PAINE #PANCE Pearl – Gynecology


27yo, G1P1001, presents to the OBGYN office with complaints of a “breast lump”. She states she first noticed it during her pregnancy last year, but did not think anything of it until her mother told her to have it checked it out. She denies any personal or family history of malignancies or any change in size since her pregnancy. Visual inspection shows no nipple retraction, skin dimpling, or asymmetry, and physical examination reveals a 1.5cm, well-defined, non-tender mobile mass 4cm from the nipple in the 1 o’clock position.

  1. What would be the next step in the diagnostic evaluation of this lesion?
  2. She is obviously concerned about breast cancer. Are they any concerning features in this presentation?


  1. Given the ease of palpation, an ultrasound of the breast to further evaluate the lesion is the next appropriate step. Fine needle aspiration (FNA) or biopsy is not warranted in this patient because of her age and the morphology of the lesion.
  2. There are no concerning features in this patient presentation that would raise suspicion of malignancy. < 30 years of age, no nipple retraction, skin dimpling, asymmetry, and a well-defined border on palpation all suggest benignity.

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