Skill Checkup: A 64-Year-Old Woman With a Breast Mass and Back and Hip Pain

Maurie Markman, MD


September 08, 2021

Correct Answer: C. Biopsy

Evaluation of a breast mass is guided by findings on history, physical examination, imaging, and biopsy. Although all of the tests might be appropriate at some point, the triad of clinical breast examination, imaging (eg, mammography and ultrasonography), and needle biopsy can lead to a definitive diagnosis in nearly all cases. Thus, the next test would be biopsy.

Hormone receptor (ie, estrogen receptor and progesterone receptor) status as well as HER2 status are usually confirmed via immunohistochemistry staining of a biopsy specimen if there is evidence of cancer. There are four main histologic subtypes of breast cancer: hormone receptor (HR)–positive/human epidermal growth factor receptor 2 (HER2)–negative, HR-negative/HER2-negative (triple negative), HR-positive/HER2-positive, and HR-negative/HER2-positive. Determination of hormone receptor status is crucial for selecting therapy.



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