title: Woman feels breast lump--surgeon cannot: the role of ultrasound in arbitration.
abstract: The role of ultrasound scanning (USS) in patients complaining of a breast lump where the clinical examination (CE) is normal is not clearly defined. To determine this in greater detail, all patients complaining of a breast lump underwent CE. Where no lump could be found, but was still reported by the patient, an USS was performed. All lesions underwent biopsy and/or aspiration, as well as mammography in suspicious cases or those over 40 years of age. This cohort represented 5% of all referrals in the study period. Four hundred and twenty women were prospectively studied in this way. Median follow up is 3.4 years (range 2.5-4.2 years). Twenty two had solid lumps (of which 3 were cancers) and 48 had cysts. Nineteen patients re-presented with symptoms in the same breast (median time = 12 months (range 4.5-20 months), all of which were imaged on USS: 15 cysts and 4 further cancers (3 in the same quadrant as the original lump, one contralateral) were identified. Women with symptomatic breast lumps and a normal CE can be considered a reliable indication that cancer is very unlikely to be present (negative predictive value = 0.98). Ultrasound may be a suitable complimentary investigation, which will relieve symptoms in those with cysts and can detect small clinically--and sometimes mammographically--occult breast cancers.
authors.affiliation: The Breast Institute, City Hospital, Nottingham, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Cid
authors.forename: R S
authors.initials: RS
authors.lastname: Rampaul
authors.forename: I O
authors.initials: IO
authors.lastname: Ellis
authors.forename: A R M
authors.initials: AR
authors.lastname: Wilson
authors.forename: H C
authors.initials: HC
authors.lastname: Burrell
authors.forename: A J
authors.initials: AJ
authors.lastname: Evans
authors.forename: R W
authors.initials: RW
authors.lastname: Blamey
authors.forename: R D
authors.initials: RD
authors.lastname: Macmillan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000592:standards; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D016504:Breast Self-Examination; D003560:Cysts / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000592:standards*