Case 26 Answer 4

BI-RADS 2, Benign. Simple cyst. This mass is entirely anechoic, has imperceptibly thin walls, and has increased through transmission, and thus is a classic simple cyst.

If we could not definitively show this, and the margins look somewhat lobulated or indistinct, then it would be suspicious, and should be aspirated. If the margins were circumscribed, then it would fall into a probably benign category (IF there were no comparisons!) BUT-- when a cancer has already been demonstrated elsewhere in the breast tissue, then biopsy of Probably Benign lesions makes sense for surgical and oncologic planning.

Special Oral Boards Note: BEWARE of the case with more than one finding!

A good practice is to identify the obvious finding... "I see a 2cm round mass in the central breast"

and diligently search the rest of the breast tissue... "I am looking for any other finding."

IF you don't see anything else then... "I don't see anything else, so we have a round mass with smooth margins in the..."

IF you see a second finding... "I also see a second finding which looks more suspicious. I'll first describe the more suspicious area: a 1.5cm spiculated mass is present in the..."