Role of needle core biopsy in patients presenting with a breast lump associated with trauma

Patients often present to the breast clinic with a lump following trauma to the breast. Routinely, triple assessment is performed on such patients. We investigated whether a proportion of them can be safely diagnosed on the basis of clinical and radiological assessment without the need for histological confirmation.

We prospectively assessed all patients with a history of trauma presenting to the breast clinic over a 5-year period.

We included 135 patients, constituting 1 % of total patients seen. They were divided into two groups for analysis. Group A included patients with trauma-related pathologies (n = 70, 52 %), comprising 47 haematomas and 23 fat necrosis. This group had a higher proportion of anti-coagulant usage (20/70). Owing to concordant clinical and radiological benign features, core biopsy was only carried out in 16 cases (23 %). All patients in this group were followed up to confirm clinical and radiological resolution of findings with no case of delayed cancer diagnosis. Group B included patients with incidental pathologies (n = 65, 48 %), consisting of 23 cancers and 42 benign lesions. Comparatively fewer patients (13/65) were on anti-coagulants. They had a history of minimal trauma and mostly no bruising, but found a lump on self-examination. The 23 cancer patients in this group had prompt triple assessment and no delay in cancer treatment.

Triple assessment is vital in patients with suspicious clinical or radiological breast lesions. However, a core biopsy can be avoided in patients with a clear history of trauma with concordant clinical and radiological features and follow-up confirming complete resolution of findings.