A 28-year-old woman presents to her primary care physician with a palpable lump in her right breast that she noticed one week ago. Her last menstrual period was 3 weeks ago, and her cycles are regular. Past medical history is unremarkable. She takes a combined oral contraceptive pill and a multivitamin daily. She has no family history of breast cancer. Vital signs are within normal limits. On physical examination, there is a 1.5 cm firm, non-tender mass in the upper outer quadrant of the right breast.
Which of the following is the most appropriate next step in the evaluation of this patient?
The correct answer is:
E) Ultrasound of the breast
Ultrasound is the first-line imaging choice for women under 30 years of age with a breast mass because breast tissue in this age group is too dense for mammography to be useful. Ultrasound can help differentiate between solid and cystic masses and guide further management.
Answer choice A: Core needle biopsy, is incorrect. While a core needle biopsy may be necessary for definitive diagnosis, the first step in evaluation for a woman under 30 with a breast mass is imaging with ultrasound.
Answer choice B: Fine-needle aspiration, is incorrect. Fine-needle aspiration may be necessary for definitive diagnosis, but imaging is the most appropriate next step. Initial imaging with ultrasound is preferred to guide further management.
Answer choice C: Mammography, is incorrect. Mammography is not the first-line imaging choice for women under 30 due to the density of breast tissue in this age group, which limits its effectiveness.
Answer choice D: Magnetic resonance imaging (MRI) of the breast, is incorrect. MRI of the breast is not the first-line imaging choice for initial evaluation of a breast mass in women under age 30. It is typically reserved for further evaluation if ultrasound findings are inconclusive or to help determine the extent of breast cancer if it has already been diagnosed.
Key Learning Point
Ultrasound is the first-line imaging choice for women under 30 years of age with a breast mass because breast tissue in this age group is too dense for mammography to be useful.
