achilles
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A 49-year-old woman has a firm, 2-cm mass in the right breast that has been present for 3 months. Mammogram has been read as "cannot rule out cancer," but it cannot diagnose cancer either. A fine-needle aspiration of the mass (FNA) and cytology do not identify any malignant cells. Which of the following is the most appropriate next step in management?
A. Reassurance and reappointment in a year
B. Repeat mammogram and FNA in 1 month
C. Core or incisional biopsies
D. Lumpectomy and axillary dissection
E. Modified radical mastectomy
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| DrS
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I believe the correct step in a situation like this is excisional biopsy, but as this is not in the list the options i would go for C?
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| drkpp
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A
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| DrS
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Achilles, i think its time to end the suspense 
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| achilles
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this last comment from you really got me laughing...that was a good one...
well DrS you hardly get a question wrong...the answer is C- core or incisional biopsies.
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| achilles
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Negative findings do not have the same diagnostic value that positive findings have.
If this had been a 19-year-old woman suspected of having a fibroadenoma, one would have been satisfied with negative imaging studies (in that age, a sonogram) or the negative FNA.
But, at age 49, the risk of cancer is much higher. Given negative findings in the least invasive studies, one would feel compelled to move to more aggressive ways to obtain better tissue sampling and that is an incisional biopsy.
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| achilles
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a question though to everyone here...
what should you go for in this patient if the choices had included both excisional biopsy and core/incisional biopsy. is the size of the beast mass the deciding factor ? and if yes then what is the size at which one should go for an excisional or an incisional biopsy.
is 2 cms a large or a small mass?
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| DrS
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Thats a good question, i guess the answer would be in the american breast cancer management guidelines. Any idea where u can find them online?
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| achilles
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well, looked it up in aafp.org...core needle biopsy is a more accurate and sensitive test than FNAC too and is considered to be better...CNB takes a much bigger sample than FNAC and thus has better chances of diagnosing if a malingnancy is +nt or not.
the first steps are generally FNAC and then CNB if FNAC is equivocal and the gold standard to diagnose if the tissue samples are equivocal in a highly suspicious lesion is excisional biopsy if the mass is small and an incisional biopsy in a larger mass.
but could not find which size is considered small and which large...if anyone can come up with that pls post it...
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| anjushree
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after google search ---mass smaller than an inch -----excisional biopsy
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