Gynecology Book

http://www.fpnotebook.com/

Breast Lump

Aka: Breast Lump, Breast Mass
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  1. History: Risk Factors Evaluation
    1. See Breast Cancer Risk Factors
  2. History: Characteristics of Breast Mass
    1. Mass Location ("Point with one finger to its location")
    2. Changes in size, pain, swelling
    3. Nipple Discharge
    4. Method of discovery
    5. Duration mass has been present
    6. Change with Menstrual Cycle (Hormonal influences)
    7. Tenderness at Breast Mass site
  3. Etiologies of Discrete Breast Lumps
    1. Age under 20 years
      1. Fibroadenoma: 50%
      2. Benign Breast Mass: 50%
    2. Age 20 to 29 years
      1. Fibroadenoma: 35%
      2. Benign Breast Mass: 52%
      3. BreastCyst: 10%
      4. Breast Cancer: 3%
    3. Age 30 to 39 years
      1. Fibroadenoma: 18%
      2. Benign Breast Mass: 62%
      3. BreastCyst: 10%
      4. Breast Cancer: 10%
    4. Age 40 to 55 years
      1. Fibroadenoma: 9%
      2. Benign Breast Mass: 31%
      3. BreastCyst: 25%
      4. Breast Cancer: 35%
    5. Age over 55 years
      1. Benign Breast Mass: 13%
      2. BreastCyst: 2%
      3. Breast Cancer: 85%
  4. Types of Breast Masses
    1. BreastCyst
    2. Fibroadenoma
    3. Fibrocystic Breast
    4. Breast Cancer
  5. Exam
    1. See Breast Exam
    2. Document patient identified Breast Mass location
      1. Patient points to the lump with one finger
  6. Diagnostics
    1. BreastUltrasound
    2. Mammogram in mass evaluation
      1. Not used to evaluate palpable mass
      2. Used to evaluate for other concurrent lesions
      3. Delay Mammogram 2 weeks after aspiration
        1. Aspiration may cause hematoma
        2. Wait time avoids false positives
    3. Breast aspiration, fine needle aspirate or core biopsy
    4. Excisional Breast biopsy
    5. Triple Test Score
  7. Management: Protocol 1 based on starting with Ultrasound
    1. Start with BreastUltrasound
    2. Ultrasound shows simple cyst
      1. Aspirate and
        1. See Breast Cyst Aspiration
      2. Repeat Clinical Breast Exam in 4-6 weeks
    3. Ultrasound shows complex cyst or solid lesion
      1. Mammogram and
      2. Fine needle aspirate or core-needle biopsy
        1. See Breast Cyst Aspiration
    4. Ultrasound does not reveal lesion
      1. Mammogram and
      2. Fine needle aspirate or core-needle biopsy
        1. See Breast Cyst Aspiration
  8. Mangement: Protocol 2 based on starting with FNA
    1. Start with fine-needle aspirate of Breast Mass
      1. See Breast Cyst Aspiration
    2. Breat mass is cystic
      1. No residual cyst after aspiration
        1. Age over 40: Mammogram or core needle biopsy
        2. Age under 40: Ultrasound or core needle biopsy
      2. Residual cyst or bloody fluid aspirated
        1. Repeat Clinical Breast Exam in 6 weeks
    3. Breast Mass is solid
      1. FNA malignant: Treat
      2. FNA Suspicious: Core-needle or Excisional Biopsy
      3. FNA non-diagnostic
        1. Age over 40: Mammogram or core needle biopsy
        2. Age under 40: Ultrasound or core needle biopsy
      4. FNA benign
        1. Obtain Mammogram
        2. If Mammogram positive
          1. Ultrasound or
          2. Core-needle biopsy
        3. If Mammogram negative
          1. Repeat Clinical Breast Exam in 6 weeks
  9. Management: Protocol 3 Basic Approach based on age
    1. Premenopausal asymmetrical palpable mass
      1. Reexamine during days 5-10 of Menstrual Cycle
      2. Mammogram if age over 30 years
      3. BreastUltrasound if difficult localization
      4. Attempt aspiration of Breast lesion
        1. See Breast Cyst Aspiration
    2. Postmenopausal asymmetrical palpable mass
      1. Exercise high level of suspicion (High Risk)
      2. Mammogram
      3. Attempt aspiration of Breast lesion
        1. See Breast Cyst Aspiration
  10. References
    1. Klein (2005) Am Fam Physician 71:1731-8

Mass in breast (C0024103)

Definition (NCI) A mass in the mammary gland, either mobile or immobile. Once the mass has reached the size of a small garden pea, it can be detected by palpation. With mammography a larger number of early breast cancers are being detected since this techniques allows detection prior to the point at which the mass can be felt. Breast masses are not always malignant. Benign fibrocystic breast disease is not uncommon. A fine needle biopsy aspiration can distinguish a cystic mass from a solid one.
Concepts Finding (T033)
ICD9 611.72
ICD10 N63
SnomedCT 89164003, 271940008, 290062006, 155958009, 274113005, 163440007
English BREAST MASS, BREAST NODULE, Lump in breast, Mass in breast, Unspecified lump in breast, MASS BREAST (NOS), Lump, breast - NOS, breast lump, breast mass, Lumpy breast (finding), Lump, breast - NOS (disorder), lump or mass of breast (diagnosis), lump or mass of breast, Breast lump NOS, Mass breast (NOS), Breast nodule, BREAST MASS OR LUMP, BREAST LUMPY, breast lump or mass, Lump, breast - NOS (finding), BREAST LUMPS, LUMPS, BREAST, breast nodule, mass in breast, breast nodules, lump in breast, nodule breast, lumpy breast, lumpy breasts, breast lumps, breasts lumps, breast masses, Breast mass NOS, Breast lump, Breast irregular nodularity, Lumpy breasts, Lumpy breast, Breast mass, Breast lump (finding), Mammary gland mass, breast; lump, breast; mass, breast; node, lump; breast, mass; breast, node; breast, Lump in Breast, Mass in Breast, Breast Lump, Breast Mass, Breast Nodule, Lump or mass in breast
Italian Massa in sede mammaria, Massa della mammella (NAS), Mammelle nodulari, Nodulo mammario, Nodulo mammario NAS, Massa in sede mammaria NAS, Nodulo o massa nella mammella, Massa della ghiandola mammaria
Dutch knobbel of gezwel in borst, borstkliergezwel, borstgezwel NAO, borstknobbel, borstknobbel NAO, borstnodule, knobbelige borsten, gezwel borst (NAO), knobbel; mamma, mamma; knobbel, mamma; massa, mamma; nodus, massa; mamma, nodus; mamma, Palpabele weerstand in mamma, niet gespecificeerd, borstgezwel
French Nodule mammaire, Masse mammaire, Nodule du sein SAI, Seins nodulaires, Masse mammaire SAI, Masse de la glande mammaire, Nodule ou masse du sein, Masse du sein SAI, Masse du sein
German Raumforderung in der Brust NNB, Brustknoten NNB, Brust mit Knoten, Raumforderung in der Brust (NNB), Brustknoetchen, Knoten oder Raumforderung in der Brust, Brustknoten, Raumforderung der Milchdruese, Nicht naeher bezeichnete Knoten in der Mamma [Brustdruese], Raumforderung im der Brust
Portuguese Nódulo mamário, Massa na glândula mamária, Nódulo mamário NE, Nódulo ou massa mamária, Mamas com nódulos, Massa mamária NE, Mass mamária NE, Massa da mama
Spanish Nódulo o masa en la mama, Nodulo mamario, Nódulo mamario, Masa en mama (NEOM), Tumor en la mama NEOM, Masa mamaria, Nódulo mamario NEOM, Nódulos mamarios, Lumpy breasts, Breast lump, Lumpy breast, Breast irregular nodularity, bulto mamario, SAI (trastorno), Lump, breast - NOS, bulto mamario (hallazgo), bulto mamario, SAI (hallazgo), bulto mamario, SAI, bulto mamario, masa mamaria (hallazgo), masa mamaria, tumoración mamaria, Masa en mama
Japanese 乳房腫瘤ＮＯＳ, 乳房塊, 乳腺腫瘤, 乳房腫瘤, 乳房腫瘤（ＮＯＳ）, 乳房小結節, ﾆｭｳｾﾝｼｭﾘｭｳ, ﾆｭｳﾎﾞｳｼｮｳｹｯｾﾂ, ﾆｭｳﾎﾞｳｼｭﾘｭｳNOS, ﾆｭｳﾎﾞｳｼｭﾘｭｳ, ﾆｭｳﾎﾞｳｶｲ
Czech Útvar v prsu (NOS), Útvar v prsu, Útvar v prsní žláze, Bulka v prsu, Bulka v prsu NOS, Uzlinka v prsu, Bulka nebo resistence v prsu, Mnohočetné rezistence v prsu, Rezistence v prsu NOS
Korean 유방의 상세불명의 소괴
Hungarian Emlő térfoglaló folyamata, Emlőmassza (k.m.n.), Emlőpúp k.m.n., Emlőpúp, Emlőcsomó, Mammalis mirigytömeg, Csomós emlők, Emlő térfoglaló folyamata, k.m.n., Csomó vagy térfoglalás az emlőben
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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