Pinpoint palpable mass in breast.(Gynecology)

KAILUA KONA, HAWAII -- Inform the radiologist about the specific location of any palpable mass in a patient's breast that prompted you to order a mammogram, Dr. R. James Brenner said at a meeting on medical negligence and risk management.

Avoid vague descriptions like "a general fullness in the breast upper right quadrant" and be more specific--"a palpable lump at 10 o'clock," said Dr. Brenner, chief of breast imaging at the University of California, San Francisco.

If the radiologist doesn't know there's a palpable mass, the patient gets a screening mammography. But mention a palpable mass, preferably with a specific area for interrogation, and the radiologist can perform ultrasound and potentially detect carcinomas that can't be seen by mammography.

"I need to know from the gynecologist that he or she feels something there. Otherwise, this ultrasound is not performed, and the diagnosis is not made in a timely fashion," he said. "This is an example where the clinician and the radiographic team either sink or swim together."

American College of Radiology guidelines state that ultrasound examinations should be performed for mammographic masses or palpable masses that are insufficiently characterized on mammographic findings.

The use of ultrasonography for screening is not the standard of care, but is being investigated in a National Cancer Institute trial.

The most common reason for medical malpractice lawsuits is a delay in the diagnosis of breast cancer, according to data from the Physicians Insurance Association of America.