Which of the following is the best next step in management of this patient's breast mass?

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11ec25c8_d893_945b_bc81_614fa4e9972a_MD0003_00 In young women, solitary palpable breast masses are often benign (eg, fibroadenoma). Further evaluation depends on patient age and risk factors: In adolescents with a suspected fibroadenoma, reassurance and reexamination after the next menstrual cycle may be appropriate. However, adults with a palpable breast mass (such as this 24-year-old patient) require further evaluation with imaging because history and physical examination alone cannot reliably diagnose or exclude cancer in this population (Choice D). In women age <30, initial assessment of a palpable breast mass is with breast ultrasound. In this age group, ultrasound is better able to distinguish between cystic (typically benign) and solid (potentially malignant) masses. If breast ultrasound findings are concerning for malignancy (eg, solid, complex-appearing), mammography may then be used as an adjunctive study. (Choice A) Breast masses concerning for malignancy on ultrasound or mammography require biopsy, which is typically with image-guided core needle biopsy. Excisional biopsies (eg, lumpectomies) are typically reserved for patients with an abnormal core needle biopsy result or for symptomatic relief of large, growing, benign breast lesions. (Choice B) Mammography, which is used for initial assessment in women age ≥30, is inferior in patients age <30 due to increased breast tissue density, which can cause false positives on mammography and lead to unnecessary biopsies. (Choice C) Breast MRI is used to assess for metastatic disease in patients with diagnosed breast cancer or as breast cancer screening in high-risk patients (eg, BRCA carrier). It is not used to evaluate a new breast mass because MRI has high sensitivity but low specificity for breast cancer (ie, both benign and malignant masses appear enhanced). Educational objective: Palpable breast masses in women age <30 are initially evaluated with breast ultrasound due to increased density of breast tissue. Solid or complex-appearing masses on ultrasound may require additional imaging (eg, mammography) or biopsy to exclude malignancy. References: Practice bulletin no. 164: diagnosis and management of benign breast disorders. (http://www.ncbi.nlm.nih.gov/pubmed/27214189) An evaluation of ultrasound features of breast fibroadenoma. (http://www.ncbi.nlm.nih.gov/pubmed/29285483)

Which of the Following Is the Best Next Step in Management