Concern over a possible breast lump is the commonest reason for referral to a symptomatic breast clinic (Figures 3.1,3.2,3.3,3.4,3.5,3.6,3.7,3.8,3.9,3.10,3.11,3.12,3.13,3.14,3.15,3.16,3.17). More than 90% of all patients who attend such clinics and more than 80% of those referred with a lump will not have cancer. All patients with a localized abnormality (lump or localized nodularity) require triple assessment. Distinguishing an area of normal breast nodularity from a pathological lump can be difficult clinically. This is particularly important in young women with breast cancer, who often present with localized nodularity rather than a discrete mass.
Visible lump in an atrophic breast due to a cancer.
Visible distortion of the normal contour of the breast due to a lump. In this case, the lump turned out to be due to a cyst.
Visible lump in the left axilla due to metastatic lymph node involvement from a breast cancer. Such an appearance is unusual except in very thin patients. Suspicious palpable nodes can be core biopsied or sampled for cytology with or without ultrasound guidance in an attempt to stage the axilla prior to surgery.
Management of a breast lump. B, biopsy; C, cytology; R, mammogram; U, ultrasound. Numbers refer to triple assessment scoring (see Table 2.1, page 7).
The likely cause of a breast lump varies with age. Fibroadenomas are common in young women, cysts are most common in the mid to late forties, while cancers are more likely with increasing age.
Ultrasound scan image of a well-defined homogeneous hypoechoic lesion in the breast due to a fibroadenoma.
Excised fibroadenoma showing smooth surfaced, apparently encapsulated lump. The size of this lesion gave rise to some concern but sections showed benign features.
Fibroadenoma showing even distribution of glandular elements and intervening stroma. H&E, original magnification x2.
Mammogram showing multiple well-defined opacities consistent with cysts.
Ultrasound scan image of two adjacent cysts. The lesions are well ...