Examkin

Soru

Zorluk: ZorBreast Disorders

A 58-year-old nulliparous woman is evaluated in the clinic following a recent breast biopsy. She initially presented with a vague firmness in her left breast. Subsequent mammography revealed a 2.2-cm irregular, highly dense lesion with radiating spicules and clustered pleomorphic microcalcifications in the lower outer quadrant. Ultrasound imaging confirmed a solid, hypoechoic mass with architectural distortion and posterior acoustic shadowing. An uncomplicated core needle biopsy was performed under ultrasound guidance. The pathology report indicates fragments of dense fibrous stroma and benign ductal epithelium, with no atypical cells identified. The patient takes no medications and has no family history of breast cancer. On physical examination, there is a vague thickening in the left lower outer quadrant but no dominant mass. Which of the following is the most appropriate next step in this patient's care?

  1. Surgical excision of the lesionCevap
  2. B
    Short-interval follow-up imaging in 6 months
  3. C
    Reassurance and resumption of routine screening
  4. D
    Contrast-enhanced breast magnetic resonance imaging
  5. E
    Initiation of prophylactic tamoxifen therapy

Cevap

Surgical excision of the lesion
The correct answer is surgical excision of the lesion. This patient presents with classic features of radiologic-pathologic discordance. The imaging findings (a spiculated, highly dense mass with pleomorphic microcalcifications, architectural distortion, and posterior acoustic shadowing) are highly suspicious for malignancy (BI-RADS 4 or 5). However, the core needle biopsy returned entirely benign tissue. When histopathology does not provide a concordant benign explanation for highly suspicious imaging, sampling error (missing the malignant focus during the needle biopsy) must be assumed. Therefore, the next most appropriate step is an excisional biopsy to obtain the entire lesion and definitively rule out breast cancer.

Adım Adım Çözüm

1
Analyze the patient's imaging findings.
The mammogram and ultrasound demonstrate classic malignant features (spiculated mass, pleomorphic microcalcifications, architectural distortion), representing a highly suspicious (BI-RADS 4 or 5) lesion.
To establish the pre-test probability of malignancy before interpreting the biopsy.
2
Evaluate the core needle biopsy results.
The biopsy shows only benign changes (dense fibrous stroma, benign epithelium) without any atypical cells.
To determine if the histopathology provides a concordant explanation for the suspicious imaging findings.
3
Determine the appropriate management for radiologic-pathologic discordance.
Surgical excision of the lesion is required.
Because the benign pathology does not correlate with the highly suspicious imaging, a sampling error (false-negative biopsy) must be assumed, mandating definitive surgical excision to rule out carcinoma.

Anahtar Kavram

Radiologic-pathologic discordance in breast biopsy requires surgical excision.
Bu soruyu puanla

Konular

Breast Disorders

Bu konudan daha fazla soru