Surgical Oncology And Breast Disease Practice Test

A 46-year-old woman presents with a palpable breast mass. She has dense breasts on prior imaging and is worried that mammography will miss cancer. Exam shows a 2-cm firm mass; no skin changes. She has no contraindications to imaging. The clinician explains that for women ≥40 with a palpable mass, diagnostic mammography is first-line, often combined with targeted ultrasound; breast MRI is reserved for specific indications such as high-risk screening, problem-solving, or staging in selected cases, not as initial test for most palpable masses.

What is the most appropriate initial diagnostic test for this patient's breast mass?

A 45-year-old G2P2 woman presents with a new right breast lump noticed 3 weeks ago. She reports mild tenderness but no fever, nipple discharge, or recent trauma. Menarche was at age 11; first pregnancy at 34. She drinks 1–2 glasses of wine nightly and has obesity. Her mother had breast cancer at 52. She has never had breast surgery and last screening mammogram was 4 years ago. On exam, there is a 2.5-cm firm, irregular, nonmobile mass in the upper outer quadrant of the right breast with subtle skin dimpling; no erythema. One right axillary node is palpable and firm. Vitals are normal. The clinician is concerned for malignancy and wants the most appropriate initial imaging as part of triple assessment (clinical exam, imaging, tissue diagnosis). According to current guidelines, evaluation of a palpable mass in a woman ≥40 begins with diagnostic mammography with targeted ultrasound as needed to further characterize the lesion and guide biopsy planning.

What is the most appropriate initial diagnostic test for this patient's breast mass?