1. Asymptomatic without signs and symptoms without risk factors → Clinical breast physical examination (including visual examination and palpation, etc.) every 1~3 years.
2.Asymptomatic without signs and symptoms with family genetic history, history of chest radiation therapy, pathologically confirmed lobular carcinoma in situ (LCIS) or heterogeneous ductal hyperplasia (ADH), heterogeneous lobular hyperplasia (ALH) → annual review of mammography + clinical palpation every 6 months~1 year, and annual breast MRI if necessary.
3. With the following symptoms or positive signs, mammogram ± ultrasonography
(1) Masses can be retrieved on physical examination of the breast.
(2) Nipple overflow.
(3) Asymmetric thickening of the breast, small nodules.
(4) Skin changes.
(1) cellulite-like changes.
(2) erythema and rash.
(3) nipple desquamation.
(4) peeling, eczema.
(5) Skin ulcers.
4. Imaging findings and follow-up.
(1) Solid → suspicious benign BI-RADs grade 3 → observation (low clinical malignancy possible) → clinical palpation ± ultrasonography/diagnostic mammography every 6-12 months for 2-3 years → volume increase/stability → biopsy/continued observation.
(2) Solid → suspicious or highly suspicious BI-RADS grade 4-5 → biopsy
(3) non-simple cystic → complex density → short-term follow-up with BI-RADS classification grade 3 → physical examination, ultrasound ± diagnostic mammogram every 6-12m for 2-3 years → volume increase/stability → biopsy/continued observation
(4) Non-simple cystic → complex density → direct needle aspiration biopsy
(5) non-simple cystic → mixed density, BI-RADS grade 4 → imaging-guided biopsy
(6) Simple cystic, BI-RADS grade 2 → continued observation.
(7) No imaging abnormality, BI-RADS grade 1 → continued observation (low clinical malignancy possible) ± imaging every 3-6m for 1-2 years → volume increase/stability → biopsy/continued observation.