Mammogram

Mammography
All patient of breast lump should undergo triple assessment as it has very high PPV(positive predictive value). The first step is clinical examination- and determine if the lump is likely to be benign or malignant (clinical suspicion).
The next should be radiology, before proceeding to tissue diagnosis. Options are mammogram if the age is >30yrs and USG for younger patients of <30 yrs of age.
The idea of doing imaging before tissue diagnosis is to avoid change in morphology and size of tumor after tissue diagnosis (FNAC or CNB), a hematoma may form which will alter the architecture and size of the primary tumor, both of which are very important in making decisions in management and follow-up of patient. if clinical suspicion is benign, it can be followed up and if doesnt resolve then subjected to radiology investigation.
In the above question, 45 yrs old lady with hard lump- clinical suspicion should be of malignancy --> next step is MMG.