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Abstract：
The objective was to evaluate the diagnostic value of clinical examination and complementary imaging in the exploration of a breast lump or microcalcifications occurring in a postmenopausal woman taking hormonal replacement therapy (HRT), based on a systematic review of the literature in order to make recommendations for HRT management.
A literature review was conducted using Medline, Cochrane Library data and international recommendations in French and English until 2020.
In the presence of a clinical breast mass in postmenopausal women, there is no clinical evidence to rule out cancer. A double evaluation by mammography and ultrasound is recommended and allows the imaging to be classified into 5 BI-RADS categories. The diagnostic management of masses classified BI-RADS 4 and 5 should be based on percutaneous sampling, with microbiopsy being the first step. A total of four situations may arise: 1. Clinical examination has detected a breast mass, but there is no imaging abnormality. In this case, the imaging NPV is high (>96%). If the clinical lesion increases in size, a tissue biopsy should be performed, while continued routine breast screening is recommended if the lesion remains stable and HRT can be continued. 2. Clinical examination, mammography, and ultrasound are in favour of a cyst. Simple cysts can be punctured if painful. There is no contraindication to continuing HRT in the case of simple cysts. Management options for complicated and complex cysts are no different from those offered to women without HRT. Continuation of HRT must consider their histological nature. 3. Clinical examination, mammography, and ultrasonography suggest a benign solid tumour. The management of these benign breast lesions (fibroadenoma…) is not different in women taking an HRT and there is no contraindication to continue the HRT. 4: Clinical examination, imaging and microbiopsy diagnose a malignant tumour. It is imperative that the HRT be stopped, whatever the hormonal dependence of the tumour and whether it is invasive or in situ. The management of the cancerous tumour must consider the updated breast cancer treatment guidelines. In the presence of microcalcifications, the course of action to be taken depends on the BI-RADS classification, established according to the morphology and arrangement of the calcifications. In case of suspicious microcalcifications (BI-RADS 4 or 5), a guided macrobiopsy should be performed. Diagnostic and therapeutic management in these patients is no different from that offered to women without HRT. Discontinuation of HRT is necessary in cases of malignancy (in situ or invasive cancer).
A rigorous multidisciplinary approach is necessary for the exploration of a breast mass or microcalcifications in a postmenopausal woman.
A literature review was conducted using Medline, Cochrane Library data and international recommendations in French and English until 2020.
In the presence of a clinical breast mass in postmenopausal women, there is no clinical evidence to rule out cancer. A double evaluation by mammography and ultrasound is recommended and allows the imaging to be classified into 5 BI-RADS categories. The diagnostic management of masses classified BI-RADS 4 and 5 should be based on percutaneous sampling, with microbiopsy being the first step. A total of four situations may arise: 1. Clinical examination has detected a breast mass, but there is no imaging abnormality. In this case, the imaging NPV is high (>96%). If the clinical lesion increases in size, a tissue biopsy should be performed, while continued routine breast screening is recommended if the lesion remains stable and HRT can be continued. 2. Clinical examination, mammography, and ultrasound are in favour of a cyst. Simple cysts can be punctured if painful. There is no contraindication to continuing HRT in the case of simple cysts. Management options for complicated and complex cysts are no different from those offered to women without HRT. Continuation of HRT must consider their histological nature. 3. Clinical examination, mammography, and ultrasonography suggest a benign solid tumour. The management of these benign breast lesions (fibroadenoma…) is not different in women taking an HRT and there is no contraindication to continue the HRT. 4: Clinical examination, imaging and microbiopsy diagnose a malignant tumour. It is imperative that the HRT be stopped, whatever the hormonal dependence of the tumour and whether it is invasive or in situ. The management of the cancerous tumour must consider the updated breast cancer treatment guidelines. In the presence of microcalcifications, the course of action to be taken depends on the BI-RADS classification, established according to the morphology and arrangement of the calcifications. In case of suspicious microcalcifications (BI-RADS 4 or 5), a guided macrobiopsy should be performed. Diagnostic and therapeutic management in these patients is no different from that offered to women without HRT. Discontinuation of HRT is necessary in cases of malignancy (in situ or invasive cancer).
A rigorous multidisciplinary approach is necessary for the exploration of a breast mass or microcalcifications in a postmenopausal woman.
摘要：
目的是评估临床检查和补充成像在探索绝经后妇女服用激素替代疗法（HRT）的乳腺肿块或微钙化中的诊断价值。在系统回顾文献的基础上，为HRT管理提出建议。
使用Medline进行了文献综述，到2020年，Cochrane图书馆的法语和英语数据和国际建议。
在绝经后妇女出现临床乳腺肿块的情况下，没有临床证据可以排除癌症.建议通过乳房X线照相术和超声进行双重评估，并允许将成像分为5个BI-RADS类别。分类为BI-RADS4和5的肿块的诊断管理应基于经皮采样，显微活检是第一步。总共可能出现四种情况:1.临床检查发现乳房肿块，但没有影像异常.在这种情况下,成像NPV高(>96%)。如果临床病变增大,应该进行组织活检，而如果病变保持稳定并且可以继续进行HRT，则建议继续进行常规乳腺筛查。2.临床检查,乳房X线照相术,超声检查有利于囊肿。如果疼痛，可以刺穿简单的囊肿。在简单囊肿的情况下，继续进行HRT没有禁忌症。复杂和复杂囊肿的管理选择与没有HRT的女性没有什么不同。HRT的延续必须考虑其组织学性质。3.临床检查,乳房X线照相术,超声检查提示为良性实体瘤。这些良性乳腺病变（纤维腺瘤...）的管理在接受HRT的女性中没有差异，并且没有禁忌症可以继续进行HRT。4：临床检查，影像学和显微活检诊断恶性肿瘤。必须停止HRT，无论肿瘤的激素依赖性如何，无论它是侵入性的还是原位的。癌性肿瘤的管理必须考虑更新的乳腺癌治疗指南。在存在微钙化的情况下，采取的行动取决于BI-RADS分类，根据钙化的形态和排列建立。在可疑的微钙化（BI-RADS4或5）的情况下，应进行引导宏观活检。这些患者的诊断和治疗管理与没有HRT的女性没有什么不同。在恶性肿瘤（原位癌或浸润性癌）的情况下，必须停止HRT。
严格的多学科方法对于探索绝经后妇女的乳房肿块或微钙化是必要的。
使用Medline进行了文献综述，到2020年，Cochrane图书馆的法语和英语数据和国际建议。
在绝经后妇女出现临床乳腺肿块的情况下，没有临床证据可以排除癌症.建议通过乳房X线照相术和超声进行双重评估，并允许将成像分为5个BI-RADS类别。分类为BI-RADS4和5的肿块的诊断管理应基于经皮采样，显微活检是第一步。总共可能出现四种情况:1.临床检查发现乳房肿块，但没有影像异常.在这种情况下,成像NPV高(>96%)。如果临床病变增大,应该进行组织活检，而如果病变保持稳定并且可以继续进行HRT，则建议继续进行常规乳腺筛查。2.临床检查,乳房X线照相术,超声检查有利于囊肿。如果疼痛，可以刺穿简单的囊肿。在简单囊肿的情况下，继续进行HRT没有禁忌症。复杂和复杂囊肿的管理选择与没有HRT的女性没有什么不同。HRT的延续必须考虑其组织学性质。3.临床检查,乳房X线照相术,超声检查提示为良性实体瘤。这些良性乳腺病变（纤维腺瘤...）的管理在接受HRT的女性中没有差异，并且没有禁忌症可以继续进行HRT。4：临床检查，影像学和显微活检诊断恶性肿瘤。必须停止HRT，无论肿瘤的激素依赖性如何，无论它是侵入性的还是原位的。癌性肿瘤的管理必须考虑更新的乳腺癌治疗指南。在存在微钙化的情况下，采取的行动取决于BI-RADS分类，根据钙化的形态和排列建立。在可疑的微钙化（BI-RADS4或5）的情况下，应进行引导宏观活检。这些患者的诊断和治疗管理与没有HRT的女性没有什么不同。在恶性肿瘤（原位癌或浸润性癌）的情况下，必须停止HRT。
严格的多学科方法对于探索绝经后妇女的乳房肿块或微钙化是必要的。
