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Background: Breast cancer is the most common cancer worldwide. An early and accurate diagnosis is essential in optimizing the disease outcome. Triple assessment which includes clinical assessment, imaging and pathological examination is recommended for diagnosing breast cancer.
The Case: A 43-year-old lady with a strong family history of cancer presented with a right breast lump for 2 months. Physical examination revealed a 2x3 cm mass in the right breast with no malignancy features. Mammogram and ultrasound revealed BI-RADS 1 (negative) and BI-RADS 2 (benign) respectively. A lumpectomy was done, and the sample was sent for pathological examination. The result came back as a grade 2 invasive breast carcinoma, no special type, stage pT1b. ER was negative while PR and HER2 were not tested. The patient then underwent right total mastectomy with level II axillary clearance. CT thorax, abdomen & pelvis was scheduled a month later to complete the cancer staging. PR and HER2 status were tested for further management.
Conclusion: All 3 components of triple assessment is indispensable for diagnosing breast cancer. Despite the high sensitivity of imaging modalities, minimally invasive biopsy technique (MIBT) is still the gold standard. False-negative tests can happen due to multiple factors; they should not become the absolute guidance for further management of patients. A doctor’s clinical judgement, based on thorough history taking and physical examination, is more important in guiding the next step of patient care.
Key Words: Breast Neoplasms, Mammography, Ultrasonography, Biopsy
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