Choose between exams

Case study:

A 38-year-old female has had a fully movable, firm, and well-circumscribed mass for 5 years. During the past 5 years, the size of the mass remained approximately the same. The mammography showed a shadow with slightly irregular border. Nothing else is remarkable. What exam should be done to determine the nature of the mass? (The options here are fine needle aspiration, cone biopsy, incisional biopsy, and excisional biopsy.)

Opinion:

Ask her attitude toward the mass.

• She wants it out even if the tumor is benign.

Do a fine needle aspiration.

Reason
If the cytology result turns out to be benign, a fine needle aspiration dealt a minimal injury and preserves the possibility to have a conservation surgery.

Do not do a excisional biopsy.

Reason
If the biopsy result shows malignancy, the excision border may not sufficient to provide a tumor cell-free margin.

• She wants it out only if the tumor is malignant.

Do a cone biopsy