[size=20px]A 14-year-old girl presents to your clinic with a palpable, non-tender right breast mass noted for the past 3 weeks. She denies trauma, fever, or nipple discharge. On exam, the mass is firm, mobile, and measures approximately 4 cm in diameter. An ultrasound shows a solid, well-circumscribed lesion with features consistent with a fibroadenoma. She has no family history of breast cancer or known genetic syndromes. What is the most appropriate next step in management?

 

a Core needle biopsy

 

b Immediate excisional biopsy without a margin

 

c Immediate excisional biopsy with a 1 cm margin

 

d Observation with ultrasound surveillance at 6 and 12 months[/size]

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Correct answer

d Observation with ultrasound surveillance at 6 and 12 months

 

This patient has a breast mass less than 5 cm in diameter with benign sonographic features and no high-risk history. Current guidelines recommend observation and serial imaging for low-risk fibroadenoma-like lesions of this size. If there is >50% growth on follow-up imaging, if the patient becomes symptomatic, or if patient or family are requesting further intervention, excisional biopsy is acceptable. Clear margins are not necessary unless a lesion is greater than 5 cm in diameter.