PERSISTENT BREAST MASS
A 35-year-old woman has a persistent breast mass after a fine-needle
aspiration has been performed. The breast mass is confirmed by
ultrasonography.Diagnosis. With the combination of physical examination, fine-needle aspiration
or core biopsy, and mammography, open biopsies are being performed less
frequently. Excisional biopsy has the advantage of a complete evaluation of the
size and histologic characteristics of the tumor before definitive therapy is
selected. An excisional biopsy is usually recommended in the following
circumstances:
In the past, recurrent or persistent simple breast cysts were routinely excised.
Because of improvement in ultrasonographic technology, these cysts may now
be followed conservatively. This patient, who has had a fine-needle aspiration
before, is a candidate for an excisional biopsy.
Management. Treatment is based on the established histologic diagnosis.
Cellular bloody cyst fluid on aspiration
Failure of a suspicious mass to disappear completely upon fluid aspiration
Bloody nipple discharge, with or without a palpable mass
Skin edema and erythema suggestive of inflammatory breast carcinoma, and a
needle core biopsy cannot be performed