Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate the physical exam finding with imaging. Ultrasound is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The negative-predictive value of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative.