From the Guidelines
For a new breast lump, the initial imaging modality of choice should be determined by the patient's age, with diagnostic mammography or DBT recommended for women aged 40 years or older, breast US for women younger than 30 years, and either US or diagnostic mammography/DBT for women aged 30-39 years. When evaluating a clinically detected palpable breast mass, it is essential to complete a thorough imaging workup prior to biopsy due to inconsistencies in clinical examination 1. The choice of initial imaging modality is crucial, and the following guidelines should be followed:
- For women aged 40 years or older, diagnostic mammography or DBT is the preferred initial imaging modality 1.
- For women younger than 30 years, breast US is the initial imaging modality of choice 1.
- For women aged 30-39 years, either US or diagnostic mammography/DBT can be used for initial evaluation 1. It is also important to note that any highly suspicious breast mass detected by imaging should be biopsied, irrespective of palpable findings, and any highly suspicious breast mass detected by palpation should be biopsied, irrespective of imaging findings 1. Correlation between imaging and the palpable area of concern is essential to ensure accurate diagnosis and appropriate management 1.
From the Research
Imaging Recommendations for a New Breast Lump
The following are the recommended imaging modalities for a new breast lump:
- For women under 30 years of age, ultrasound is usually the appropriate initial imaging 2
- For women between 30 to 39 years of age, ultrasound, diagnostic mammography, and tomosynthesis are usually appropriate 2
- For women 40 years of age or older, diagnostic mammography and tomosynthesis are the appropriate initial imaging, with ultrasound being appropriate if the patient had a negative mammogram within 6 months of presentation or immediately after mammography findings are suspicious or highly suggestive of malignancy 2
- If the diagnostic mammogram, tomosynthesis, and ultrasound findings are probably benign, no further imaging is necessary unless the clinical scenario indicates a biopsy 2
Role of Repeat Mammography
- Repeat mammography does not appear to add value beyond sonography performed by trained ultrasound technologists and should not be routinely performed for interval palpable breast lumps 3
- Targeted ultrasound is recommended for evaluating interval palpable breast lumps, rather than repeat mammography 3
Diagnostic Accuracy of Imaging Modalities
- The combination of physical examination, imaging (mammogram and ultrasound), and fine-needle aspiration cytology (FNAC) is more accurate than any modality alone in diagnosing breast cancer 4
- Core biopsy is a reliable tool for diagnosing breast cancer, with a diagnostic rate of 95.5% in one study 4
- Ultrasound has a high positive predictive value (81.3%) when combined with mammography, making it a valuable tool in breast cancer diagnosis 4
Follow-up Recommendations
- Increased surveillance is necessary after a benign breast biopsy, with recommendations for clinical breast examination and mammogram or ultrasound at 6 months, 1 year, and 2 years after the biopsy 5
- The risk of subsequent cancer development is increased after a benign breast biopsy, highlighting the need for regular follow-up 5