TRIPLE ASSESSMENTS FOR BREAST LUMP

FIRST ASSESSMENT:

• Clinical examination of the breast including axillary lymph nodes
• If the lump is mobile, not attached to underlying structure, firm in consistence, smooth surface: It’s likely to be fibroadenoma, especially in young patient.
• If non-mobile lump, hard in consistency, attached to the underlying structure, irregular surface: It’s likely to be carcinoma.
• If there are lumps int he axilla it means carcinoma because that is a sign of metastasis.
• If there is no palpable masses the investigation of choice is stereotactic biopsy.

SECOND ASSESSMENT:

• If woman is <35 years : Perform USS only
• If woman is 35 years or above: Do mammography first and then USS

THIRD ASSESSMENT:

• Cytology
• In either case, you have done USS which will differentiate whether the lump is cystic or solid. If cystic, perform FNAC. Further management depends upon the type of fluid aspirated:

1. If aspirate is a clear fluid: Just aspirate and reassure the patient.
2. If blood stained: send the aspirate to lab for cytology.
3. If clear fluid but residual mass, perform core biopsy.
4. If the lump is solid, perform core biopsy.