Objective: Women commonly present to imaging departments with a palpable breast abnormality. However, widespread confusion remains regarding the most appropriate sequence and extent of imaging required. The purpose of this article is to discuss the evidence informing current management guidelines for the care of patients with palpable breast abnormalities.
Conclusion: Ultrasound is a highly effective imaging tool for guiding effective evaluation of women with palpable breast abnormalities and should be used for all women with suspicious findings at clinical breast examination. The exception is cases in which mammography shows a clearly benign correlate or a normal, fatty area of breast tissue in the location of the palpable finding. Breast ultrasound should be the primary imaging tool for women with palpable lumps who are pregnant, lactating, or younger than 30 years. For women 40 years old and older, mammography, followed in most cases by ultrasound, is recommended. For women 30-39 years old, ultrasound or mammography may be performed first at the discretion of the radiologist or referring provider. There is little to no role for breast MRI or other advanced imaging technologies in the routine diagnostic evaluation of palpable breast abnormalities.
Keywords: breast; evidence-based medicine; mammography; ultrasound.