Palpable breast findings in high-risk patients: Are self- and clinical breast exams worthwhile? Journal Article


Authors: Portnow, L. H.; D'Alessio, D.; Morris, E. A.; Bernard-Davila, B.; Mango, V. L.
Article Title: Palpable breast findings in high-risk patients: Are self- and clinical breast exams worthwhile?
Abstract: Objective: To assess breast imaging findings, biopsy rates, and malignancy rates in areas of palpable concern in women at high risk for breast cancer. Methods: An IRB-approved retrospective review of a tertiary cancer center's breast imaging database was performed. Breast imaging and electronic medical records of high-risk women with palpable findings detected on self- or clinical breast examination from January 1, 2010, to January 1, 2016, were reviewed. Descriptive statistical analyses were conducted. Results: Imaging correlates for 322 palpable findings in 238 high-risk women included 55/203 (27.1%) on mammography, 183/302 (60.6%) on US, and 20/47 (42.6%) on MRI. Biopsies were performed for 104/322 (32.3%) palpable findings: 95/104 (91.3%) under imaging guidance and 9/104 (8.7%) under palpation after negative imaging. Of 322 palpable findings, 16 (5.0%) were malignant in 16/238 (6.7%) women, yielding a positive predictive value of biopsy of 16.8% (95% CI: 9.2%-24%). Women diagnosed with cancer had 16/16 (100%) sonographic, 9/14 (64.3%) mammographic, and 7/7 (100%) MRI correlates. Cancer histopathology included 12 invasive ductal carcinomas, 1 ductal carcinoma in situ, 1 invasive lobular carcinoma, 1 malignant phyllodes tumor, and 1 metastatic carcinoid tumor. Over two years of follow-up imaging in 183/238 (76.9%) women were reviewed; 7/183 (3.8%) were diagnosed with breast cancer at least one year after presenting with a palpable concern in a different location. Conclusion: High-risk women with palpable findings exhibit a 6.7% malignancy rate, indicating the value of imaging workup in this population. In our cohort, imaging demonstrated a high negative predictive value. © 2020 Society of Breast Imaging 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Keywords: high-risk; palpable; clinical breast examination; self-breast examination
Journal Title: Journal of Breast Imaging
Volume: 3
Issue: 2
ISSN: 2631-6110
Publisher: Oxford University Press  
Date Published: 2021-03-01
Start Page: 190
End Page: 195
Language: English
DOI: 10.1093/jbi/wbaa105
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 June 2021 -- Source: Scopus
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MSK Authors
  1. Elizabeth A Morris
    324 Morris
  2. Victoria Lee Mango
    25 Mango
  3. Bianca Bernard
    24 Bernard