US is more frequently used following DBT/mammography in this age group [2,26] (see Variants 2, 3, and 5). The negative predictive value of mammography with US in the context of a palpable mass ranges from 97.4% to 100% [7-9]. Variant 2: Adult female, 40 years of age or older. Palpable breast mass. Mammography findings are suspicious or highly suggestive of malignancy (BI-RADS 4 or 5). Next imaging study. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast dedicated as the next step in evaluating a palpable mass in the context of a suspicious mammographic finding [2]. Image-Guided Core Biopsy Breast It is preferable for imaging to occur before biopsy because changes related to the biopsy may confuse, alter, obscure, and/or limit image interpretation. If a mammographically suspicious lesion is identified that correlates with the palpable mass, US is recommended as the next step in evaluation before image-guided core biopsy is pursued. However, the lack of sonographic correlate should not deter biopsy of a suspicious mammographic or DBT abnormality in this setting. Core biopsy is superior to FNAB in terms of sensitivity, specificity, and correct histological grading of palpable masses [27]. In addition, core biopsy allows for ready evaluation of tumor receptor status. When a mammographically or DBT-detected suspicious lesion is identified that correlates with a palpable mass, biopsy is warranted. If a lesion is only identified on mammography or DBT, mammographically or DBT- guided core biopsy may be pursued [28,29]. If the lesion can be seen with US, US-guided biopsy may be pursued [30]. At image-guided biopsy, a marker clip is placed, and a postbiopsy diagnostic mammogram confirms that the US and mammographic findings correlate. Similarly, a postbiopsy DBT confirms that the US and DBT findings correlate.
Palpable Breast Masses. US is more frequently used following DBT/mammography in this age group [2,26] (see Variants 2, 3, and 5). The negative predictive value of mammography with US in the context of a palpable mass ranges from 97.4% to 100% [7-9]. Variant 2: Adult female, 40 years of age or older. Palpable breast mass. Mammography findings are suspicious or highly suggestive of malignancy (BI-RADS 4 or 5). Next imaging study. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast dedicated as the next step in evaluating a palpable mass in the context of a suspicious mammographic finding [2]. Image-Guided Core Biopsy Breast It is preferable for imaging to occur before biopsy because changes related to the biopsy may confuse, alter, obscure, and/or limit image interpretation. If a mammographically suspicious lesion is identified that correlates with the palpable mass, US is recommended as the next step in evaluation before image-guided core biopsy is pursued. However, the lack of sonographic correlate should not deter biopsy of a suspicious mammographic or DBT abnormality in this setting. Core biopsy is superior to FNAB in terms of sensitivity, specificity, and correct histological grading of palpable masses [27]. In addition, core biopsy allows for ready evaluation of tumor receptor status. When a mammographically or DBT-detected suspicious lesion is identified that correlates with a palpable mass, biopsy is warranted. If a lesion is only identified on mammography or DBT, mammographically or DBT- guided core biopsy may be pursued [28,29]. If the lesion can be seen with US, US-guided biopsy may be pursued [30]. At image-guided biopsy, a marker clip is placed, and a postbiopsy diagnostic mammogram confirms that the US and mammographic findings correlate. Similarly, a postbiopsy DBT confirms that the US and DBT findings correlate.