A 45-year-old woman presents to her primary care physician with a palpable lump in her right breast that she noticed two weeks ago. She denies any breast pain or nipple discharge. Past medical history is negative, and she does not take any medications. Her last mammogram was one year ago and was normal. She has no history of breast cancer in her family. Vital signs are within normal limits. On physical examination, there is a 2 cm firm, non-tender mass in the upper outer quadrant of the right breast. An ultrasound of the breast reveals a solid mass that is not clearly identified as a cyst.
C) Perform a core needle biopsy
Every palpable breast mass that is not clearly identified as a cyst by ultrasound in a woman over 35 years of age should be biopsied to ensure that a breast cancer is not missed. A core needle biopsy is the preferred initial approach in most scenarios to obtain a tissue sample for histopathological examination. Fine needle aspiration (FNA) with intraprocedural cytopathology is an alternative that may expedite patient management.
Answer choice A: Administer antibiotics and observe, is incorrect. Administering antibiotics and observing is not appropriate for a solid breast mass, as it could delay the diagnosis of a potential malignancy.
Answer choice B: Order a follow-up ultrasound in 6 months, is incorrect. Delaying further evaluation with a follow-up ultrasound in 6 months is not appropriate for a solid breast mass, as it could delay the diagnosis of a potential malignancy.
Answer choice D: Schedule a mammogram, is incorrect. While a mammogram can be useful in the evaluation of a breast mass, the next best step in this case is to perform a biopsy to obtain a definitive diagnosis.
Answer choice E: Surgical excision, is incorrect. While surgical excision can be used to remove a breast mass, it is more invasive than a core needle biopsy and is not the first-line approach for initial evaluation.
Key Learning Point
Every palpable breast mass that is not clearly identified as a cyst by ultrasound in a woman over 35 years of age should be biopsied to ensure that a breast cancer is not missed.
