Non-palpable breast lesions
With increasing use of screening mammography and ultrasound for various indications, a large number of non-palpable breast lesions are being detected.
Among this large number of non-palpable masses, not all are malignant. The incidence of malignancy among these non-palpable lesions varies between 20-30%.
The radiologist plays an important role in the further work up and management of this subset of patients.
Radiologists role
What role can we as radiologists play?
- be careful in evaluating any breast lesion; comparison with previous images is invaluable; lesions that change over time is a significant finding but is not necessarily a predictor of malignancy.
- be sure not to overdiagnose
- rule out pseudo mass lesions; if necessary, perform extra views in mammography like magnification views
- use ultrasound to correlate the abnormal findings on mammography.
- can perform wire needle localization of non-palpable lesions detected by mammography which are not seen on ultrasound
- can use same procedure of stereotactic biopsy to place a hook wire in the center of the lesion
- following the excision, can do specimen mammography to ensure that there is an adequate margin by comparing the specimen mammogram with the preoperative mammograms
- the suspicious lesion may be just a cluster of microcalcifications
- in such cases, we need to be careful evaluating adequate margins on specimen mammogram
- in lesions seen on mammography, needle placement can be done under sonographic guidance. In such cases, intraoperative sonography can be performed to assess complete removal
- ultrasound-guided FNAC/biopsy can be performed preoperatively.
- recent technique of radionuclide localization (ROLL) is emerging as an adjunct.
Triple assessment
To be convinced a lesion is benign, the lesion has to always be benign/innocuous on
- clinical exam
- breast imaging, i.e. mammography, ultrasound and or MRI or a combination of each
- tissue sampling (cytology or histology)
If one of the three bullets above is not satisfied, the lesion cannot simply be called benign. If the lesion is clinically suspicious and even if imaging is negative, cytology is indicated. If the lesion is palpable and not seen on mammogram ultrasound is mandatory and unless the ultrasound is convincingly benign, tissue sampling is indicated.
Related Radiopaedia articles
Breast imaging and pathology
- breast screening
-
mammography
- breast imaging and the technologist
- forbidden (check) areas in mammography
-
mammography views
- craniocaudal view
- mediolateral oblique view
- additional (supplementary) views
- true lateral view
- lateromedial oblique view
- late mediolateral view
- step oblique views
- spot view
- double spot compression view
- magnification view
- exaggerated craniocaudal (axillary) view
- cleavage view
- tangential views
- caudocranial view
- bullseye CC view
- rolled CC view
- elevated craniocaudal projection
- caudal cranial projection
- 20° oblique projection
- inferomedial superolateral oblique projection
- Eklund technique
- normal breast imaging examples
- digital breast tomosynthesis
- breast ultrasound
- breast ductography
- breast MRI
- breast morphology
- breast intervention
- breast pathology
- malignant lesions
-
breast cancer
- breast adenocarcinoma
- ductal breast carcinoma
- ductal carcinoma in situ (DCIS)
- invasive ductal carcinoma
- lobular breast carcinoma
- ductal breast carcinoma
- adenoid cystic carcinoma of the breast
- apocrine carcinoma of the breast
- breast cancer metastases
- breast lymphoma
- breast sarcoma
- inflammatory carcinoma of breast
- intracystic breast cancer
- male breast cancer
- malignant phyllodes tumor
- metastases to the breast
- metaplastic carcinoma the breast
- gamuts
- breast adenocarcinoma
-
breast cancer
- borderline breast disease / high risk breast lesion
- benign lesions
- adenosis of the breast
- benign papillary lesions of the breast
- breast cyst
- breast hematoma
- breast hamartoma
- breast lipoma
- ductal adenoma of the breast
- epidermal inclusion cysts of the breast
- fat necrosis of the breast
- fibroadenoma
- granular cell tumor of the breast
- gynecomastia
- lymphocytic mastitis
- mammary fibromatosis
- oil cyst
- phyllodes tumor
- post-surgical breast scar
- post-radiation breast changes
- post-traumatic fibrosis
- pseudoangiomatous stromal hyperplasia (PASH)
- pseudogynecomastia
- tubular adenoma
-
breast calcifications (approach)
- morphology
- distribution
- location
- lobular calcification within breast tissue
- intraductal calcification within breast tissue
- milk of calcium within a breast cyst
- vascular calcification in breast tissue
- skin (dermal) calcification in / around breast tissue
- suture calcification within breast tissue
- stromal calcification within breast tissue
- artifactual calcification from outside the breast
- suspicious breast calcifications
- infection/inflammation
- vascular lesions
- systemic disease
- gamuts
- classification systems
- malignant lesions
- breast cancer staging