Examkin

Soru

Zorluk: KolayBreast Disorders

A 23-year-old nulliparous woman comes to the clinic because she found a lump in her right breast 2 weeks ago. She has no family history of breast cancer or other malignancies. Menarche was at age 12, and her menses are regular, occurring every 28 days. She takes no medications. On physical examination, her temperature is 37.0°C (98.6°F), blood pressure is 110/70 mm Hg, and pulse is 72/min. Breast examination reveals a 2-cm, firm, mobile, rubbery, well-circumscribed, non-tender mass in the upper outer quadrant of the right breast. There is no overlying skin erythema, dimpling, nipple retraction, or abnormal discharge. Examination of the axillae reveals no palpable lymphadenopathy. Which of the following is the most appropriate next step in evaluation?

  1. Targeted ultrasound of the breastCevap
  2. B
    Diagnostic mammography
  3. C
    Core needle biopsy
  4. D
    Reassurance and clinical follow-up in 1 year
  5. E
    Magnetic resonance imaging of the breast

Cevap

Targeted ultrasound of the breast
The correct answer is targeted ultrasound of the breast. When a patient presents with a palpable breast mass, the initial workup depends primarily on the patient's age. For women under the age of 30, targeted breast ultrasound is the first-line imaging modality. This is because young women typically have radiographically dense breast tissue, which makes mammography difficult to interpret and less sensitive for detecting abnormalities. Ultrasound can accurately characterize the mass as simple cystic, complex cystic, or solid. If the mass is solid, the ultrasound features can help determine whether it appears benign (e.g., fibroadenoma, which this patient likely has) or suspicious, thereby guiding the decision for subsequent tissue biopsy.

Adım Adım Çözüm

1
Identify the patient's age and clinical presentation.
The patient is a 23-year-old woman presenting with a new, discrete, palpable breast mass that feels clinically benign (firm, mobile, rubbery).
Age and clinical findings determine the diagnostic algorithm for breast masses.
2
Determine the appropriate initial diagnostic modality based on the patient's age.
For women under age 30, ultrasound is the first-line modality.
Young women typically have dense breast tissue, which decreases the sensitivity of mammography. Ultrasound effectively characterizes the mass (solid vs. cystic) and can guide biopsy if necessary.

Anahtar Kavram

In women under 30 years of age presenting with a palpable breast mass, targeted ultrasound is the most appropriate initial imaging step. For women 30 years of age and older, diagnostic mammography is preferred.
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Breast Disorders

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