Suspicious Breast Lumps

Diagnosis

Evaluation of suspicious lumps includes a clinical breast exam by a health care provider, diagnostic imaging with mammography and/or ultrasound, and sometimes biopsy.

Types of biopsies include:

• Fine-needle aspiration -- This procedure is used to drain a fluid-filled cyst that is painful or to evaluate a complex cyst.
• Core needle biopsy -- The physician uses local anesthesia and a small needle to take a small sample of tissue from the lump. Often, the procedure is done by radiologists using ultrasound to localize the lump and guide the needle.
• Stereotactic biopsy -- Radiologists perform this newer procedure in a clinic setting with local anesthesia. Computer-generated images help the physician guide the needle to the lump to take a sample. Patients lie on their stomach on a table which has a hole through which their breast is suspended. Computer images give a three-dimensional view of the breast.
• Surgical or excisional biopsy -- This procedure, also called a lumpectomy, involves removal of the entire lump under either local or general anesthesia.

In all cases, the tissue removed is sent to a laboratory for analysis.

Physicians at Mayo Clinic use an algorithm (formula) to determine how to evaluate a breast lump. If the lump is palpable (able to be felt in a clinical breast exam), patients first undergo diagnostic evaluation with mammogram and/or ultrasound. The choice of imaging technique is based on the lump's location and the patient's age. Women under 40 often have dense breast tissue that may make ultrasound a better choice. If diagnostic screening indicates no problem or the lump is a cyst and the patient has no symptoms, more frequent follow-up examinations may be all that are needed. If the cyst is painful, the physician may drain it with fine-needle aspiration.

Lumps that remain suspicious following diagnostic screening need to be biopsied. The most common procedures are stereotactic biopsy and ultrasound-guided core needle biopsy. Physicians may also use ultrasound to help guide a needle to a lump for a biopsy. The choice of technique depends on the appearance of the lump in the diagnostic imaging tests. Both stereotactic and ultrasound-guided biopsies are done as outpatient procedures under local anesthetic.