excisional biopsy is based on recommendations from pathologist, radiologist, and surgeons.

Surgery

Management of breast lumps after confirmation on the basis of core needle biopsy:^[1]

Breast lump	Surgical management
Atypical ductal hyperplasia	Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ	Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Flat epithelial atypia	Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Papillomas	Multiple, peripheral papillomas, lesions with atypia, and size >10 mm require surgical consultation and follow-up with clinical breast examination every 12 months and mammography, annually.
Complex sclerosing lesion, radical scar	If the size < 10mm and adequately sampled: observation. If the size > 10mm: surgical consultation is required. If papilloma is excised: follow-up with annual clinical breast examination and mammography.
Fibroadenoma	If accompanied with atypia and enlarging size, surgical consultation is required. Follow-up with annual clinical breast examination and mammography.
Complex fibroadenoma	Observation and follow-up with clinical breast examination and mammography, annually.
Sclerosing adenosis	Observation and follow-up with clinical breast examination and mammography, annually.
Fat necrosis	Observation and follow-up with clinical breast examination and mammography, annually.
Columnar cell hyperplasia	Observation and follow-up with clinical breast examination and mammography, annually.
Phyllodes tumor	Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
Desmoid tumor and mammary fibromatosis	Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
Pseudoangiomatous stromal hyperplasia:	In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
Apocrine metaplasia	In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually.

The final decision for excisional biopsy is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathological findings which help to reach the best possible management for patient care.

References

↑ 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.

Template:WikiDoc Sources

[pmid25341156-1] 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.

[1]

@@ Line 14: / Line 14: @@
 | style="background:#DCDCDC;" align="center" + |'''Atypical ductal [[hyperplasia]]'''
 | style="background:#F5F5F5;" + |
-*Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
+*Excision of lump by surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]'''
 | style="background:#F5F5F5;" + |
-*Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
+*Surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''Flat [[epithelial]] [[atypia]]'''
 | style="background:#F5F5F5;" + |
-*Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
+*Surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Papillomas]]'''
 | style="background:#F5F5F5;" + |
-*Multiple, peripheral [[papillomas]], lesions with [[atypia]], and size >10 mm require surgical consultation and follow-up with clinical breast examination every 12 months and mammography, annually.
+*Multiple, peripheral [[papillomas]], lesions with [[atypia]], and size >10 mm require surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 12 months and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''Complex sclerosing lesion, radical scar'''
@@ Line 32: / Line 32: @@
 *If the size < 10mm and adequately sampled: observation.
 *If the size > 10mm: surgical consultation is required.
-*If papilloma is excised: follow-up with annual clinical breast examination and mammography.
+*If papilloma is excised: follow-up with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]].
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Fibroadenoma]]'''
 | style="background:#F5F5F5;" + |
 *If accompanied with atypia and enlarging size, surgical consultation is required.
-*Follow-up with annual clinical breast examination and mammography.
+*Follow-up with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and mammography.
 |-
 | style="background:#DCDCDC;" align="center" + |'''Complex [[fibroadenoma]]'''
 | style="background:#F5F5F5;" + |
-*Observation and follow-up with clinical breast examination and mammography, annually.
+*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Sclerosing adenosis]]'''
 | style="background:#F5F5F5;" + |
-*Observation and follow-up with clinical breast examination and mammography, annually.
+*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Fat necrosis]]'''
 | style="background:#F5F5F5;" + |
-*Observation and follow-up with clinical breast examination and mammography, annually.
+*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''Columnar [[cell]] [[hyperplasia]]'''
 | style="background:#F5F5F5;" + |
-*Observation and follow-up with clinical breast examination and mammography, annually.
+*Observation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Phyllodes tumor]]'''
 | style="background:#F5F5F5;" + |
-*Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
+*Surgical consultation is required with follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Desmoid tumor]] and [[mammary]] [[fibromatosis]]'''
 | style="background:#F5F5F5;" + |
-*Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
+*Surgical consultation is required with follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]], annually.
 |-
 | style="background:#DCDCDC;" align="center" + |'''Pseudoangiomatous [[stromal]] [[hyperplasia]]:'''
 | style="background:#F5F5F5;" + |
-*In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
+*In symptomatic and large lesions, surgical consultation is required with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]] follow-up.
 |-
 | style="background:#DCDCDC;" align="center" + |'''[[Apocrine]] [[metaplasia]]'''
 | style="background:#F5F5F5;" + |
-*In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually.
+*In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]] annually.
 |}
-The final decision for excisional [[biopsy]] is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathologic findings which help to reach the best possible management for patient care.
+The final decision for excisional [[biopsy]] is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathological findings which help to reach the best possible management for patient care.
 ==References==

Breast lumps surgery: Difference between revisions

Revision as of 16:24, 9 January 2019

Overview

Surgery

References

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