HOW A BREAST LUMP OR A MAMMOGRAPHIC LESION IS EVALUATED

It is important for any patient to understand the difference between a "palpable lump or breast mass or lesion" and a "non palpable or mammographic lesion".

A palpable lump or breast mass or lesion is a lump or mass that can be readily felt by palpation by your physician.

A non palpable or mammographic lesion is a lump or mass (also be called a lesion) which cannot be felt by palpation by your physician. It is a lump or lesion which has been detected by a routine, screening mammogram. If this lesion does not have the hallmarks of a benign lesion on mammogram, it will be called a suspicious mammographic lesion.

Your surgeon can evaluate a breast lump or a mammographic lesion in a variety of ways:

• Palpation is the physical examination of the breast. A surgeon is well trained to thoroughly examine your breasts in order to evaluate the tissue. Both breasts will be examined while you are lying down. The surgeon will also examine your underarm lymph nodes. If your examination is normal and there are no physical findings, your surgeon will suggest you schedule a follow-up appointment to reexamine the area you were concerned about. Until your next visit, it is important you continue to do your breast self-examination (BSE) on a routine basis.

• Aspiration. Aspiration allows the surgeon to know immediately if a lump is fluid-filled or is a solid mass. The procedure is done in the surgeon’s office. The surgeon inserts a needle into the lump and, if it is a cyst, withdraws the fluid and collapses the cyst. The aspirated contents of the cyst are sometimes sent to pathology for a diagnosis. This is not a painful procedure.

• Fine Needle Aspiration. This is performed once the surgeon has determined the mass is solid. A needle is inserted into the area in question in the breast, and cells are aspirated (taken out). A technician from the pathology department is present for this procedure and prepares slides with the aspirated fluid. These slides are analyzed by a pathologist. The procedure is brief and well tolerated by the patient.

• Mammography or xeromammography. This is an X-ray technique using low levels of radiation to create an image or picture of the breast on film or paper. Mammography has made it possible to detect breast cancer at very early stages. There are several types of mammographic lesions that are suspicious and associated with early cancer. Mammograms can be helpful in determining whether a lump is benign or malignant. In fact, at times it can detect cancer in the breast before a lump can be felt. Mammography is recommended by our office on a yearly basis for women over 35 years old or for high-risk patients as a means for detecting a breast cancer before it can be felt.

• Ultrasound. This is another method of evaluating the breast. This procedure creates a picture of the breast from sound waves. Although useful, this method is not reliable enough to be used alone. It is helpful when combined with other methods.

• Stereotactic Breast Biopsy. In some patients, some nonpalpable, suspicious (cannot be felt) breast lesions/masses can only be seen on mammography. This will now be called a suspicious mammographic lesion or mass. Using a special X-ray device (stereotactic biopsy table), a biopsy of this mass can be done under local anesthesia with a special needle. The only problem with this technique is that it is not 100% accurate and only remove small pieces of this lesion/mass.

• ABBI Biopsy. This breast biopsy device is the newest and most advanced method to perform a breast biopsy under local anesthesia. It ressembles the stereotactic biopsy technique, but uses a sophisticated computer system to remove large portions of abnormal breast tissue. In some patients, it can even remove the entire section of abnormal breast tissue. It is best used for non palpable breast lesions or mammographic lesions.

• Excisional or Surgical Breast biopsy. This is the most accurate way to diagnose a lump or a mammographic lesion. The breast biopsy is usually performed as an outpatient procedure in a hospital setting under general or local anesthesia. The surgeon removes the entire lump. This is referred to as an excisional biopsy. The tissue is sent to the pathologist for microscopic analysis.

Your surgeon may select one or a combination of these procedures to evaluate a breast lump or other changes in your breast. Or he may choose to "wait and watch" the lump before recommending a biopsy. As mentioned before, many lumps are due to normal hormonal changes in the breast, and can be safely watched.