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Excisional biopsy
0%
0/6
Fine needle aspiration
17%
1/6
Mammography
Reassurance
33%
2/6
Surgical excision
50%
3/6
Select Answer to see Preferred Response
This patient is presenting with a symptomatic benign cystic mass in her breast as found on ultrasound. The next step in management is fine needle aspiration (FNA).Breast masses can present along a spectrum of completely benign to invasive cancer. When a mass is found in the breast, the next step in management is imaging with an ultrasound being performed in young women (< 30 years of age) and a mammogram being performed in older women (> 30 years of age). If a symptomatic (painful, skin changes, or breast discharge) benign and simple cyst is found on imaging, the next step in management is aspiration with an FNA. If the mass disappears, then the patient can follow up for an exam to see if the mass has reappeared at a later time. If an FNA yields insufficient or inconclusive results or the mass recurs, a follow-up core needle or surgical biopsy could be indicated. FNA is preferred when there is a low pretest probability of cancer (such as in a young and otherwise healthy patient). Figure/Illustration A is an ultrasound image showing a simple breast cyst without any septations or irregularity to the structure (red arrows).Incorrect Answers:Answer 1: Excisional biopsy is reserved for lesions that cannot be definitively diagnosed by imaging and biopsy techniques or for patients that request removal of a benign mass for comfort or cosmetic reasons. Answer 3: Mammography would be indicated to work up a breast mass in an older woman (typically age > 30). Ultrasound is a more effective imaging modality in women less than 30 years of age, as the dense breast tissue of younger women leads to poor image quality on mammography.Answer 4: Reassurance would be appropriate if there was no palpable mass, no mass found on imaging, or if an FNA was performed and the mass resolved and did not recur. A cyst on breast ultrasound requires continued workup with fine needle aspiration in order to rule out malignancy and to resolve the mass.Answer 5: Surgical excision would be indicated in the management of a confirmed malignancy after biopsy had been performed. A simple breast cyst may resolve after FNA and would not need any further workup.Bullet Summary:The best initial step in management for a simple breast cyst is fine needle aspiration.
3.5
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