Monday, November 10, 2008

Management of solitary breast lump

Breast cancer is the most common cancer in women. Breast lump is one of its presentation. All women should learn how to do Self-Breast Examination starting from their twenties. Fortunately, only 1 in 10 breast lumps are cancers.

Once a lump is discovered by BSE, the patient should be refered for ultrasound. Ultrasound is useful to differentiate solid from cystic mass. If it is solid, the most likely diagnosis is fibroadenoma. However, if the clinical presentation or ultrasound features suggest otherwise, biopsy should be performed. If the lump is more than 2 cm on ultrasound, a biopsy should also be performed.

If the lump is cystic and it has all the features of a simple cyst, a diagnosis of benign breast cyst can be safely made. Cancer is unlikely and no further investigation required.

This 44 year old lady was refered for ultrasound after finding a breast lump on BSE. Ultrasound showed a 3cm solid mass in the upper outer quadrant of the left breast. As she is above 40 and the mass is more than 2cm, a biopsy is recommended.

In contrast, this 34 year old lady with similar presentation, was found to have a benign breast cyst in the upper quadrant of the left breast. After some assurance, no further investigation necessary.


Anonymous said...

excuse me dr. but shouldnt you omit the pt's name in the pic to protect her identity? thanks

Dr A Rahman said...

Thanks for pointing that out to me. It was an oversight on my part. The images have been edited.