DrVirgo
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HELP!!!
-This was a tricky one... I will post the explanation later, but the answer is not what I thought it would be as per Kap.
A 35 year old woman comes to the physician after she palpated a lump in her right breast. She has no other complaints. She has not seen a doctor for 10 years. She regularly performs breast self-exams after menses. She has no history of medical problems. Her mother died of breast cancer at teh age of 40. Visual examination of the breasts shows no abnormalities. Manual breast examination shows a 1 X ! cm, rubbery, firm, freely mobile round mass in the upper outer quadrant of the right breast; no axillary lymph nodes are palpated. Which of the following is the most appropriate next step in management:
A. Observation
B. Ultrasound
C. Excisional biopsy
D. Fine Needle Aspiration
E. Mammography
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| Aashi
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E. Mammography
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| DrVirgo
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Kap says U/S and FNA...
WHY mammo?
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| yu
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D
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| fox
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its FNAC
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| Aashi
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Dear Dr.Virgo
Shez got a family HX of Breast cancer ,and for such individuals screening mamo irrespective of wether they have breast mass or not,is started at an earlier age ,by age 35 to be precise...otherwise the screening is done at 40
If it was a 35 yr old lady presenting with a mass,WITHOUT a family hx -->the ans is FNA-->FNA can be done without preceding a U/S.
Kaplan surgery notes has this info..
GL
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| DrVirgo
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Thanks for the explanation aashi...
According to UW: The answer is E
They say: The findings on physical exam are consistent with a fibroadenoma. Choices A-E are all appropriate management of this condition in this patient, however mammography is the best initial step.
And the educational objective is:
Know how to evaluate breast mass.
Apart from the fibroadenoma, this patient might have other anomalies, imperceptible on physical exam that might be seen on the mammogram. Ultrasound is inferior for that purpose. Thus, it is best to make the decision for this patient's management after the mammogram is obtained.
This is confusing because Kap says:
FNA or sonogram is sufficient to establish diagnosis (surgery)
The example given with fibroadenoma is in an 18 year old girl, and they say sonogram happens to be quite diagnostic for fibroadenomas. Mamograms are useless at this age because the breast is too dense. Sonogram is the only imaging technique suitable for the very young breast.
Then there is another example with a 35 year old woman, but she has fibrocystic disease and for this case the first step is to do a mammogram.
So to conclude -when to answer mammogram I believe has to do with age. Over the age of 35-40, a mammogram would be useful.
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| Dr.Luck
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but guys...why don't we do FNAC to see that if the mass goes away & histologic exam is benign then no furtther Rx & if histo is bad then we do rest of the management?
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| snowdrops
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Dr.Luck wrote:
but guys...why don't we do FNAC to see that if the mass goes away & histologic exam is benign then no furtther Rx & if histo is bad then we do rest of the management?
Your explanation is exactly same as what Kaplan lecturer said.
Mammography is for screening to detect mass. If the mass is so obvious, why need bother to go back from screening test?!
UW got wrong answer.
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| DrVirgo
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We need to do mammo to find OTHER possible masses (that may be non-palpable), not confirm this one.
snowdrops wrote:
Your explanation is exactly same as what Kaplan lecturer said.
Mammography is for screening to detect mass. If the mass is so obvious, why need bother to go back from screening test?!
UW got wrong answer.
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| DrVirgo
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Dr.Luck wrote:
but guys...why don't we do FNAC to see that if the mass goes away & histologic exam is benign then no furtther Rx & if histo is bad then we do rest of the management?
FNA is different from Aspiration of the cyst!
FNA is done in a solid tumor (e.g., in Fibroadenoma) and
Aspiration of a cyst to see if it goes away is done in Fibrocystic disease.
This is a case of fibroadenoma, not fibrocystic disease so we can't do what you said.
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| doyoudig
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does FNA not stand for Fine needle aspiration , i mean aspiration and aspiration means the same thing to me?? I don't get what u said??
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| ram3
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mammography is wrong with a history of breast cancer and age thirty five or over
you always do fine needle biopsy first come on guys this was easy
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| klimt
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FA says:
- low risk (<35y, no family history) do FNA
- high risk (>35y, family history) do mammography
so it's E
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| oggn
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I think mammoraphy--Excision biopsy.
if young patient <35--mass,then do Excision biopsy or FNAB without mammo .If older pt.then mammo--excision biopsy.
If mass is there biopsy for sure .Choose acc to pt age and preference.
FNAC we do if we suspect fibrocystic disease/cyst/don't know.Here it is clear mass,so no FNAC.Please correct me if I am wrong.
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| dr19
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mammography is an obligatory exam for this patient,which has not yet been done ,considering that there is possibility of presence of other risky masses which are not palpable.
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