ACR Appropriateness Criteria® on Palpable Breast Masses

doi:10.1016/j.jacr.2007.01.017

Journal of the American College of Radiology

Volume 4, Issue 5, May 2007, Pages 285-288

https://doi.org/10.1016/j.jacr.2007.01.017 Get rights and content

Palpable breast masses may become evident during breast self-examination or clinical breast examination or retrospectively after screening mammography. Because most breast masses do not exhibit distinctive physical findings, imaging evaluation is almost always necessary to characterize the lesions and screen the reminder of both breasts. Depending on age, the primary imaging evaluation of a palpable breast mass is mammography or breast ultrasound. Negative imaging results should not deter the biopsy of a clinically suspicious breast mass.

Section snippets

Summary of Literature Review

Breast cancer is the most common malignancy among women and the second leading cause of cancer deaths in the United States. The American Cancer Society [1] estimated that 212,920 new cases of invasive breast cancer and 61,980 new cases of in situ breast cancer would be diagnosed in 2006. A breast mass is one of the most frequent surgical indications. A palpable breast mass may become evident during breast self-examination or clinical breast examination or retrospectively after screening

Acknowledgments

I wish to thank the following members of the Women’s Imaging-Breast Panel on Appropriateness Criteria: W. Phil Evans, MD; Lawrence Bassett, MD; Wendie A. Berg, MD, PhD; Carl D’Orsi, MD; Dione M. Farria, MD, MPH; Cheryl R. Herman, MD; Stuart S. Kaplan, MD; Laura Liberman, MD; Ellen Mendelson, MD; and Stephen B. Edge, MD.

Disclaimer:The ACR Committee on Appropriateness Criteria® and its expert panels have developed criteria for determining appropriate imaging examinations for the diagnosis and

References (30)

N.F. Boyd et al.
Prospective evaluation of physical examination of the breast
Am J Surg
(1981)
S.A. Feig
Breast massesMammographic and sonographic evaluation
Radiol Clin North Am
(1992)
M.L. Palmer et al.
Breast biopsy in women 30 years old or less
Am J Surg
(1993)
Cancer facts and figures 2006
(2006)
W.L. Donegan
Evaluation of a palpable breast mass
N Engl J Med
(1992)
D. Rosner et al.
What ultrasonography can tell in breast masses that mammography and physical examination cannot
J Surg Oncol
(1985)
L.H. Baker
Breast cancer detection demonstration project: five-year summary report
CA Cancer J Clin
(1982)
G.W. Eklund et al.
The art of mammographic positioning
Radiol Clin North Am
(1992)
D.D. Dershaw et al.
Sonographic and clinical findings in women with palpable breast disease and negative mammography
Breast Dis
(1995)
D. Georgian-Smith et al.
Sonography of palpable breast cancer
J Clin Ultrasound
(2000)

L. Liberman et al.

Palpable breast masses: is there a role for percutaneous imaging-guided core biopsy?

AJR

(2000)

A.T. Stavros et al.

Solid breast nodules: use of sonography to distinguish between benign and malignant lesions

Radiology

(1995)

M.S. Soo et al.

Negative predictive value of sonography with mammography in patients with palpable breast lesions

AJR

(2001)

M.K. Shetty et al.

Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast

J Ultrasound Med

(2002)

L. Moy et al.

Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review

Radiology

(2002)

Cited by (14)

Breast diseases in adolescents
2013, Imagerie de la Femme
Les masses palpables chez l’adolescente sont inhabituelles. Un examen clinique soigneux et répété et une échographie de première intention en cas de persistance de l’anomalie clinique sont souvent suffisants au diagnostic. La pathologie est bénigne dans la très grande majorité des cas, mais la prise en charge doit être rigoureuse lors de situations particulières : masse d’évolution rapide, images ambiguës qui peuvent correspondre à des lésions bénignes rares (papillome sclérosant ou papillomatose juvénile, radial scar, adénome).
Palpable masses arising in adolescent patients are uncommon. A careful physical examination with clinical follow-up and US help the evaluation of patient symptoms. Benign findings are overwhelmingly the most common cause but additional medical attention is needed in certain situations such as rapidly enlarging masses or ambiguous images, which may reveal a rare benign lesion (sclerosing papilloma and juvenile papillomatosis, radial scar, adenoma).
Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO)
2009, International Journal of Radiation Oncology Biology Physics
Citation Excerpt :
Patients in the “cautionary” group should also be counseled regarding the specific limitations of the data and the greater uncertainty for this patient subgroup. Patients treated with APBI should undergo standard imaging assessment, which typically includes diagnostic mammography and breast ultrasonography (89). At present there are insufficient data to justify routine use of breast magnetic resonance imaging (MRI) in patients selected for APBI.
To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion.
A systematic search of the National Library of Medicine's PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein.
The Task Force proposed three patient groups: (1) a “suitable” group, for whom APBI outside of a clinical trial is acceptable, (2) a “cautionary” group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an “unsuitable” group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety.
Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer.
Applying the 2011 Canadian guidelines for breast cancer screening in practice
2012, CMAJ. Canadian Medical Association Journal
Office management of a palpable breast lump with aspiration
2010, CMAJ. Canadian Medical Association Journal
Pleural and lung metastasis from degenerated multiple adenofibromas: About a case
2017, Pan African Medical Journal
Clinical value of mammography in the evaluation of palpable breast lumps in women 30 years old and older
2017, American Journal of Roentgenology

View all citing articles on Scopus

View full text

Original articleACR Appropriateness Criteria® on Palpable Breast Masses

Section snippets

Summary of Literature Review

Acknowledgments

Am J Surg

Radiol Clin North Am

Am J Surg

Cancer facts and figures 2006

Evaluation of a palpable breast mass

N Engl J Med

What ultrasonography can tell in breast masses that mammography and physical examination cannot

J Surg Oncol

Breast cancer detection demonstration project: five-year summary report

CA Cancer J Clin

The art of mammographic positioning

Radiol Clin North Am

Sonographic and clinical findings in women with palpable breast disease and negative mammography

Breast Dis

Sonography of palpable breast cancer

J Clin Ultrasound

Palpable breast masses: is there a role for percutaneous imaging-guided core biopsy?

AJR

Solid breast nodules: use of sonography to distinguish between benign and malignant lesions

Radiology

Negative predictive value of sonography with mammography in patients with palpable breast lesions

AJR

Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast

J Ultrasound Med

Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review

Radiology

Original article
ACR Appropriateness Criteria^® on Palpable Breast Masses