In another study of 375 palpable masses in 320 women, 68.8% of the masses (n = 258) were only identified with US and were typically oval (n = 275, 73.3%) and hypoechoic (n = 336 in 372 US examinations, 90.3%) [39]. When both mammography and US are negative or benign in the evaluation of a palpable breast mass, the negative predictive value is very high, more than 97% [8,9,38,40]. Together, these imaging modalities can be reassuring when the physical examination is not highly suspicious and clinical follow-up is planned. If almost entirely fatty tissue is identified in the palpable region of concern, US may not be necessary [2]. In a study that included 323 palpable masses in 271 women with almost entirely fatty tissue on diagnostic mammography, mammography alone yielded a negative predictive value of 99.6% [22]. Of the 294 (91%) of women with almost entirely fatty breasts who also underwent targeted US for the evaluation of palpable symptoms, US yielded 11 false- positives and 8 benign correlates at sites with no mammographic findings [22]. Variant 6: Adult female, younger than 30 years of age. Palpable breast mass. Initial imaging. Digital Breast Tomosynthesis Diagnostic Because of the low incidence of breast cancer (<1%) in younger women, the recommended initial imaging differs from older patients [41-44]. Younger women tend to have relatively denser breast tissue [45], which is associated with decreased mammographic/DBT sensitivity [46]. DBT is not useful as the initial imaging modality in younger women. Digital Breast Tomosynthesis Screening In women presenting with signs or symptoms, including a palpable breast mass, screening DBT, with or without DM, is not useful as the initial imaging study. Screening mammography is provided to women without signs or symptoms of breast disease. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast dedicated as the initial imaging workup in women <30 years of age with a palpable mass [2].
Palpable Breast Masses. In another study of 375 palpable masses in 320 women, 68.8% of the masses (n = 258) were only identified with US and were typically oval (n = 275, 73.3%) and hypoechoic (n = 336 in 372 US examinations, 90.3%) [39]. When both mammography and US are negative or benign in the evaluation of a palpable breast mass, the negative predictive value is very high, more than 97% [8,9,38,40]. Together, these imaging modalities can be reassuring when the physical examination is not highly suspicious and clinical follow-up is planned. If almost entirely fatty tissue is identified in the palpable region of concern, US may not be necessary [2]. In a study that included 323 palpable masses in 271 women with almost entirely fatty tissue on diagnostic mammography, mammography alone yielded a negative predictive value of 99.6% [22]. Of the 294 (91%) of women with almost entirely fatty breasts who also underwent targeted US for the evaluation of palpable symptoms, US yielded 11 false- positives and 8 benign correlates at sites with no mammographic findings [22]. Variant 6: Adult female, younger than 30 years of age. Palpable breast mass. Initial imaging. Digital Breast Tomosynthesis Diagnostic Because of the low incidence of breast cancer (<1%) in younger women, the recommended initial imaging differs from older patients [41-44]. Younger women tend to have relatively denser breast tissue [45], which is associated with decreased mammographic/DBT sensitivity [46]. DBT is not useful as the initial imaging modality in younger women. Digital Breast Tomosynthesis Screening In women presenting with signs or symptoms, including a palpable breast mass, screening DBT, with or without DM, is not useful as the initial imaging study. Screening mammography is provided to women without signs or symptoms of breast disease. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast dedicated as the initial imaging workup in women <30 years of age with a palpable mass [2].