Primary care guide to managing a breast mass: step-by-step workup.

Missed breast cancer is the most common malpractice suit filed in the US. But even without a biopsy of every mass, clinicians can reduce the risk of failed diagnosis to 1% by using a triple-diagnosis method to working up a breast mass, according to these experts, who offer a step-by-step guide. Includes QuickTimeTM video of breast exam. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the US. Unless the potential for false-negative results of physical examination, mammography, ultrasound, and fine-needle aspiration biopsy (FNAB) is recognized, delay in the diagnosis of breast cancer will continue to occur. A systematic, thorough approach to the workup of any breast mass-- including a careful history, clinical breast examination, and documentation--is crucial. Upon detection of a mass, distinguishing the cyst from the solid mass (often by fine-needle aspiration or FNAB) is one of the most important tasks facing the clinician. Although most cysts resolve upon aspiration, solid masses require further workup to rule out cancer. Because of the false-negatives associated with individual methods of diagnosis, the authors recommend the triple-diagnosis method of detection. Simultaneous evaluation of a breast mass using clinical breast examination, radiography, and FNAB can lower the risk of missing cancer to only 1%, effectively reducing the rate of diagnostic failure and increasing the quality of patient care.