A 36-year-old woman comes to the office after discovering a lump in her right breast. She has no other symptoms. This patient regularly performs breast self-examinations after menses, and her last menstrual period ended 2 days ago. She has no significant medical history and has not seen a physician in 10 years. The patient takes no medications and has no allergies. Her grandmother died at age 78, 2 years after being diagnosed with breast cancer. Breast examination shows a 1-cm firm, round mass in the upper outer quadrant of the right breast. No axillary lymph nodes are palpable. Which of the following is the most appropriate next step in management of this patient?

Question

A 36-year-old woman comes to the office after discovering a lump in her right breast.  She has no other symptoms.  This patient regularly performs breast self-examinations after menses, and her last menstrual period ended 2 days ago.  She has no significant medical history and has not seen a physician in 10 years.  The patient takes no medications and has no allergies.  Her grandmother died at age 78, 2 years after being diagnosed with breast cancer.  Breast examination shows a 1-cm firm, round mass in the upper outer quadrant of the right breast.  No axillary lymph nodes are palpable.  Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d8d1_8814_bc81_97241a2b7866_MD0003_00 A palpable breast mass requires further evaluation as physical examination alone is insufficient for excluding malignancy. Mammography is the first-line imaging study for women age >30 with a palpable mass. Although screening mammograms are used in asymptomatic women, diagnostic (eg, multiple-view) mammograms are used to evaluate a palpated mass or an abnormal screening result. Targeted ultrasound is used with mammography to further characterize the mass (eg, solid versus cystic). In women <30, ultrasound is preferred for a palpable abnormality, although mammography can be used for further characterization if an abnormality (eg, irregular borders, complex cyst, indistinct borders) is seen on ultrasound. < (Choices A and B) Biopsy, often ultrasound guided, is required to confirm the diagnosis of a palpable mass. Core biopsy is used for solid, acellular (eg, stromal) masses, whereas excisional biopsy is used for large or suspicious ones. Fine-needle aspiration may be used for suspected cystic or small masses. However, the first step in management is imaging to further characterize the mass and guide biopsy approach. (Choices D and E) Although reassurance and reevaluation after 1 or 2 menstrual cycles (not 6 months) are appropriate for adolescents, all palpable breast masses in adult women require further evaluation (eg, imaging, possible biopsy) due to the increasing risk of breast cancer with age. Educational objective: Mammography is the first-line imaging study for assessing a palpable breast mass in women age >30. Ultrasound may be added for better characterization of the mass. Tissue biopsy is required to confirm the diagnosis. > References: Diagnostic ultrasonography and mammography for invasive and noninvasive breast cancer in women aged 30 to 39 years. (http://www.ncbi.nlm.nih.gov/pubmed/17485910) ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. (http://www.ncbi.nlm.nih.gov/pubmed/16738183)

A 36-Year-Old Woman Comes to the Office After Discovering a Lump