New Palpable Breast Lump With Recent Negative Mammogram: Is Repeat Mammography Necessary?

The purpose of this article is to determine the utility of repeat mammography, compared with targeted ultrasound and previous mammogram, in the assessment of an interval palpable breast lump found within 1 year after a negative mammogram study.

Women who were examined for a new palpable lump with mammography and targeted ultrasound between January 2005 and December 2012, who also had a negative mammogram within the previous 6-12 months, were included. The following data were collected: age, mammographic findings, change from previous mammogram, ultrasound findings, BI-RADS category, and biopsy results.

A total of 618 palpable lumps in 612 women (mean [± SD] age, 55.9 ± 11.2 years) were included in this study. In 314 of 618 cases (50.8%), a sonographic finding or mammographic change, or both was detected in the region of the palpable lump. Ultrasound detected a finding in 311 cases (50.3%), whereas repeat mammography detected a change in only 80 (12.9%) cases (p < 0.001). Of the 314 cases with imaging findings, 234 findings (74.5%) were detected by ultrasound alone. Repeat mammography identified a more prominent focal asymmetry in the palpable region in three cases with no sonographic correlate; none had malignancy. Eighty lesions were biopsied, and 48 (60.0%) of them were positive for malignancy. The repeat mammogram findings were unchanged for 10 of these lesions.

Interval palpable breast lumps should be evaluated with targeted ultrasound. Mammography does not appear to add value beyond sonography performed by trained ultrasound technologists and should not be routinely performed.