Breast symptoms such as nipple discharge and mastalgia require assessment as well. Breast cancer differential diagnoses medscape reference. Potential role of shearwave ultrasound elastography for the differential diagnosis of breast nonmass lesions. Jan 19, 20 evaluation of abreast lumpcharacteristics of a breast mass size position mobility composition fluctuant, hard, rubbery fixation to underlying tissue or skin 16. Oct 12, 2018 mastitis an infection in breast tissue that most commonly affects women who are breastfeeding milk cyst galactocele a milkfilled cyst thats usually harmless. The differential diagnosis of coarse heterogeneous calcifications includes. Table 1 differential diagnosis of benign breast lesions. To assess the role of doppler sonography when used in conjunction with mammography and gray scale sonography in differentiating solid breast lesions and to. This article provides an overview of the standard birads terminology used to describe breast masses in radiology reports and other reporting suggestions. In one study, 16% of women age 4069y presented to their physician with a. Differential diagnosis of benign and malignant breast.
Management of pediatric and adolescent breast masses. Recognizing nonmass findings is important because breast cancer can manifest as such lesions, and us correlate findings for mammographic and breast mri. Evaluation of abreast lumpcharacteristics of a breast mass size position mobility composition fluctuant, hard, rubbery fixation to underlying tissue or skin 16. Differential diagnosis ofa breast lump fibrocystic disease cysts adenomas fibroadenoma fat necrosis papilloma breast cancer 17. There was overlying skin redness, but no extension and some tenderness of the mass. A breast cyst can be diagnosed and treated by aspiration. Every breast lump is breast cancer until proven otherwise young women get breast cancer patients aged under 50 the triple test is positive if any component is indeterminate, suspicious or malignant offer the use of a chaperone prior to breast examination resources read the investigation of a new breast symptom. Fineneedle aspiration is fast, inexpensive, and accurate. To assess the role of doppler sonography when used in conjunction with mammography. Breast cancer differential diagnoses medscape emedicine.
The differential diagnosis for a tender, unilateral breast mass includes breast abscess, galactocele, mastitis, lymph node, mondor syndrome, and hematoma. Breast masses are broadly classified as benign or malignant. Oslo university hospital shall not be liable for any loss whether direct, indirect, incidental or consequential, arising out of access to, use of, or reliance upon any of the content on this website. Ps shows overlapping features or may coexist in 50% to 60% of cases. A delay in the diagnosis of breast cancer remains a leading cause of medical malpractice suits. Mar 08, 2019 breast masses are broadly classified as benign or malignant. Some lumps cause pain, while others go unnoticed until identified during an imaging test. A missed diagnosis of breast cancer is one of the most frequent. This practical, fullcolor reference uses selected images of pathological findings, together with succinct, expert instructions, to guide you through the decisionmaking process by. Evaluation of breast mass differential diagnosis of symptoms bmj. In one study, 16% of women age 4069y presented to their physician with a breast. Apr 15, 2000 a dominant breast mass requires histologic diagnosis. Palable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy. Missed breast cancer is the most common malpractice suit filed in the us.
Oil cyst after reduction mammoplasty in a 23yearold woman with a palpable mass in the region of postoperative scarring in the left breast. In late pregnancy and lactation period, the main differential diagnosis for a palpable solid breast mass is lobular hyperplasia which is a normal physiological event, fibroadenoma, focal mastitis, lactating adenoma, tubular adenoma, phyllodes tumor, and breast carcinoma. The differential diagnosis of a breast mass can be broad, including malignancies such as primary breast cancer, lymphoma, or sarcoma, or benign breast lesions such as cysts, fibroadenoma, and fat necrosis. Comprehensive assessment, involving clinical examination, imaging and biopsy, are required for definitive diagnosis. It is most commonly observed in the subcutaneous soft tissues of the upper back and posterior neck in males. Stellate lesions breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma. The differential diagnosis of benign and malignant breast cancer using shear wave elastography swe. Differential diagnosis based on history and presentation differential diagnosis consider the following. Mastitis an infection in breast tissue that most commonly affects women who are breastfeeding milk cyst galactocele a milkfilled cyst thats usually harmless. A breast lump is a mass that develops in the breast.
As in nonpregnant women of childbearing age, most breast masses encountered during pregnancy and lactation are benign. The radiologic evaluation of an ultrasound of the breast showed fluid and blood within the mass consistent with an abscesshematoma. Evaluation of a breast mass is guided by findings on history, physical exam, imaging, and biopsy. Work with your doctor or other health care professional for an accurate diagnosis. Among them, lactating adenoma and fibroadenoma are most prevalent. A subscription is required to access all the content in best practice.
Common causes of a benign breast mass include fibrocystic disease, fibroadenoma. Frequently, pain occurs or worsens and size increases during premenses. A breast mass in premenopausal woman our case see attached flow chart clinically malignant. Pediatric and adolescent breast masses formation, except for a portion at the anterior fourth intercostal space 3. Breast masses are threedimensional spaceoccupying lesions in the breasts. Whether the cancer is only in the breast, is found in lymph nodes under your arm, or has spread outside the breast determines your stage of breast cancer. The results revealed that dwmri had an overall detection rate of 94. The clinical features, diagnosis, and management of breast cysts are the focuses of this topic. Differential diagnosis with a new classification scheme during the study, some special color aliasing types on pdvt images which have distinguishing forms according to the tissue composition noted and commented, also. Learn more about the symptoms and diagnosis of phyllodes tumors. Causes shown here are commonly associated with this symptom.
Consider whether the lump fits into one of these categories. Description of breast calcifications differential diagnosis birads classification. Evaluation of breast mass differential diagnosis of. Baohua wang1, zhenyu cai2, ying hu 1, jing wang 1, yanhua chu 1, tianan jiang 1, jing cheng 1, shusen zheng 3 1department of ultrasound, the first affiliated hospital, college of medicine, zhejiang university, hangzhou, pr china 2department of ultrasound, zhejiang medical and health group. Frequently, pain occurs or worsens and size increases. Even without the presence of the mass these calcifications would be classified as birads 5. If non mass like enhancement is present, the differential diagnosis is mainly between intraductal tumor versus benign causes of enhancement without mass. This mass with associated large, coarse calcifications arrows is a degenerating fibroadenoma.
Depending on the type, breast lumps may be large or small and may feel hard or spongy. Differential diagnosis of solid breast lesions wiley online library. The evaluation of common breast problems american family. In primary care, breast lumps are a common complaint among women. For breast cancer management recommendations, please refer to breast cancer.
But even without a biopsy of every mass, clinicians can reduce the risk of failed diagnosis to 1% by using a. Evaluation of palpable breast masses american family. Read on to learn everything you need to know, from how it. Differential diagnosis of solid breast lesions contribution of doppler studies to mammography and gray scale imaging ays. Choose one of the access methods below or take a look at our subscribe or free trial options. A nonmass finding at us has been described as a discrete identifiable area of altered echotexture compared with that of the surrounding breast tissue that does not conform to a mass shape.
Differential diagnosis of benign and malignant breast masses. Breast cancer must be differentiated from other diseases such as malignancy, cysts, inflammation and noninflammatory solid lumps. Circumscribed breast lesions benign breast disease eg. Benign breast conditions the journal of the american.
A missed diagnosis of breast cancer is one of the most frequent causes of malpractice claims in the united states. Mmg, biopsy, preop eval and counseling not clinically malignant. If breast cancer is diagnosed, other tests are done to find out if cancer cells have spread within the breast or to other parts of the body. Approximately 95% of all dcis is diagnosed because of mammographically detected microcalcifications. With the technological advances in gray scale sonography that have permitted the use of higherfrequency transducers and expansion of the acoustic dynamic range, increas. A thorough patient history and physical exam are essential for evaluation of any breast mass. The purpose of our study was to evaluate the value of dwmri in the diagnosis of benign and malignant breast masses, which would help the clinical surgeon to decide the scope and pattern of. Differentiating breast cancer different types of breast lumps are based on imaging findings and breast clinical exam results. Information on evaluation and treatment of solid breast masses, both benign and cancerous, can be found in other uptodate topics. The differential diagnosis of a breast mass or enlargement is based on the age and sex of the child. Mediolateral oblique digital mammogram of the right breast in a 66yearold woman with a new, opaque, irregular mass approximately 1 cm in diameter.
The differential diagnosis of breast masses by the primary care provider should be based on thorough history and physical assessment, ageappropriate diagnostic tools, and careful followup. Breast lumps have different characteristics that allow simplification of differential diagnosis by breaking down the vast list into sections. Peripheral vessels were those that coursed along the margin of the mass only, and central vessels were those that could be reproducibly detected within the lesion but did not extend to its mar. Obese children may sometimes appear to have breast enlargement without any breast tissue being present. Diffusionweighted magnetic resonance imaging dwmri is different from conventional diagnostic methods and has the potential to delineate the microscopic anatomy of a target tissue or organ.
For two reasons breast lumps are a high risk presentation, and registrars are likely. Limited value of additional imaging in a young female without. Stability of malignant breast microcalcifications pdf by as levtoaff, et al radiology, vol 192, 153156. At approximately 10 weeks, the primitive ectodermally derived breast tissue begins to proliferate, growing into the dermis and forming the pri mary mammary bud. The differential diagnosis of benign and malignant breast. The differential diagnosis of a dominant breast mass includes a macrocyst clinically palpable cyst. Evaluation of palpable breast masses american family physician. Our case details a 65yearold female who presents for routine screening mammogram and was subsequently found to have an enlarging oval mass in the right breast. Pdf differential diagnosis of benign and malignant breast masses.
Common causes of a benign breast mass include fibrocystic disease, fibroadenoma see the image below, intraductal papilloma, and abscess. Pdf axillary masses are uncommon alterations when detected as an isolated finding. The most common symptom of a phyllodes tumor is a painless breast lump that you or your doctor can feel while examining the breasts. Breast masses are encountered frequently during pregnancy. Ductal carcinomainsitu dcis represents 2530% of all reported breast cancers. A smallerrange roi focusing on the highest signal has a better differential value. Differential diagnosis of benign and malignant breast masses using. The diagnosis of a breast abscess was made and she was placed on cephalexin keflex. Ncp nursing care plans for breast cancer international.
Cystic lesions that resolve after fna do not require further evaluation unless they recur. May 07, 2007 there was overlying skin redness, but no extension and some tenderness of the mass. Spindle cell lipoma scl of the breast is a rare variant of breast lipoma. Breast lumps are common and usually benign, but understandably may cause significant anxiety for the patient. Differential diagnosis must be established with other pulmonary defects, including cdh and bronchopulmonary sequestration bps. Symptoms and diagnosis of phyllodes tumors of the breast. If a mass is identified, the differential diagnosis is usually between a benign versus a malignant solid tumor, i. Pash presents as a painless palpable breast mass in 4454% of women and is detected incidentally at screening. Differential diagnosis an overview sciencedirect topics. Pdf diffusionweighted magnetic resonance imaging dwmri is different from conventional diagnostic methods and has the potential to. A delayed or missed breast cancer diagnosis can severely affect patient outcome. The majority of palpable breast masses are benign, but 10% of women who present with this finding will have a diagnosis of cancer. In pediatric clinical advisor second edition, 2007. The diagnosis was based on the results of a coreneedle biopsy.
The clinical manifestations, differential diagnosis, and. A lump may be discovered by a woman doing breast selfexam or by her health care provider during a physical exam. Over time, the primary bud begins to branch, forming secondary. The differential diagnosis of a complicated cyst is the same as that of a simple cyst, with the addition of abscess discussed later.
If nonmasslike enhancement is present, the differential. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. This study assessed the role of dwmri in the diagnosis of benign and malignant breast masses, with the goals of providing guidance for clinical diagnosis. Spiculation is a feature of neoplasms and all masses that display spiculation should be further imaged and biopsied where possible. The first 3 conditions are commonly associated with breastfeeding, and hematoma may be iatrogenic. Complete history and physicalexamination should be done in a woman with a new breast mass. Missed and delayed diagnoses in the ambulatory setting.
What is the differential diagnosis of a breast mass. Clinical manifestations, differential diagnosis, and clinical evaluation. Dilated ducts with or without nipple discharge papilloma, ductal carcinoma, duct ectasia, and fibrocystic disease. Baohua wang1, zhenyu cai2, ying hu 1, jing wang 1, yanhua chu 1, tianan jiang 1, jing cheng 1. Diagnosing phyllodes tumors usually involves a combination of steps, such as a physical exam, a mammogram, and a biopsy. A thorough clinical breast examination, imaging, and tissue sampling are needed for a definitive diagnosis. Palpable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are. They are usually not painful and can feel like marbles in your breast. May 01, 2005 digital palpation of the breast is effective in detecting masses and can help determine whether a mass is benign or malignant. The 3 most common breast complaints are breast lumps, breast pain, and nipple discharge. Scribd is the worlds largest social reading and publishing site. Complex cysts a cyst with thick walls or some discrete solid component, such as septa greater than 0. Breast masses are a common clinical finding, and may be palpable or nonpalpable, benign or malignant.
Refer to appendix a pdf, 236kb for the algorithms associated with these guidelines. Evaluation of a palpable breast mass requires a systematic approach to the history, physical examination, and radiographic imaging studies to ensure a correct diagnosis. Palpable breast mass in a lactating woman postgraduate. Careful detail pertaining to the breast mass, including pain, nipple discharge, precipitating factors, duration and progression, is essential to guiding diagnosis. The purpose of our study was to evaluate the value of dwmri in the diagnosis of benign and malignant breast masses, which would help the clinical surgeon to decide the scope and pattern of operation. Systematically approach tough diagnostic challenges in breast pathology with this new title in the differential diagnoses in surgical pathology series. Fibroepithelial tumor of the breast is a heterogenous group of lesions ranging from fibroadenoma. Differential diagnosis for breast lump other than carcinoma. Most breast masses in children and adolescents are benign. See clinical manifestations, differential diagnosis, and clinical evaluation of a palpable breast mass.