Breast lumps often are found during breast self-exam, "accidentally" (while bathing, for example), and during a breast exam by a medical professional. Lumps found one of these ways are called palpable masses or palpable lesions. (Palpable means something that can be touched or felt.) Doing a mammogram or ultrasound (or both) of the palpable mass is usually the next step your doctor will take to evaluate the mass. A biopsy may then be done to figure out if the mass is cancer. Most palpable masses are benign (not cancer).
The study reviewed here suggests that if a mammogram or ultrasound shows a palpable mass is benign, keeping a close eye on it with regular medical exams and mammograms is a reasonable and safe alternative to immediately biopsying the mass.
The researchers reviewed the records of 320 women about 34 years old who had developed one or more palpable breast masses. The study looked at 375 breast masses. All of the masses were first evaluated with either a mammogram and ultrasound, or just ultrasound, and all were classified as benign. About 80% of the masses were managed with careful observation and no biopsy. The average follow-up time was nearly 3 years. The researchers looked for any differences between the outcomes of the masses that weren't biopsied right away and masses that were biopsied immediately.
More than 70% (264) of the masses were benign in follow-up; this means that the masses went away, got smaller, or didn't change in any way. The benign masses were most likely benign fibroadenomas (a benign lump that is firm and moveable) or cysts.
Of the masses that weren't immediately biopsied, 7% (26) grew during follow-up; most of these were biopsied and none of those biopsied were found to be cancer.
About 25% (75) of the masses were biopsied immediately at the request of the woman or her doctor:
Close monitoring with no biopsy is common follow-up if a mass can't be felt, is first identified by mammogram, and the mammogram shows characteristics that suggest the mass is benign. Only about 1% to 2% of these types of masses eventually are diagnosed as cancer. The results of the study reviewed here suggest that the risk of a palpable mass being cancer when the mass has benign features is similarly very low. So the researchers feel that a wait and watch approach is a good and safe alternative to immediate biopsy for a palpable breast mass.
If you or your doctor discover a palpable breast mass, you'll understandably worry that the mass might be cancer. But be reassured that it's likely not cancer. Your doctor will order one or more imaging tests to evaluate the mass and will consider many factors -- including the mass's characteristics -- in deciding on a course of action that makes the most sense for you. If all factors suggest the mass is very likely benign, your doctor may recommend close follow-up, including follow-up mammograms or ultrasound, without doing a biopsy right away. The study reviewed here suggests that this approach is reasonable and safe.
If you've found a breast lump, you may think an immediate biopsy to get an immediate answer is a better option. Still, remember that a biopsy is an invasive procedure that should be done only when absolutely necessary. If waiting and watching doesn't feel like a good approach to you, talk to your doctor about your situation, your concerns, and your preferences. Together you can decide on a plan that makes the most sense for you.
Short-term follow-up is a reasonable alternative to biopsy of palpable breast lesions with benign imaging features, researchers say.
In a retrospective study of women with palpable masses, breast cancer prevalence was low (only 0.3%), with only one case of ductal carcinoma in situ diagnosed, Jennifer A. Harvey, MD, and colleagues reported in the December issue of the American Journal of Roentgenology.
"Our study of palpable breast lesions with benign features showed an acceptably low prevalence of breast cancer -- so low that short-term follow-up is a reasonable alternative to biopsy," Harvey said in a statement. "Application of the results of our study may reduce the number of biopsies that result in benign findings."
Short-term follow-up for managing a non-calcified, well-circumscribed solid mass found on a baseline screening mammogram is well accepted when the mass is not palpable, the researchers said. But the data regarding palpable masses is less clear.
So to evaluate the feasibility of short-term follow-up of palpable masses that have benign imaging features, the researchers retrospectively identified cases of women with palpable masses who'd had short-term follow-up recommended between July 1997 and December 2003.
Of 379 women with 443 palpable masses, outcome data were available for 320 women -- mean age 34.4 years -- with a total of 375 masses.
Lesions were evaluated with mammography and ultrasound or ultrasound alone, and mean follow-up time was 2.7 years.
The researchers said that the mean mass size was 14 mm and they were most commonly oval, equal in density to surrounding normal breast tissue, and hypoechoic.
The masses were usually thought to be probable fibroadenoma or complicated cyst, as opposed to a solid mass.
A total of 70.4% of lesions had a benign outcome, either resolving, decreasing in size, dropping in BI-RADS assessment to category 2, or remaining stable at follow-up.
Only 6.9% of lesions had grown at imaging followup, the researchers said, and most of them were biopsied with no cancers diagnosed.
A total of 22.7% of lesions were biopsied -- for several reasons, among them patient or healthcare provider request -- and one 1.5-mm ductal carcinoma in situ was diagnosed. It was in a 59-year-old woman.
"This case was included in this study as a false-negative worst-case scenario, although it is likely that the [cancer] found in this case was an incidental finding and not related to the palpable or imaging finding," the researchers said.
Overall cancer prevalence was similar and not statistically different for palpable and nonpalpable masses, they said (0.3% and 1.6%, respectively).
Harvey said the study also showed that short-term follow-up is less expensive than immediate biopsy.
One concern, however, about recommending short-term follow-up of palpable solid masses with benign features may be the difficulty in differentiating fibroadenoma from phyllodes tumor. The two lesions have similar features on mammograms and ultrasound images, the researchers said.
They noted that the study was limited in its retrospective design and short follow-up time, as well as by its high drop-out rate of 13.9%.
Still, they concluded that "because of an acceptably low incidence of breast cancer, short-interval follow-up of palpable masses with benign imaging features is a reasonable alternative to immediate biopsy. ... Additional studies confirming our findings would be useful."
The researchers reported no conflicts of interest.
Primary source: American Journal of Roentgenology Source reference: Harvey JA, et al "Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women" Am J Roentgenol 2009; 193: 1723-1730.
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