What should I do about the lump in my armpit, especially now that I'm 40 and considering a health screening?

Management of an Axillary Lump at Age 40

You should undergo an ultrasound of the axillary mass as the initial diagnostic step, followed by appropriate biopsy if the ultrasound findings are suspicious. 1, 2

Initial Evaluation

Imaging Approach

• First step: Ultrasound of the axilla

  • Ultrasound is the recommended initial imaging modality for evaluating axillary masses 1, 2
  • Provides excellent characterization of axillary findings and can distinguish between:
    • Normal lymph nodes
    • Reactive/inflammatory lymphadenopathy
    • Suspicious/malignant lymphadenopathy
    • Other soft tissue masses

• Additional imaging based on age and risk factors:

  • Since you are 40 years old, a diagnostic mammogram should also be performed 1, 2
  • The American College of Radiology recommends combined mammography and ultrasound as the initial approach for women 30 and older 2

Interpretation of Findings

Ultrasound Findings and Next Steps

Based on ultrasound appearance, your axillary lump will be categorized:

1. Normal or benign-appearing lymph node:

   • Oval shape with fatty hilum
   • Follow-up in 6-12 months 2

2. Suspicious lymph node features:

   • Round shape, cortical thickening, loss of fatty hilum, or increased vascularity
   • Proceed to image-guided core needle biopsy 1, 2

3. Other soft tissue mass:

   • Proceed to appropriate biopsy based on characteristics 1

Biopsy Considerations

• Core needle biopsy is preferred over fine needle aspiration for tissue diagnosis 2
• According to UK guidelines for soft tissue sarcomas, a pre-treatment histopathological diagnosis should be made by percutaneous core biopsy 1

Health Screening Considerations

At age 40, your health screening should include:

• Breast cancer screening:

  • Begin annual mammography at age 40 1
  • Clinical breast examination

• General health screening:

  • Blood pressure measurement
  • Lipid profile
  • Fasting blood glucose
  • BMI assessment

Important Cautions

• Do not ignore axillary lumps: Even if mammography is negative, ultrasound has significantly higher sensitivity (50.3% vs 12.9%) for detecting abnormalities in the region of palpable lumps 3

• Avoid delay in evaluation: Proper assessment of soft tissue masses is crucial as delays may lead to inappropriate treatment 4

• Be aware of potential diagnoses: Axillary lumps can represent:

  • Reactive lymphadenopathy (infection, inflammation)
  • Metastatic breast cancer
  • Lymphoma
  • Other primary malignancies
  • Benign conditions (e.g., fat necrosis) 5

By following this systematic approach with appropriate imaging and possible biopsy, you'll receive an accurate diagnosis and appropriate management for your axillary lump while also addressing age-appropriate health screening needs.