Ans is 'c' ie. Biopsy First investigation is -------> FNAC Best & the definitive investigation is -------> Open biopsy Preferred method -------> Core needle biopsy "Core-needle biopsy is the preferred method for diagnosis of palpable or nonpalpable breast abnormalities." - Schwaz 9/e p425 The diagnosis of breast cancer depends ultimately upon examination of tissue or cells removed by biopsy or FNAC (also known as FNA biopsy). The treatment should never be undeaken without a confirmed diagnosis of cancer. Thus a biopsy (biopsy includes all kinds of biopsy including FNA biopsy, also known as FNAC) should be done of all suspicious masses found on physical examination and in the absence of a mass of suspicious lesions demonstrated by mammography. A breast mass should not be followed without a biopsy. Exception to this is perhaps in the premenopausal woman with a nonsuspicious mass presumed to be fibrocystic disease. A lesion such as this could be observed through one or two menstrual cycles. However if the mass does not completely resolve during this time, it must be biopsied. For biopsy, FNAC (or FNAB) is the simplest method Schwaz writes - "The combination of diagnostic mammography, ultrasound or sterotactic localization and fine needle aspiration biopsy is almost 100% accurate in the diagnosis of breast cancer. However while FNA biopsy permits cytological evaluation, core-needle or open biopsy also permits the analysis of breast tissue architecture and allows the pathologist to determine whether invasive cancer is present. Core-needle biopsy is preferred over open biopsy for nonpalpable breast lesions because a single surgical procedure can be planned based on the results of the core biopsy. The advantages of core-needle biopsy include a low complication rate, avoidance of scarring, and a lower cost." CSDT writes? "Open biopsy under local anaesthesia as a separate procedure prior to deciding upon definitive treatment is the most reliable means of diagnosis."