American Board of Internal Medicine (ABIM) Certification Practice Exam

When managing patients with a history of early breast cancer and suspicious findings for metastasis, what should be performed?

1. CT scan of the abdomen

2. Biopsy of a metastatic site

3. Immediate surgery

4. Start chemotherapy

The correct answer is: Biopsy of a metastatic site

In the context of managing patients with a history of early breast cancer who present with suspicious findings for metastasis, performing a biopsy of a metastatic site is the most appropriate action. This approach allows for definitive histological confirmation of metastasis, which is crucial in determining the most appropriate treatment plan. When suspicious findings arise, imaging studies may suggest metastatic disease; however, these findings need to be corroborated by a biopsy to ascertain the presence of cancer cells in the suspected metastatic site. This step is essential as it also helps to characterize the biology of the metastatic disease, which can influence treatment decisions. By obtaining a biopsy, clinicians can gain insights into the tumor's receptor status and other molecular markers, guiding more personalized and effective therapy. Other options, such as conducting a CT scan of the abdomen, while useful for detecting metastasis, do not provide the necessary confirmation of malignancy and cannot replace the critical step of obtaining tissue for diagnosis. Immediate surgery is not warranted without definitive evidence of metastatic disease, as the management strategy shifts based on whether the disease is localized or systemic. Starting chemotherapy should also be based on confirmed metastatic disease, as it is generally not indicated without a clear diagnosis and understanding of the disease's current state. Hence, a biopsy of a metastatic