DBT may demonstrate findings not readily detected at US (calcifications or subtle architectural distortion); this may provide a more accurate assessment of the extent of disease in the ipsilateral breast and can identify contralateral lesions as well. In addition, DBT may have relatively high diagnostic accuracy in dense breast tissue, often encountered in younger patients [48,49]. Digital Breast Tomosynthesis Screening In women presenting with signs or symptoms, including a palpable breast mass, screening DBT, with or without DM, is not useful as the next imaging study. Screening mammography is provided to women without signs or symptoms of breast disease. 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 with suspicious sonographic features in women <30 years of age [2]. Image-Guided Core Biopsy Breast If a suspicious mass has been identified on US, tissue sampling (US guided) is warranted. It may be appropriate to proceed directly to image-guided biopsy if a palpable lesion has suspicious features on US followed by placement of a biopsy clip. If US findings are particularly worrisome for malignancy, diagnostic mammography or DBT may be performed prior to 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]. Image-Guided Fine Needle Aspiration Breast If a suspicious mass has been identified on US, tissue sampling (US guided) is warranted.
Palpable Breast Masses. DBT may demonstrate findings not readily detected at US (calcifications or subtle architectural distortion); this may provide a more accurate assessment of the extent of disease in the ipsilateral breast and can identify contralateral lesions as well. In addition, DBT may have relatively high diagnostic accuracy in dense breast tissue, often encountered in younger patients [48,49]. Digital Breast Tomosynthesis Screening In women presenting with signs or symptoms, including a palpable breast mass, screening DBT, with or without DM, is not useful as the next imaging study. Screening mammography is provided to women without signs or symptoms of breast disease. 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 with suspicious sonographic features in women <30 years of age [2]. Image-Guided Core Biopsy Breast If a suspicious mass has been identified on US, tissue sampling (US guided) is warranted. It may be appropriate to proceed directly to image-guided biopsy if a palpable lesion has suspicious features on US followed by placement of a biopsy clip. If US findings are particularly worrisome for malignancy, diagnostic mammography or DBT may be performed prior to 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]. Image-Guided Fine Needle Aspiration Breast If a suspicious mass has been identified on US, tissue sampling (US guided) is warranted.