0:00

So to start, we're going to start

0:02

speaking about palpable lumps.

0:05

The ACR appropriateness criteria,

0:08

I think, are really very important.

0:10

Basically, the ACR convenes an expert panel

0:13

on breast imaging for each topic, and the

0:17

panel reviews all of the relevant literature

0:20

and then, uh, writes the ACR appropriateness

0:23

criteria, which includes a nice narrative

0:26

section, which is a review of that topic.

0:30

And then uh, tables of appropriate imaging,

0:34

um, and ratings for each type of, uh,

0:37

modality that you might use for each scenario.

0:41

Those appropriateness criteria are

0:43

available through the ACR website, acr.org.

0:46

17 00:00:47,125 --> 00:00:49,594 And also, each of the topics are

0:49

published as a, uh, paper in the Journal

0:52

of the American College of Radiology.

0:54

So this is the one that we're going to

0:56

look at first, which is ACR appropriateness

0:59

criteria for palpable breast masses.

1:02

So the ACR recommends that under age

1:05

30, we would start with ultrasound.

1:07

And for age 30 to 39, um,

1:11

both ultrasound and mammogram get equal

1:13

ratings as, as being the initial exam.

1:17

And age 40 and up, they recommend

1:19

starting with, uh, mammography and

1:21

then going to ultrasound thereafter.

1:24

At Hopkins, we've made a little bit of an

1:27

adjustment to that protocol, and really it

1:30

is that for age 30 and up, so that age 30

1:33

to 39 group where ACR said, well, you could

1:36

do a mammogram first or an ultrasound first,

1:38

we've made the decision that we're going

1:39

to do mammogram first for those patients,

1:42

so they're going to have a bilateral

1:43

diagnostic mammogram and then ultrasound.

1:46

So for age under 30, we're going to start

1:48

with ultrasound and do a mammogram if

1:50

it's, um, if indicated, you know, at the

1:52

discretion of the radiologist, age 30 and

1:55

up, we're going to start with a diagnostic

1:56

mammogram and then move to ultrasound.

1:59

We place a triangular-shaped skin

2:02

marker over the area that the patient

2:04

is feeling, and we do a full CC and MLO

2:08

view for each breast with tomosynthesis.

2:12

If it's a 2D mammogram, we'll do full

2:14

CC and MLO views plus spot compression

2:17

views over the lump, and then we'll

2:19

ultrasound the palpable lump as well.

2:23

There are many entities that can

2:25

cause a palpable lump in the breast.

2:27

Sometimes it's just normal breast tissue

2:30

or a normal subcutaneous fat lobule.

2:32

Other etiologies include cyst, abscess,

2:36

fibroadenoma, phyllodes tumor, breast cancer,

2:40

lymph node, lymphoma, and metastatic disease.

Palpable Lump Overview

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0:00

So to start, we're going to start

0:02

speaking about palpable lumps.

0:05

The ACR appropriateness criteria,

0:08

I think, are really very important.

0:10

Basically, the ACR convenes an expert panel

0:13

on breast imaging for each topic, and the

0:17

panel reviews all of the relevant literature

0:20

and then, uh, writes the ACR appropriateness

0:23

criteria, which includes a nice narrative

0:26

section, which is a review of that topic.

0:30

And then uh, tables of appropriate imaging,

0:34

um, and ratings for each type of, uh,

0:37

modality that you might use for each scenario.

0:41

Those appropriateness criteria are

0:43

available through the ACR website, acr.org.

0:46

17 00:00:47,125 --> 00:00:49,594 And also, each of the topics are

0:49

published as a, uh, paper in the Journal

0:52

of the American College of Radiology.

0:54

So this is the one that we're going to

0:56

look at first, which is ACR appropriateness

0:59

criteria for palpable breast masses.

1:02

So the ACR recommends that under age

1:05

30, we would start with ultrasound.

1:07

And for age 30 to 39, um,

1:11

both ultrasound and mammogram get equal

1:13

ratings as, as being the initial exam.

1:17

And age 40 and up, they recommend

1:19

starting with, uh, mammography and

1:21

then going to ultrasound thereafter.

1:24

At Hopkins, we've made a little bit of an

1:27

adjustment to that protocol, and really it

1:30

is that for age 30 and up, so that age 30

1:33

to 39 group where ACR said, well, you could

1:36

do a mammogram first or an ultrasound first,

1:38

we've made the decision that we're going

1:39

to do mammogram first for those patients,

1:42

so they're going to have a bilateral

1:43

diagnostic mammogram and then ultrasound.

1:46

So for age under 30, we're going to start

1:48

with ultrasound and do a mammogram if

1:50

it's, um, if indicated, you know, at the

1:52

discretion of the radiologist, age 30 and

1:55

up, we're going to start with a diagnostic

1:56

mammogram and then move to ultrasound.

1:59

We place a triangular-shaped skin

2:02

marker over the area that the patient

2:04

is feeling, and we do a full CC and MLO

2:08

view for each breast with tomosynthesis.

2:12

If it's a 2D mammogram, we'll do full

2:14

CC and MLO views plus spot compression

2:17

views over the lump, and then we'll

2:19

ultrasound the palpable lump as well.

2:23

There are many entities that can

2:25

cause a palpable lump in the breast.

2:27

Sometimes it's just normal breast tissue

2:30

or a normal subcutaneous fat lobule.

2:32

Other etiologies include cyst, abscess,

2:36

fibroadenoma, phyllodes tumor, breast cancer,

2:40

lymph node, lymphoma, and metastatic disease.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Lesson

Sample Lesson

Lesson

Palpable Lumps

Lesson

Breast Pain

Lesson

Nipple Discharge

Lesson

Skin Changes/Inflammation

Lesson

Recall from Screening

Lesson

Surveillance After Breast Cancer Treatment

Lesson

Follow Up Probably Benign Findings - BI-RADS 3

Lesson

Follow up Benign Biopsy

Lesson

Pregnant and Lactating Women

Lesson

Male Patients

Palpable Lump Overview