Which of the following is the most appropriate step to take next in the evaluation of these patients breast mass? A 55-year-old woman presents to the clinic because she noticed a change in the contour of her left breast and thinks she feels a mass in this breast. She has never noticed similar lesions in either breast. Her mother died of metastatic breast cancer at 52 years of age, and the patient has two aunts who were diagnosed with breast cancer when they were in their 50s. On physical examination, a palpable mass is noted in the upper left outer quadrant of the patients left breast.
A. Refer for fine-needle aspiration and core-needle biopsy B. Instruct the patient to continue monthly BSEs and have the patient return in 6 months for follow-up of the mass C. Schedule an excisional biopsy of the left breast mass D. Continue routine breast cancer screening with annual mammograms and clinical breast examinations
Refer for fine-needle aspiration and core-needle biopsy-many cases of early, clinically occult breast cancer are diagnosed on the basis of architectural changes or microcalcification seen on a mammogram. women with clinically evident breast cancer generally present with breast-specific complaints, such as a palpable mass, a change in breast contour, or skin or nipple changes. for both clinically occult and clinically apparent cancer, pathologic evaluation is mandatory to establish a diagnosis. in the past, incisional or excisional biopsies were routinely employed for this purpose. today, fine-needle aspiration and core-needle biopsy are the standard diagnostic modalities. these procedures can be performed in the office in patients with suspicious palpable lesions. for women with nonpalpable lesions, biopsies guided by mammography, ultrasonography, or magnetic resonance imaging are now routine. these technologies permit an accurate diagnosis, which can be followed by definitive treatment planning; consequently, only a single surgical procedure is required. alternatively, women whose diagnoses are unequivocally negative can be spared an open surgical biopsy. however, it is axiomatic that further evaluation be undertaken for suspicious lesions that yield an equivocal diagnosis after needle aspiration or core biopsy. in addition, bilateral breast imaging is required to identify any unsuspected lesions in the contralateral breast that may also mandate further evaluation.