A 28-year-old woman presents with a painless, mobile, firm breast lump in the upper outer quadrant of the left breast, noticed 3 months ago. Clinical examination confirms a well-defined, non-tender mass approximately 2 cm in size. What is the investigation of choice to confirm the diagnosis of fibroadenoma?

## Investigation of Choice for Fibroadenoma **Key Point:** In a young woman (<35 years) with a clinically benign breast lump, the investigation of choice is **Ultrasound breast combined with Fine-Needle Aspiration Cytology (FNAC)** — forming the "triple assessment" alongside clinical examination. This is the standard recommended approach in NEET PG / Indian surgical practice (Bailey & Love's Short Practice of Surgery, 27th ed.). ### Why Ultrasound + FNAC? 1. **Superior soft tissue characterization** in dense breast tissue (common in young women aged 20–35) 2. **No ionizing radiation** — critical in young, potentially reproductive-age women 3. **Real-time guidance** for accurate needle placement during FNAC 4. **High sensitivity (~90%) and specificity (~95%)** for fibroadenoma when combined with clinical findings 5. **Minimally invasive, cost-effective, and widely available** — aligns with Indian healthcare context ### Imaging Features of Fibroadenoma on Ultrasound | Feature | Appearance | |---------|------------| | Shape | Oval, well-circumscribed | | Echogenicity | Hypoechoic or isoechoic | | Margins | Sharp, non-infiltrative | | Vascularity | Minimal on Doppler | | Posterior acoustic enhancement | Often present | **Clinical Pearl:** Fibroadenomas demonstrate a characteristic **"slipping sign"** on ultrasound — they are highly mobile and compressible under the probe, helping distinguish them from malignancy. ### Why Not Other Options? - **Mammography (A):** Less sensitive in dense breast tissue of young women; not first-line for lesions <3 cm in women <35 years. Recommended as part of triple assessment in women >35 years. - **Core Needle Biopsy under ultrasound guidance (C):** Provides histological architecture and is increasingly preferred in Western practice for definitive diagnosis of indeterminate lesions. However, for a clinically typical fibroadenoma in a young woman, CNB is reserved for cases where FNAC is non-diagnostic or the lesion appears atypical. In NEET PG / Indian surgical curricula (Bailey & Love, SRB's Manual of Surgery), ultrasound + FNAC remains the investigation of choice for initial evaluation. - **Excision biopsy (D):** Both therapeutic and diagnostic but is invasive; reserved for symptomatic, enlarging, or histologically indeterminate lesions after non-operative workup. **High-Yield:** The **triple assessment** — clinical examination + ultrasound + FNAC — is the cornerstone of benign breast disease evaluation in young women per Indian surgical textbooks. Core needle biopsy is a valid and increasingly used alternative in modern practice, but FNAC-based triple assessment remains the NEET PG standard answer for investigation of choice in a young woman with a typical fibroadenoma.