palpable mass not on mammogram or ultrasound

[pawleygirl]

I recently went for my annual mammogram exam and the tech asked me if there was anything i wanted looked at. I mentioned that I felt a lump a few weeks ago  - left breast, upper outer quadrant toward my underarm. the tech felt it and marked it. we could not find it on the mammogram, so the tech spoke with the radiologist, who then ordered an ultrasound. the ultrasound also showed nothing, even though the ultrasound tech could feel the lump too. Then the radiologist came in and did another ultrasound herself, and she too could feel it (with the wand from the u/s) but could not see it on the screen. she said she was sending over a report to my gyn immediately letting them know that I had a palpable mass which needed a clinical diagnosis. she described it to me as a nodule. I asked her if it was good news that we could not see it, and she said no, that these two tests see many things that are nothing and also do not see things that turn out to be something serious. I have an appointment with my gyn monday morning, and I want to be prepared for the next steps. should I ask for an mri or go straight for a biopsy? also how would they do a biopsy if they cannot see the lump on the ultrasound? I've also read that mri's can have false positive results, so I'd like to take the path that will provide the least invasive but most conclusive answer. I am 48 years old and currently in menopause - have not had a period in 6 months,  after a year of irregular periods. how worried should I be and how aggressive should I be? one other question, the lump is hard, and not movable, could it still be a cyst?

[pawleygirl]

Thank you very much for your reply. When I see my gyn tomorrow morning I'll ask for the referral.  I'm mostly concerned due to the fact that it was not seen on either imaging test, which makes me wonder how long it has really been there, even with my yearly mammograms.

[zouzi]

Hi,
Usually breast lumps will be found by mammography or ultrasound, some abnormalities escape detection on both imaging tests. For example, a lump may be able to be felt but does not appear on mammography or ultrasound images.In your case, then a biopsy( fine needle aspiration (FNA) is often performed}. In cases where the abnormality is not apparent on mammogram or ultrasound, the chances of cancer are significantly less.If it's a cyst it will go away with the needle aspiration. If it's solid, the needle can sample it. So if there's a palpable lump there, it really doesn't matter what the mammogram or ultrasound show. A lump is a lump and it needs some sort of biopsy to know it's true nature.
If I were you I would prefer to consult with a breast specialist to better evaluate this lump.
Take care and best wishes...