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  #1  
Old 08-19-2012
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Default mammogram -> benign breast lump. next step ?

A 45-year-old woman is evaluated for a lump in the right breast that has been present for 3
months. The patieant is gravida 1, para 1. She has menses every 28 days. She is otherwise
healthy. No family history of breast cancer exists. Her mother died of endometrial cancer at
the age of 63 years.
On physical examination, vital signs are normal. A firm and nontender 2-cm mass in the
upper outer quadrant of the right breast is palpated. No other masses or axillary adenopathy
are noted.
A mammogram is suggestive of benign findings.
Which of the following is the most appropriate next step in the management of this
patient?
(A) Obtain a fine needle aspirate
(B) Obtain an ultrasound of the right breast
(C) Repeat mammogram in 1 year
(D) Test for BRCA-1 and BRCA-2 genes
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  #2  
Old 08-19-2012
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A.....
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  #3  
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Since this is an elderly Woman, A mammogram would have a good visualization and thus if suggestive of benign findings, should be repeated next year. the answer hence,
(C)
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Old 08-19-2012
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Quote:
Originally Posted by rocketprinciple View Post
Since this is an elderly Woman, A mammogram would have a good visualization and thus if suggestive of benign findings, should be repeated next year. the answer hence,
(C)
you are correct.
as per kaplan surgery uncle, i remember he said if mammo is negative then we can go ahead for FNAC. if FNAC gets negative for cancer, then go for excisional bx. basically, to make sure there is no cancer. i was wondering then would have been FNAC.
ur thoughts ?
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Quote:
Originally Posted by tyagee View Post
you are correct.
as per kaplan surgery uncle, i remember he said if mammo is negative then we can go ahead for FNAC. if FNAC gets negative for cancer, then go for excisional bx. basically, to make sure there is no cancer. i was wondering then would have been FNAC.
ur thoughts ?
i think then FNAC would be the best option
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Old 08-19-2012
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Quote:
Originally Posted by riya_rai84 View Post
i think then FNAC would be the best option
ans is C!
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Quote:
Originally Posted by tyagee View Post
ans is C!
1 year long period,it may be asociated with bad outcome.i think beter to do FNAC.
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Quote:
Originally Posted by tyagee View Post
you are correct.
as per kaplan surgery uncle, i remember he said if mammo is negative then we can go ahead for FNAC. if FNAC gets negative for cancer, then go for excisional bx. basically, to make sure there is no cancer. i was wondering then would have been FNAC.
ur thoughts ?
IMHO, you don't proceed to the next step just coz the 1st one is a -ive, essentially in this case "benign finding of the mass" = -ive finding, right?!
Then, why go to FNAC?
You MIGHT BE confusing it with the mammo results are -ive but the clinical suspicion stays high and circumstances (say a young lady with high density of breast tissue) are against it(the -ive result), THEN you go for FNAC and the same rule downhill from there!
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Old 08-20-2012
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Its C
If it shows benign findings (BIRADS 1) you repeat mammogram in one year, there is no point on FNAC in a moderately young patient
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Old 08-20-2012
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i know the ans is C , I fell for A ..............

well she has painless mass ( CA is painless) +
in outer quadrant ( is the most common location for CA ) +
2cm is size ( that is not very small infact TMN classification counts a size more than 2 cm as T2 not T1) these point to CA

but her age is 45 ( breast CA screening starts at 50 yr & below that its low risk + two pregnancies and shorter periods of 28 days ) so mammography result can be counted valid and repeat later .....
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I think the key point here is that she is a low risk for breast Ca.
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Quote:
Originally Posted by Novobiocin View Post
I think the key point here is that she is a low risk for breast Ca.
age 45 with breast lump! should we consider that as low risk ?
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Old 08-20-2012
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Quote:
Originally Posted by tyagee View Post
age 45 with breast lump! should we consider that as low risk ?
No histoy of breast cancer/ovary cancer, findings that indicate benign lesion are indicative of low risk.


Intermediate risk would be her age and the fact that she has a lump.

No high risk whatsoever given in the history (maybe firm and nontender) but yet again thatsonly "suggestive" and by itself not a good predictor
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Old 08-21-2012
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Quote:
Originally Posted by XpaezX View Post
No histoy of breast cancer/ovary cancer, findings that indicate benign lesion are indicative of low risk.


Intermediate risk would be her age and the fact that she has a lump.

No high risk whatsoever given in the history (maybe firm and nontender) but yet again thatsonly "suggestive" and by itself not a good predictor
so are you going with mammo after 1 year ? i cant get the concept still
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Old 08-21-2012
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(C) Repeat mammogram in 1 year
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