Palpable breast mass

Last updated: June 13, 2023

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Summarytoggle arrow icon

A palpable breast mass is a distinct lesion detected during self-examination or routine breast cancer screening. The underlying etiology of palpable breast masses may be inflammatory (e.g., breast abscess, fat necrosis of the breast), neoplastic (benign breast tumors, breast cancers), or idiopathic (e.g., breast cysts). The initial workup of a breast mass should include a comprehensive history and clinical breast examination. Breast imaging is required in most patients with a palpable breast mass. Ultrasonography is the preferred initial imaging modality in individuals < 30 years of age, while diagnostic mammography or digital breast tomosynthesis is preferred in individuals ≥ 30 years of age. An image-guided biopsy (usually core needle biopsy) is indicated for all patients with clinical or imaging features concerning for malignancy. Further management depends on the diagnosis and is covered in the respective articles. See “Overview of common breast conditions” for details.

The evaluation of breast masses in male individuals is not addressed in this article.

Clinical evaluationtoggle arrow icon

A palpable breast mass should be thoroughly evaluated, regardless of patient age or risk factors for breast cancer. [2]

Initial diagnosticstoggle arrow icon

Patients < 30 years of age [2][6][8][9]

Patients ≥ 30 years of age [2][6][8][9]

In patients with a palpable breast mass, breast ultrasound is the preferred first-line imaging modality in patients < 30 years of age; mammography or DBT is preferred in patients ≥ 30 years of age. [2][6]

In patients 30–39 years of age, breast ultrasound, mammography, and DBT are all appropriate first-line imaging options. [6]

Observation without initial breast imaging is not appropriate in patients ≥ 30 years of age. [2][9]

Imagingtoggle arrow icon

Initial age-appropriate imaging of a palpable breast mass [2][6]

Results of breast imaging are typically reported using the standardized American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). [10]

Premenopausal women < 30 years of age and lactating women often have dense breast tissue, which decreases the diagnostic power of mammography; ultrasound is recommended in these individuals. [6][11][12]

MRI breast is not routinely indicated in the evaluation of a palpable breast mass. [6]

Findings on breast ultrasound [2][13]

Features of breast mass on ultrasound [6][9]
Likely benign lesion Likely malignant lesion
  • Oval or round
  • Irregular or lobular
  • Well-defined, smooth
  • Poorly defined or indistinct, spiculated


  • Compressible
  • Firm, rigid
Additional findings

Ultrasound is the preferred imaging modality to differentiate solid from cystic lesions and to evaluate axillary lymph nodes. [14][15]

Findings on mammography or digital breast tomosynthesis

Features of breast mass on mammography or DBT [10][16][17]
Likely benign lesion Likely malignant lesion
  • Round or oval mass
  • Irregular shape
  • Noncircumscirbed mass (indistinct or microlobular borders)
  • Spiculated margins (stellar mass)
  • High-density
  • Macrocalcifications (e.g., calcified cyst)
  • Coarse popcorn-like calcifications
  • Diffuse microcalcifications (e.g., fibrocystic breast changes)
  • Clustered (grouped) microcalcifications
  • Linear calcifications

Subsequent management based on ultrasound findingstoggle arrow icon

Breast ultrasound is the first diagnostic step in patients < 30 years of age who have clinical features concerning for malignancy. In patients ≥ 30 years of age whose mammography or DBT findings are normal, benign, or probably benign, a breast ultrasound should be performed for further evaluation. [2][6][8][9]

No abnormalities [2][6][9]

  • Low clinical suspicion of malignancy: clinical surveillance for 1–2 years
    • Increase in size and/or clinical suspicion on surveillance: biopsy
    • No change in clinical suspicion or size of the mass on surveillance: Routine breast cancer screening is sufficient.
  • High clinical suspicion of malignancy
    • Patients < 30 years of age: Obtain a diagnostic mammogram, followed by a biopsy if needed.
    • Patients ≥ 30 years of age: biopsy

Solid mass [2][6][9]

Clinical surveillance includes a CBE every 3–6 months with or without breast imaging every 6–12 months. [2]

Breast cyst [2][6][9]

Confirmatory biopsytoggle arrow icon

Biopsy (performed under image guidance when possible) is indicated in all patients with clinical or imaging features concerning for malignancy. [2][6]

Image-guided biopsies are usually preferred because they are less invasive than excisional biopsies and have similar accuracy. [6]

CNB has a higher sensitivity and specificity than FNA, can distinguish between noninvasive and invasive carcinomas, and allows for testing receptor status if needed.

Biopsy of breast tissue can affect imaging findings. Imaging should be performed prior to biopsy. [6][19]

Subsequent management based on biopsy findingstoggle arrow icon

Differential diagnosestoggle arrow icon

Referencestoggle arrow icon

  1. Moy L, Heller SL, Bailey L, et al. ACR Appropriateness Criteria ® Palpable Breast Masses. J Am Coll Radiol. 2017; 14 (5): p.S203-S224.doi: 10.1016/j.jacr.2017.02.033 . | Open in Read by QxMD
  2. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156.doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  3. Rao AA, Feneis J, Lalonde C, Ojeda-Fournier H. A Pictorial Review of Changes in the BI-RADS Fifth Edition. RadioGraphics. 2016; 36 (3): p.623-639.doi: 10.1148/rg.2016150178 . | Open in Read by QxMD
  4. diFlorio-Alexander RM, Slanetz PJ, Moy L, et al. ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol. 2018; 15 (11): p.S263-S275.doi: 10.1016/j.jacr.2018.09.013 . | Open in Read by QxMD
  5. Mitchell KB, Johnson HM, Eglash A, et al. ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeed Med. 2019; 14 (4): p.208-214.doi: 10.1089/bfm.2019.29124.kjm . | Open in Read by QxMD
  6. Gokhale S. Ultrasound characterization of breast masses. Indian Journal of Radiology and Imaging. 2009; 19 (3): p.242.doi: 10.4103/0971-3026.54878 . | Open in Read by QxMD
  7. Bevers TB, Helvie M, Bonaccio E, et al. Breast Cancer Screening and Diagnosis, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2018; 16 (11): p.1362-1389.doi: 10.6004/jnccn.2018.0083 . | Open in Read by QxMD
  8. Lehman CD, Lee AY, Lee CI. Imaging Management of Palpable Breast Abnormalities. AJR Am J Roentgenol. 2014; 203 (5): p.1142-1153.doi: 10.2214/ajr.14.12725 . | Open in Read by QxMD
  9. Slanetz PJ, Moy L, Baron P, et al. ACR Appropriateness Criteria ® Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. J Am Coll Radiol. 2017; 14 (11): p.S462-S475.doi: 10.1016/j.jacr.2017.08.037 . | Open in Read by QxMD
  10. Horvat JV, Keating DM, Rodrigues-Duarte H, Morris EA, Mango VL. Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques. RadioGraphics. 2019; 39 (2): p.307-318.doi: 10.1148/rg.2019180124 . | Open in Read by QxMD
  11. Berment H, Becette V, Mohallem M, Ferreira F, Chérel P. Masses in mammography: What are the underlying anatomopathological lesions?. Diagnostic and Interventional Imaging. 2014; 95 (2): p.124-133.doi: 10.1016/j.diii.2013.12.010 . | Open in Read by QxMD
  12. Sánchez-Camacho González-Carrato MP, Romero Castellano C, Aguilar Angulo PM, et al. Diagnostic value of halo sign in young women (aged 45 to 49 years) in a breast screening programme with synthesized 2D mammography. Br J Radiol. 2018; 91 (1092): p.20180444.doi: 10.1259/bjr.20180444 . | Open in Read by QxMD
  13. Kopkash K, Yao K. The surgeon’s guide to fibroadenomas. Ann Breast Surg. 2020; 4: p.25-25.doi: 10.21037/abs-20-100 . | Open in Read by QxMD
  14. Simpson A, Li P, Dietz J. Diagnosis and management of phyllodes tumors of the breast. Ann Breast Surg. 2021; 5: p.8-8.doi: 10.21037/abs-20-99 . | Open in Read by QxMD
  15. Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2015; 68 (1): p.5-21.doi: 10.1111/his.12876 . | Open in Read by QxMD
  16. Pleasant V. Management of breast complaints and high-risk lesions. Best Practice & Research Clinical Obstetrics & Gynaecology. 2022; 83: p.46-59.doi: 10.1016/j.bpobgyn.2022.03.017 . | Open in Read by QxMD
  17. Salzman B, Collins E, Hersh L. Common Breast Problems. Am Fam Physician. 2019; 99 (8): p.505-514.
  18. Klein S. Evaluation of palpable breast masses.. Am Fam Physician. 2005; 71 (9): p.1731-8.
  19. Swain M, Jeudy M. Breast Masses in Biological Females. JAMA. 2022; 328 (3): p.294.doi: 10.1001/jama.2022.9554 . | Open in Read by QxMD
  20. Klassen CL, Gilman E, Kaur A, Lester SP, Pruthi S. Breast cancer risk evaluation for the primary care physician. Cleve Clin J Med. 2022; 89 (3): p.139-146.doi: 10.3949/ccjm.89a.21023 . | Open in Read by QxMD
  21. Pruthi S. Detection and Evaluation of a Palpable Breast Mass. Mayo Clin Proc. 2001; 76 (6): p.641-648.doi: 10.4065/76.6.641 . | Open in Read by QxMD
  22. $Contributor Disclosures - Palpable breast mass. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.

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