Mksap 15 Table Evaluation Of Clinical Breast Abnormalities

Front 1

Palpable lump or mass and age <30 y

Back 1

US. (Consider observation to assess resolution within 1 or 2 menstrual cycles. If persistent, do US.) If asymptomatic and cystic on US, observe. If symptomatic or not clearly cystic on US, aspirate. If aspirate fluid is bloody or a mass persists following aspiration, biopsy or excise for diagnosis. If mass is solid on US, do mammogram and obtain tissue diagnosis (fine needle aspiration, core biopsy, or surgical excision). If not visualized on US, obtain mammogram and obtain tissue diagnosis.

Front 2

Palpable lump or mass and age ≥30 y

Back 2

Mammogram: if BI-RADSa category 1-3 obtain US and follow protocol above. If BI-RADS category 4-5 obtain tissue diagnosis.

Front 3

Nipple discharge, no mass, any age

Back 3

Bilateral, milky: pregnancy test (if negative, endocrine evaluation). Persistent, spontaneous, unilateral, one duct, or serous/bloody: cytology optional, obtain mammogram and surgical referral for duct exploration.

Front 4

Thickening or asymmetry and age <30 y

Back 4

Consider unilateral mammogram; if normal, reassess in 3-6 months; if abnormal, obtain tissue diagnosis.

Front 5

Thickening or asymmetry and age ≥30 y

Back 5

Obtain bilateral mammogram; if normal, reassess in 3-6 months; if abnormal, obtain tissue diagnosis.

Front 6

Skin changes (erythema, peau d’orange, scaling, nipple excoriation, eczema) and age <30 y

Back 6

Consider mastitis: treat with antibiotics if appropriate and reevaluate in 2 weeks. Otherwise, evaluate as below.

Front 7

Skin changes (erythema, peau d’orange, scaling, nipple excoriation, eczema) and age ≥30 y

Back 7

Obtain bilateral mammogram; if normal, obtain skin biopsy; if abnormal or indeterminate, obtain needle biopsy or excision (also consider skin punch biopsy).