Breast lumps surgery: Difference between revisions

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{{Breast lumps}}
{{Breast lumps}}
{{CMG}} {{AE}} {{S.M}}
{{CMG}}; {{AE}} {{S.M}}
==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==
==Surgery==
Management of breast lumps determined by [[core needle biopsy]]<ref name="pmid25341156">{{cite journal| author=Lehman CD, Lee AY, Lee CI| title=Imaging management of palpable breast abnormalities. | journal=AJR Am J Roentgenol | year= 2014 | volume= 203 | issue= 5 | pages= 1142-53 | pmid=25341156 | doi=10.2214/AJR.14.12725 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25341156  }} </ref>
Management of breast lumps after confirmation on the basis of core needle biopsy:<ref name="pmid25341156">{{cite journal| author=Lehman CD, Lee AY, Lee CI| title=Imaging management of palpable breast abnormalities. | journal=AJR Am J Roentgenol | year= 2014 | volume= 203 | issue= 5 | pages= 1142-53 | pmid=25341156 | doi=10.2214/AJR.14.12725 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25341156  }} </ref>
*Atypical ductal [[hyperplasia]]
 
**Excision of lump by surgical consultation and follow-up with clinical breast examination for every 6-12 months accompanied with mammography annually
{|
*Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Breast lump
**Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Surgical management
*Flat [[epithelial]] [[atypia]]
|-
**Surgical consultation and follow-up with clinical breast examination for 6-12 months accompanied with mammography annually
| style="background:#DCDCDC;" align="center" + |'''Atypical ductal [[hyperplasia]]'''
*[[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
*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.
*Complex sclerosing lesion, [[radical scar]]
|-
**If the size<10mm and adequately sampled, observation would be enough
| style="background:#DCDCDC;" align="center" + |'''Atypical lobular [[hyperplasia]], lobular [[neoplasia]], [[lobular carcinoma in situ]]'''
**If the size>10mm; surgical consultation is require
| style="background:#F5F5F5;" + |
**If papillomas excised; follow-up with annual clinical breast examination and mammography is required
*Surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
*[[Fibroadenoma]]
|-
**If accompanied with atypia and enlarging size, surgical consultation is required
| style="background:#DCDCDC;" align="center" + |'''Flat [[epithelial]] [[atypia]]'''
**Follow-up with annual clinical breast examination and mammography
| style="background:#F5F5F5;" + |
*Complex [[fibroadenoma]]
*Surgical consultation and follow-up with [[Breast lumps physical examination#Breast|clinical breast examination]] every 6-12 months accompanied with [[mammography]], annually.
**Observation and follow-up with clinical breast examination and mammography annually
|-
*[[Sclerosing adenosis]]
| style="background:#DCDCDC;" align="center" + |'''[[Papillomas]]'''
**Observation and follow-up with clinical breast examination and mammography annually
| style="background:#F5F5F5;" + |
*[[Fat necrosis]]
*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.
**Observation and follow-up with clinical breast examination and mammography annually
|-
*Columnar [[cell]] [[hyperplasia]]
| style="background:#DCDCDC;" align="center" + |'''Complex sclerosing lesion, radical scar'''
**Observation and follow-up with clinical breast examination and mammography annually
| style="background:#F5F5F5;" + |
*[[Phyllodes tumor]]
*If the size < 10mm and adequately sampled: observation.
**Surgical consultation is required with follow-up with clinical breast examination and mammography annually
*If the size > 10mm: surgical consultation is required.
*[[Desmoid tumor]] and [[mammary]] [[fibromatosis]]
*If papilloma is excised: follow-up with annual [[Breast lumps physical examination#Breast|clinical breast examination]] and [[mammography]].
**Surgical consultation is required with follow-up with clinical breast examination and mammography annually
|-
*Pseudoangiomatous [[stromal]] [[hyperplasia]]
| style="background:#DCDCDC;" align="center" + |'''[[Fibroadenoma]]'''
**In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up
| style="background:#F5F5F5;" + |
*[[Apocrine]] [[metaplasia]]
*If accompanied with atypia and enlarging size, surgical consultation is required.
**In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually
*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 [[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 [[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 [[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 [[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 [[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 [[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 [[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 [[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 pathological findings which help to reach the best possible management for patient care.


==References==
==References==
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Latest revision as of 20:42, 29 July 2020

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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

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
Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ
Flat epithelial atypia
Papillomas
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
Sclerosing adenosis
Fat necrosis
Columnar cell hyperplasia
Phyllodes tumor
Desmoid tumor and mammary fibromatosis
Pseudoangiomatous stromal hyperplasia:
Apocrine metaplasia

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

  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.


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