Practice Rational imaging

Investigation of suspected breast cancer

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39234.386470.BE (Published 16 August 2007) Cite this as: BMJ 2007;335:347
  1. Peter Britton, consultant radiologist,
  2. Ruchi Sinnatamby, consultant radiologist
  1. Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ
  1. Correspondence to: P Britton peter.britton{at}addenbrookes.nhs.uk

    The local extent of breast cancer is often detected only at surgery, but modern imaging may be able to give us this information preoperatively instead

    The patient

    An 81 year old woman was referred to a multidisciplinary breast clinic with a lump in her right breast. Such patients undergo “triple” assessment—clinical examination, imaging, and, if necessary, needle biopsy. On clinical examination she had a mass in the upper outer quadrant, which was suspected to be an underlying carcinoma.

    What tests do I order?

    It is usual practice for patients over 35 years with discrete breast lumps to undergo mammography and ultrasound. In patients under 35 years, ultrasound is the first line investigation.

    Mammography

    Mammography has been evaluated more extensively than any other imaging technique and remains a mainstay of the diagnosis of breast cancer. Reported sensitivity in detecting palpable breast cancer is 80-90%,1 but it is lower in patients with dense breast parenchyma. A normal mammogram can be seen in the presence of a palpable breast cancer, so national guidance recommends that all breast units should provide triple assessment clinics for symptomatic women rather than an open access imaging service for general practitioners.2

    Ultrasound

    Targeted breast ultrasound is the most useful test when evaluating a breast lump. It can distinguish between “lumpiness” caused by a ridge of normal dense parenchyma, …

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