Skill Checkup: A Menopausal Woman With a Lump in Her Right Breast

Pavani Chalasani, MD, MPH


January 18, 2022

Although mammography and ultrasound can confirm the presence, position, dimensions, and general visual features of the mass, they cannot provide a definitive diagnosis of cancer. Even if imaging suggests that the lesion is highly suspicious, only a thorough histologic examination of the specimen, obtained with a breast core biopsy, can provide confirmation of malignancy, as well as other information about the tumor that is critical for treatment decisions.

Ultrasound-guided fine-needle aspiration is a cytologic test that can distinguish benign from malignant lesions but may not obtain sufficient tumor cells for a more thorough histologic examination. Although whole-body PET/CT may be used for staging after the initial diagnosis of cancer is made, the definitive diagnosis is based on the pathology report of the breast biopsy.

On the basis of the sample tumor cells obtained under ultrasound guidance, the pathologist reported that the tumor was a hormone receptor (HR)–positive (both estrogen receptors and progesterone receptors were strongly positive), human epidermal growth receptor 2 (HER2)–negative, histologic grade 3 breast carcinoma. The patient was referred to a breast surgeon for discussion of local treatment options. Although she initially feared that mastectomy would be recommended, the patient was reassured by the breast surgeon that lumpectomy and radiation are effective for removal of all local tumor tissue at this early disease stage.


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