11-21-2006, 08:11 AM
Hi there!
I'm confused with the management of the breast mass, more specifically with the order of either FNA, mamography or biopsy.
This is what I found in Harrison, it's sound good to me.
In premenopausal women, lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2 to 4 weeks, during the follicular phase of the menstrual cycle. Days 5 to 7 of the cycle are the best time for breast examination. A dominant mass in a postmenopausal woman or a dominant mass that persists through a menstrual cycle in a premenopausal woman should be aspirated by fine-needle biopsy or referred to a surgeon. If nonbloody fluid is aspirated and the lesion is thereby cured, the diagnosis (cyst) and therapy have been accomplished together. Solid lesions that are persistent, recurrent, complex, or bloody cysts require mammography and biopsy, although in selected patients the so-called triple diagnostic techniques (palpation, mammography, aspiration) can be used to avoid biopsy (Figs. 76-1, Figs. 76-2, and 76-3). Ultrasound can be used in place of fine-needle aspiration to distinguish cysts from solid lesions. Not all solid masses are detected by ultrasound; thus, a palpable mass that is not visualized on ultrasound must be presumed to be solid.
The reason that I'm confused because I found the questions from UW that are in contrast to this, the question was 35 year old woman, has the palpable breast mass, mother had breast Ca at 40. UW answer was that the first step in management is mamography, but mamography is never the first test based on Harrison.
So what is the right algorithm for the evaluation of the breast mass???
Thanks
I'm confused with the management of the breast mass, more specifically with the order of either FNA, mamography or biopsy.
This is what I found in Harrison, it's sound good to me.
In premenopausal women, lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2 to 4 weeks, during the follicular phase of the menstrual cycle. Days 5 to 7 of the cycle are the best time for breast examination. A dominant mass in a postmenopausal woman or a dominant mass that persists through a menstrual cycle in a premenopausal woman should be aspirated by fine-needle biopsy or referred to a surgeon. If nonbloody fluid is aspirated and the lesion is thereby cured, the diagnosis (cyst) and therapy have been accomplished together. Solid lesions that are persistent, recurrent, complex, or bloody cysts require mammography and biopsy, although in selected patients the so-called triple diagnostic techniques (palpation, mammography, aspiration) can be used to avoid biopsy (Figs. 76-1, Figs. 76-2, and 76-3). Ultrasound can be used in place of fine-needle aspiration to distinguish cysts from solid lesions. Not all solid masses are detected by ultrasound; thus, a palpable mass that is not visualized on ultrasound must be presumed to be solid.
The reason that I'm confused because I found the questions from UW that are in contrast to this, the question was 35 year old woman, has the palpable breast mass, mother had breast Ca at 40. UW answer was that the first step in management is mamography, but mamography is never the first test based on Harrison.
So what is the right algorithm for the evaluation of the breast mass???
Thanks