Nodularity

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Various pathologic terms have been used in the past to describe nodularity.

Nodularity in the breast may be focal or generalized. This is such a common finding that it should be regarded as normal or a variation of normal. Terminology such as fibroadenosis and fibrocystic disease of the breast to indicate focal or generalized nodularity has largely been abandoned.

Symptoms
The patient may complain of a lumpy area that may be either confined to a specific quadrant in one breast or alternatively, generalized. There may be associated breast pain, which is usually cyclical in premenopausal women. A history of usage of the OCP or HRT should be obtained.

Signs
Clinical examination may demonstrate focal nodularity that is often present in the upper-outer quadrants of both breasts but equally can be scattered throughout both breasts in the form of generalized nodularity.

Localized tenderness may be associated with these areas of nodularity.

Examination of the patient at a different phase of the menstrual cycle may demonstrate a fluctuation in pattern.

Investigations
Mammography is performed in patients over 35 years of age, and in addition to this, ultrasound is useful in patients with focal nodularity. At the same time, FNAB or core biopsy may be performed if necessary. In patients less than 35 years of age with focal nodularity, ultrasound examination with or without FNAB or core biopsy may be performed.

Management
Once malignancy has been excluded, patients can be reassured as to the benign nature of their symptoms and informed that they are at no increased risk of developing breast cancer. Treatment of associated breast pain is outlined above. No further follow-up is required.

A.D. Purushotham, P. Britton and L. Bobrow
A prospective study of benign breast disease and the risk of breast cancer. JAMA 2002

References

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