Breast Symptom (New)

Population Covered By The Guidance

This pathway provides guidance for women at any risk presenting with a new breast symptom including new breast lump, breast pain, breast or nipple asymmetry, skin changes or nipple changes. Imaging of new nipple discharge is covered separately

Lead Researcher: Sian Chin, Arjun Shivananda

Experts & Contributors: Michelle Bennet, Ravinder Dhillon, Glen Lo, Sarah Paton, Donna Taylor

Editorial Panel: Core Membership
Link to Editorial Panel

Date reviewed: April 2018

Date Published: November 2018

Image 1 (Ultrasound): Within the upper outer quadrant of the left breast at the 2 o'clock position is a well circumscribed, ovoid hypoechoic lesion measuring 137mm maximally. No contained calcification or vascularity is identified. The appearance is consistent with, but not diagnostic of, a fibroadenoma.

Fibroadenoma

Image 2 (H&E, x2.5): Histological section of a fibroadenoma showing compressed ducts (intra-canalicular growth pattern) surrounded by mild and bland stromal hypercellularity. The ducts are lined by a dual population of uniform epithelial and myoepithelial cells.

Fibroadenoma

Image 3a (Mammogram, right breast): A non-calcified 22mm mass is present in the upper inner quadrant of the right breast.

Breast Carcinoma

Image 3b (Ultrasound, right breast): Ultrasound of the same lesion showed an ill-defined solid mass with irregular margins, distortion of adjacent stroma and posterior acoustic shadowing, features which are suspicious for malignancy. Biopsy confirmed an invasive ductal carcinoma.

Breast Carcinoma

Image 4a: Mastectomy showing an irregular pale tumour (arrow) with surrounding fibrosis consistent with a breast carcinoma.

Breast Carcinoma

Image 4b (H&E, x2.5): Histological section of a moderately differentiated (Grade 2) invasive ductal carcinoma, type not otherwise specified, infiltrating through the breast parenchyma and surrounded by desmoplastic stroma. Occasional poorly formed tubules can be seen at the periphery (arrows).

Breast Carcinoma

Image 5 (H&E, x10): Histological section of a typical invasive lobular carcinoma showing the classical alignment of single cells in rows.

Breast Carcinoma

 

Date of literature search: August 2017 – April 2018

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

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SYMBOL RRL EFFECTIVE DOSE RANGE
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Medium radiation Medium 5-10 mSv
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Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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Breast