Improving the yield of biopsy for nonpalpable lesions of the breast

Our early experience and frustration with needle localization biopsy of nonpalpable lesions of the breast led us to develop a protocol to improve diagnostic accuracy and management of patients with mammograms read as suspicious for malignancy. In this context and as part of the program, surgical and radiologic consultation is required prior to the decision to proceed with biopsy. In this article, our experience with that protocol is summarized and mammographic description with pathological findings is correlated. In a series of 200 consecutive patients who underwent biopsies, we have achieved a positive rate of 37 per cent. Only 2 per cent of those lesions with round, oval or lobulated borders were malignant, while irregular or spiculated lesions were malignant in 69 per cent of instances. We conclude that careful adherence to this protocol and to radiologic principles of contour analysis can substantially increase the yield of needle localization biopsy.