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Difficulty: EasyBreast Disorders

A previously healthy 33-year-old female is evaluated in the clinic for a tender mass in her right breast, first noticed 5 days ago. The pain is described as a localized ache that worsens with physical pressure. Her menstrual cycles are regular, and her last menstrual period was 2 weeks ago. She has no personal or family history of breast disease. Vital signs are within normal limits. Physical examination reveals a 3.5-cm, smooth, firm, and tender mobile mass in the upper outer quadrant of the right breast. There is no overlying skin erythema, dimpling, or nipple discharge. A targeted breast ultrasound is performed, which demonstrates a well-circumscribed, thin-walled, anechoic structure with posterior acoustic enhancement.

Which of the following is the most appropriate next step in management to alleviate this patient's symptoms?

  1. Fine-needle aspirationAnswer
  2. B
    Core needle biopsy
  3. C
    Surgical excision
  4. D
    Oral dicloxacillin therapy
  5. E
    Magnetic resonance imaging of the breast

Answer

Fine-needle aspiration
The correct answer is fine-needle aspiration. This patient's presentation of a newly painful breast lump corresponds with an ultrasound demonstrating a well-circumscribed, anechoic structure with posterior acoustic enhancement. These sonographic findings are the classic, pathognomonic features of a simple breast cyst. Because simple cysts are entirely benign and carry no increased risk of malignancy, asymptomatic patients require only reassurance and routine screening. However, when a simple cyst is symptomatic (e.g., causing pain or discomfort), the most appropriate next step in management is fine-needle aspiration. Aspiration drains the cystic fluid, collapsing the walls of the cyst, which provides immediate and definitive symptomatic relief.

Step-by-Step Solution

1
Interpret the clinical presentation and ultrasound findings.
The patient has a tender, mobile breast mass with ultrasound features showing a well-circumscribed, anechoic structure with posterior acoustic enhancement.
These specific sonographic features are pathognomonic for a benign simple breast cyst.
2
Determine the management algorithm for simple breast cysts based on symptoms.
Asymptomatic simple cysts require only routine observation, whereas symptomatic (painful) cysts require intervention.
Intervention is indicated solely to relieve patient discomfort, as simple cysts carry no malignant potential.
3
Select the most appropriate intervention for a symptomatic simple cyst.
Fine-needle aspiration is selected.
Aspiration safely and effectively drains the cyst fluid, collapsing the cyst wall and immediately relieving the pain.

Key Concept

Management of symptomatic simple breast cysts
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Topics

Breast Disorders

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