From the Research
The appropriate next step for this 25-year-old woman with a 3 cm breast lump confirmed as fibroadenoma on ultrasound would be excision after core needle biopsy (CNB), as indicated in option A. Since the patient is worried and has specifically requested removal, this approach is justified. Additionally, the fibroadenoma is relatively large at 3 cm, which is another factor supporting excision, as suggested by 1. The standard management for fibroadenomas typically involves observation for smaller, asymptomatic lesions, but excision is appropriate when the lesion is larger than 2 cm, shows rapid growth, has suspicious features, or when the patient specifically requests removal due to anxiety or discomfort, as indicated in 1 and 2. Some studies, such as 3 and 4, suggest that excision based solely on size may not be warranted, but these studies do not directly address the patient's request for removal or the potential impact on quality of life. While monthly self-examination (option D) is good practice for breast health awareness, it doesn't address the current concern. A mammogram (option B) would not be the next step as ultrasound has already confirmed the diagnosis and mammography has limited value in young women with dense breast tissue. Performing only a CNB (option C) without planning for excision would not address the patient's request for removal of the lump. Key factors to consider include:
- Patient anxiety and request for removal
- Size of the fibroadenoma (3 cm)
- Potential for malignancy or other complications, although considered low, as discussed in 3, 4, and 5
- Importance of addressing patient concerns and improving quality of life. Given the most recent and highest quality evidence, excision after CNB is the most appropriate next step, as it balances the need for diagnostic certainty with the patient's desire for removal of the lump, as suggested by 1.