Breast Nodules: When to Seek Further Evaluation

Breast nodule with indistinct margins?

Hello Doctor, I discovered breast nodules during company health check-ups in 2015 (at age 25) and 2017 (at age 27).
One nodule measured approximately 1.5 cm with irregular borders, and there were two others measuring 0.6 cm each.
After both check-ups, I had follow-up visits (without fine needle aspiration), and the doctors indicated that there were no issues and that regular monitoring would suffice.
In 2021 (at age 31), a 3D mammogram also showed no abnormalities.
Recently, during a routine check at a local hospital, a breast ultrasound revealed that the original 1.5 cm nodule has decreased to 1.1 cm, while the other two nodules were not particularly noted.
However, due to the partially indistinct borders of the 1.1 cm nodule, the doctor recommended further examination at a larger hospital.
Currently, I am 14 weeks pregnant, and breast enlargement and glandular hyperplasia may affect the accuracy of the findings.
I would like to ask the doctor: 1.
Is there a possibility that nodules previously assessed as benign or without concern could become malignant after several years? 2.
Could the indistinct borders be related to glandular hyperplasia due to pregnancy? 3.
If a follow-up is recommended, should it be after I give birth or is it better to have the examination now? Thank you.

Xiao Ting, 30~39 year old female. Ask Date: 2023/06/13

Dr. Yuan Tianmin reply Breast and Thyroid

In fact, benign nodules that have undergone biopsy still have a very small possibility of subsequent biopsies revealing malignancy.
As for breast ultrasound during pregnancy, it is recommended to wait until after childbirth to perform the procedure for more accurate results.

Reply Date: 2023/06/13

More Info

Understanding breast nodules and when to seek further evaluation is crucial for maintaining breast health, especially for women who have a history of breast nodules. Based on your history and the recent findings, let's address your concerns systematically.

1. Possibility of Benign Nodules Becoming Malignant: It is important to note that while many breast nodules are benign, there is always a small risk that a previously benign nodule can become malignant over time. Factors such as changes in the nodule's size, shape, or characteristics can indicate a need for further evaluation. In your case, the initial findings of the nodules were deemed benign, and they were monitored over the years. However, the recent ultrasound showing a decrease in size of the 1.5 cm nodule to 1.1 cm, along with the observation of a blurred boundary, raises some concerns. While the reduction in size is generally a positive sign, the change in the boundary characteristics warrants further investigation. It is essential to follow up with imaging or biopsy if there are any changes in the nodules' appearance or if new symptoms arise.

2. Impact of Pregnancy on Breast Tissue: During pregnancy, hormonal changes lead to breast tissue enlargement and increased glandular tissue, which can sometimes make imaging interpretations more challenging. The blurred boundary of the nodule could indeed be related to the physiological changes occurring in your breasts due to pregnancy. However, it is crucial to differentiate between benign changes associated with pregnancy and potential pathological changes. Therefore, while pregnancy can complicate the evaluation of breast nodules, it does not eliminate the need for careful monitoring and evaluation.

3. Timing of Follow-Up Evaluations: Given your current pregnancy status and the recommendation from your doctor to seek further evaluation, it is advisable to discuss the timing of follow-up appointments with your healthcare provider. If the doctor believes that the characteristics of the nodule are concerning, it may be beneficial to have the evaluation sooner rather than later, even if it means coordinating care with a specialist who is experienced in managing breast health during pregnancy. Some imaging techniques, such as ultrasound, are safe during pregnancy and can provide valuable information without exposing the fetus to radiation.

In summary, while your previous nodules were considered benign, any changes in their characteristics, especially during pregnancy, should be taken seriously. It is essential to maintain open communication with your healthcare provider, who can guide you on the best course of action based on your individual circumstances. Regular monitoring and timely follow-up are key components of breast health management, especially when there are changes in nodules or new symptoms arise. Always prioritize your health and well-being, and do not hesitate to seek further evaluations as recommended by your healthcare team.

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