Suspicious breast lumps

Diagnosis

The diagnosis of a breast lump often requires assessment of symptoms, medical history, and family history, and conduct of a breast examination. Depending on the initial assessment, several tests may be required.

A breast examination involves feeling around the breast with fingers, in most cases, including the chest wall, underarms, and neck, while sitting and lying down to understand the lump’s cause.

In the initial appointment, these tests may be necessary:

• Diagnostic mammogram: This test is often ordered when there is a new breast concern. Diagnostic mammogram is different from a screening mammogram, which checks for breast cancer before symptoms appear. This is an X-ray of the breasts that involves compressing them between two surfaces to take black-and-white images.
• Focused or directed ultrasound: During the procedure, the transducer, which resembles a wand, is moved over the breasts. This examination creates images of the breast interior using sound waves.
• Magnetic resonance imagining (MRI): A breast MRI is recommended if the breasts are dense or if there are concerns after a clinical breast exam. Detailed images using magnetic fields and radio waves are generated after a tube-shaped machine scans the body. Breast MRI is less common than mammograms and ultrasounds, but it may still be done even if the other two show normal results.

Depending on the exam findings and any imaging results, the healthcare provider will recommend further steps. If the lump is determined to be non-cancerous, one may simply return to routine screenings. When imaging tests fail to provide a diagnosis for a lump, healthcare providers may recommend a biopsy.

• Biopsy: The procedure involves taking a small sample of the lump. The tissue samples are then sent to a lab for examination. There are various biopsy types, such as:
  • Fine-needle aspiration: This process can be applied to remove fluid from a painful cyst or to examine a complex cyst. A thin needle is used to extract a tiny amount of breast tissue or fluid.
  • Core needle biopsy: Using ultrasound guidance, this procedure involves inserting a needle into the breast lump and obtaining a sample for examination. A small, invisible clip is also inserted into the biopsied region to act as a marker so that in the future, the location can be easily located.
  • Stereotactic biopsy: This procedure may be recommended if an ultrasound is unable to locate a questionable spot that appears on a mammograms. A small clip is inserted during the biopsy procedure, which acts as an indicator for further appointments. During this biopsy, one breast is positioned in a hole in the table. X-rays of the breast create a 3D image to assist in guiding a needle to the lump and collecting a tissue sample.
  • Surgical biopsy: Medications that induce sleep may be administered during the surgery. Also known as wide local excision or lumpectomy, the entire breast lump is removed during this procedure.

Treatment

Certain instances of breast lumps may resolve without requiring treatment, and some may even dissipate spontaneously. However, if intervention becomes necessary, the course of action is dictated by the underlying cause of the lump.

Treatment options based on the cause of breast lump include:

• Breast cysts: For persistent and painful cysts that recurrently return, surgical removal of the troublesome tissue may be advised. Alternatively, fine-needle aspiration can alleviate discomfort by draining fluid from certain breast cysts. Recurring cysts frequently resolve around menopause as hormone fluctuations diminish, and spontaneous disappearance is also possible for some breast cysts.
• Fibroadenomas: If a fibroadenoma demonstrates growth or exhibits abnormal changes on ultrasound, a biopsy might be warranted. Based on the biopsy findings, surgical removal of the fibroadenoma may be advised. While some fibroadenomas may resolve spontaneously within several months, regular ultrasound examinations are essential to monitor their size and appearance.
• Fibrocystic breasts: Management of symptoms may necessitate prescription hormone therapy, such as birth control pills. Additionally, in certain instances, healthcare providers may recommend over-the-counter pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs).
• Intraductal papilloma: In certain cases, surgery may be recommended to remove both the papillomas and the affected part of the duct. However, they may not always necessitate treatment.
• Lipoma: For lipomas causing discomfort, treatment options may include surgery or liposuction. However, the majority of cases do not require any intervention.
• Infections: Incision and drainage may be required if an abscess (a pocket of pus) forms and does not heal with medications. However, in most cases, breast infections brought on by bacteria are treated with antibiotics.
• Breast cancer: Recommendations for treatment may include interventions such as surgery, chemotherapy, hormone therapy (including anti-estrogen medications), or radiation therapy. Clinical trials are also accessible to assess innovative treatment approaches. Typically, the choice of treatment options is contingent upon the type of cancer and its extent of spread.