It may be appropriate to proceed directly to image-guided biopsy if a palpable lesion has suspicious features on US. If US findings are particularly worrisome for malignancy, diagnostic mammography or DBT may be performed before tissue sampling to delineate disease extent (eg, calcifications extending beyond the margins of the US-identified solid mass) and identify any additional suspicious findings in the ipsilateral or contralateral breast. Core-needle biopsy has been shown in large series to be superior to FNA in terms of sensitivity, specificity, and correct histological grading [27]. Some practices have had good results using FNAB, but this may be facility specific, and a lower threshold for radiologic-pathologic discordance may need to be applied [50,51]. US-guided FNAB may be preferred over core biopsy in rare situations but should be used judiciously. Palpable Breast Masses Mammography Diagnostic Mammography may be useful in a woman <30 years of age with a suspicious sonographic finding that correlates to a palpable mass. If US findings are particularly worrisome for malignancy, mammography diagnostic or diagnostic DBT would usually be performed before tissue sampling to identify any additional suspicious findings and/or delineate the extent of disease (eg, calcifications extending beyond the margins of the US-identified solid mass) in the ipsilateral breast. Mammography diagnostic is recommended as a prebiopsy assessment in cases in which cancer is strongly suspected clinically [41]. Mammography Screening In women presenting with signs or symptoms, including a palpable breast mass, screening mammography is not useful as the next imaging study. Screening mammography is provided to women without signs or symptoms of breast disease. MRI Breast There is no relevant literature to support the use of the use of MRI of the breast with or without IV contrast as the next step in evaluating a palpable mass with suspicious sonographic features in women <30 years of age [2,23-25].
Palpable Breast Masses. It may be appropriate to proceed directly to image-guided biopsy if a palpable lesion has suspicious features on US. If US findings are particularly worrisome for malignancy, diagnostic mammography or DBT may be performed before tissue sampling to delineate disease extent (eg, calcifications extending beyond the margins of the US-identified solid mass) and identify any additional suspicious findings in the ipsilateral or contralateral breast. Core-needle biopsy has been shown in large series to be superior to FNA in terms of sensitivity, specificity, and correct histological grading [27]. Some practices have had good results using FNAB, but this may be facility specific, and a lower threshold for radiologic-pathologic discordance may need to be applied [50,51]. US-guided FNAB may be preferred over core biopsy in rare situations but should be used judiciously. Palpable Breast Masses Mammography Diagnostic Mammography may be useful in a woman <30 years of age with a suspicious sonographic finding that correlates to a palpable mass. If US findings are particularly worrisome for malignancy, mammography diagnostic or diagnostic DBT would usually be performed before tissue sampling to identify any additional suspicious findings and/or delineate the extent of disease (eg, calcifications extending beyond the margins of the US-identified solid mass) in the ipsilateral breast. Mammography diagnostic is recommended as a prebiopsy assessment in cases in which cancer is strongly suspected clinically [41]. Mammography Screening In women presenting with signs or symptoms, including a palpable breast mass, screening mammography is not useful as the next imaging study. Screening mammography is provided to women without signs or symptoms of breast disease. MRI Breast There is no relevant literature to support the use of the use of MRI of the breast with or without IV contrast as the next step in evaluating a palpable mass with suspicious sonographic features in women <30 years of age [2,23-25].