Palpable breast abnormalities in women under age 40

Abstract

Although the prevalence of malignancy in average risk women under age 40 presenting with a palpable breast abnormality is low, the management of benign‐appearing palpable abnormalities remains controversial. This study assesses the imaging evaluation, subsequent management, and outcomes of women under age 40 presenting with a palpable area of concern. This study also evaluates the costs, utility, and outcomes of BI‐RADS 3 assessment in this patient population. A single institution retrospective case review from July 2010 through June 2013 identified women under age 40 presenting with a new palpable breast abnormality. Diagnostic imaging evaluation was performed. BI‐RADS assessments and recommendations were recorded prospectively. Outcome was determined by tissue diagnosis, 2 years of surveillance, or search of the hospital tumor registry. Performance measures were calculated. Among 1440 cases, 1052 were initially assessed as BI‐RADS 1 or 2 (73.1%), 184 as BI‐RADS 3 (12.8%), 182 as BI‐RADS 4 (12.6%), and 22 as BI‐RADS 5 (1.5%). In all, 30 breast malignancies were diagnosed (cancer yield 2.1%). All 30 cancers were initially categorized as BI‐RADS 4 or 5. No BI‐RADS 1, 2, or 3 findings proved malignant. The imaging evaluation sensitivity was 100%, specificity was 87.7%, and accuracy was 87.9%. The negative predictive value was 100% and the positive predictive value was 14.7%. Average risk women under age 40 presenting with a palpable abnormality have a low prevalence of breast cancer. Imaging evaluation has a high sensitivity and negative predictive value, thereby allowing for confident characterization and appropriate management recommendations. For palpable solid masses with benign imaging features in women under age 40, short‐term interval follow‐up with subsequent periodic imaging or clinical examination for a total of 2 years is a cost‐effective and safe alternative to biopsy.

Breast cancer in young women: Imaging and clinical course

“…Ultrasound is an appropriate initial imaging examination for women younger than 30 presenting with a palpable abnormality due to the low incidence of malignancy. Mammography or digital breast tomosynthesis (DBT) is also typically performed in patients over the age of 30 10–12 but is not limited to this age group. According to the American College of Radiology's Appropriateness Criteria for palpable breast masses, mammography or DBT may aid in detecting additional ipsilateral or contralateral lesions in young patients, regardless of age, who are found to have suspicious clinical or imaging findings.…”

Phyllodes Tumor of the Breast during Pregnancy and Lactation; A Systematic Review

“…Figure 1 shows the number of articles retrieved in various stages of the search. Date of publication of the earliest and latest relevant articles were 1954 12,13 and 2018, 14,15 respectively. Three articles were in languages other than English and French, consisting of Spanish, 16 Polish, 17 and Portuguese.…”

Frequency of breast cancer in palpable breast lump

“…It was further revealed in the same study that the lack of knowledge and awareness about the symptoms and the screening programs for breast disease is quiteprevalent. Clinically the palpable breast lumps fail to exhibit distinctive physical findings which makes it necessary to utilize imaging evaluation to characterize the palpable lesion 13,14 . In our study, the diagnosis of breast cancer was 34.7% which is quite high and warrants a thorough checkup for women presenting with a palpable breast lump.…”