Clinical Manifestations and WorkUp of a Breast Mass

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Clinical Manifestations and Work-Up of a Breast
Mass

• Lauren Kissner MSIII
• April 10th, 2007

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Work-Up of a Breast Mass

• History and Physical!
• Duration/timing of complaints
• History of trauma to breast
• Previous breast biopsies/history
• Family history of cancer
• Age of onset of menses and menopause
• Age of 1st pregnancy and number of pregnancies
• Use of OCPs or HRT
• Medications
• Past Medical and Surgical History

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WARNING

• Although these questions are important, most
  women who get breast cancer do not have
  significant risk factors of family history
  (80-85 of women who get breast cancer have no
  family history)
• University of Michigan Cancer Center Website

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Physical Exam

• Inspection and Palpation

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Inspection

• Sitting position
• arms at side
• arms elevated towards the ceiling
• hands pressing on waist
• leaning forward

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Sitting Inspection

• In the sitting position inspection, you are
  looking for
• skin dimpling
• symmetry
• redness
• swelling
• nipple position and appearance

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Sitting Palpation

• While the patient is still sitting, palpate
  axilla and supraclavicular fossa

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Supine Palpation

• Place arm above head, resting on bed
• This spreads out breast tissue over the chest
  wall
• Several different methods of palpation, just make
  sure you palpate the entire breast tissue

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Goals of Palpation

• Size of mass
• Tender or non-tender
• Mobility
• Texture
• Nipple discharge (bloody, spontaneous, bilateral,
  location that elicits it)

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Work-Up

• All patients with a mass need a work-up!!

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Under 30 years of age

• Can choose close follow-up to evaluate for
  cyclical changes if suspect fibrocystic
• Ultrasound helps distinguish solid vs. cystic
  and simple cyst vs. complex cyst
• suggests benign sharply defined borders,
  central enhancement
• may be better than mammogram in young women with
  more dense breast tissue
• Aspiration
• Biopsy!

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Over 30 years of age

• Mammography with or without ultrasound
• BIOPSY

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Types of Biopsies

• Fine needle aspiration
• Core needle
• Stereotactic non-palpable masses, can be
  performed with mammography or ultrasound guidance
• Excision directly removes portion of mass or
  entire mass for histological analysis

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Take Home Points

• All women with a breast mass need a work-up
• Type of work-up depends on the age of the woman
  but all women need a complete history and
  physical
• Know the different types of biopsies their pros
  and cons.