In a study of women presenting with palpable breast thickening, the sensitivity of diagnostic mammography for invasive cancer detection was 60%, whereas the sensitivity of US alone was 100% [34]. Breast US should be performed using a high-resolution, real-time linear array scanner with an adjustable focal zone and a transducer with a minimum center frequency of 12 MHz [35]. Some mammographers also perform screening US of the remainder of the ipsilateral breast and the contralateral breast in the setting of a suspicious finding [33]. If there is no sonographic correlate for a suspicious mammographic finding, tissue sampling (stereotactic biopsy) should be guided by the suspicious mammographic finding. If there is no sonographic correlate for a suspicious DBT finding, tissue sampling (tomosynthesis-guided biopsy) should be guided by the suspicious DBT finding. Image-Guided Core Biopsy Breast If a palpable mass has probably benign features as identified on mammogram and/or US, imaging follow-up may be appropriate. However, if a mass is new on imaging or increasing by >20% in volume or >20% in each diameter in a 6-month period, the mass is considered suspicious, and image-guided biopsy is recommended [36]. Core biopsy is superior to FNAB in terms of sensitivity, specificity, and correct histological grading of palpable masses [27]. In addition, there are certain cases in which biopsy may be performed even on probably benign lesions. For example, BI-RADS 3 lesions in high-risk patients, patients awaiting organ transplant, patients with known synchronous cancers, or patients trying to get pregnant may be appropriate for tissue sampling. In addition, situations in which biopsy may alleviate extreme patient anxiety may prompt tissue sampling [30,37]. If an image-guided biopsy is pursued, a marker clip is placed and a postbiopsy mammogram/DBT confirms that the clip placement and mammographic/DBT findings correlate.
Palpable Breast Masses. In a study of women presenting with palpable breast thickening, the sensitivity of diagnostic mammography for invasive cancer detection was 60%, whereas the sensitivity of US alone was 100% [34]. Breast US should be performed using a high-resolution, real-time linear array scanner with an adjustable focal zone and a transducer with a minimum center frequency of 12 MHz [35]. Some mammographers also perform screening US of the remainder of the ipsilateral breast and the contralateral breast in the setting of a suspicious finding [33]. If there is no sonographic correlate for a suspicious mammographic finding, tissue sampling (stereotactic biopsy) should be guided by the suspicious mammographic finding. If there is no sonographic correlate for a suspicious DBT finding, tissue sampling (tomosynthesis-guided biopsy) should be guided by the suspicious DBT finding. Image-Guided Core Biopsy Breast If a palpable mass has probably benign features as identified on mammogram and/or US, imaging follow-up may be appropriate. However, if a mass is new on imaging or increasing by >20% in volume or >20% in each diameter in a 6-month period, the mass is considered suspicious, and image-guided biopsy is recommended [36]. Core biopsy is superior to FNAB in terms of sensitivity, specificity, and correct histological grading of palpable masses [27]. In addition, there are certain cases in which biopsy may be performed even on probably benign lesions. For example, BI-RADS 3 lesions in high-risk patients, patients awaiting organ transplant, patients with known synchronous cancers, or patients trying to get pregnant may be appropriate for tissue sampling. In addition, situations in which biopsy may alleviate extreme patient anxiety may prompt tissue sampling [30,37]. If an image-guided biopsy is pursued, a marker clip is placed and a postbiopsy mammogram/DBT confirms that the clip placement and mammographic/DBT findings correlate.