Palpable Lump Overview
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So to start, we're going to start
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speaking about palpable lumps.
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The ACR appropriateness criteria,
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I think, are really very important.
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Basically, the ACR convenes an expert panel
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on breast imaging for each topic, and the
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panel reviews all of the relevant literature
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and then, uh, writes the ACR appropriateness
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criteria, which includes a nice narrative
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section, which is a review of that topic.
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And then uh, tables of appropriate imaging,
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um, and ratings for each type of, uh,
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modality that you might use for each scenario.
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Those appropriateness criteria are
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available through the ACR website, acr.org.
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17 00:00:47,125 --> 00:00:49,594 And also, each of the topics are
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published as a, uh, paper in the Journal
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of the American College of Radiology.
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So this is the one that we're going to
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look at first, which is ACR appropriateness
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criteria for palpable breast masses.
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So the ACR recommends that under age
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30, we would start with ultrasound.
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And for age 30 to 39, um,
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both ultrasound and mammogram get equal
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ratings as, as being the initial exam.
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And age 40 and up, they recommend
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starting with, uh, mammography and
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then going to ultrasound thereafter.
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At Hopkins, we've made a little bit of an
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adjustment to that protocol, and really it
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is that for age 30 and up, so that age 30
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to 39 group where ACR said, well, you could
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do a mammogram first or an ultrasound first,
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we've made the decision that we're going
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to do mammogram first for those patients,
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so they're going to have a bilateral
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diagnostic mammogram and then ultrasound.
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So for age under 30, we're going to start
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with ultrasound and do a mammogram if
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it's, um, if indicated, you know, at the
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discretion of the radiologist, age 30 and
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up, we're going to start with a diagnostic
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mammogram and then move to ultrasound.
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We place a triangular-shaped skin
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marker over the area that the patient
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is feeling, and we do a full CC and MLO
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view for each breast with tomosynthesis.
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If it's a 2D mammogram, we'll do full
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CC and MLO views plus spot compression
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views over the lump, and then we'll
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ultrasound the palpable lump as well.
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There are many entities that can
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cause a palpable lump in the breast.
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Sometimes it's just normal breast tissue
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or a normal subcutaneous fat lobule.
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Other etiologies include cyst, abscess,
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fibroadenoma, phyllodes tumor, breast cancer,
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lymph node, lymphoma, and metastatic disease.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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