Evaluation and management of breast abnormalities

The increasing use of screening mammography, liability risks, and volume control legislation by the federal government pose a major challenge to clinicians to safely select patients for breast biopsy. Despite a normal mammogram, a palpable breast mass often requires aspiration or excisional biopsy. Careful clinical judgement must prevail if observation is elected. A biopsy should be performed on a clinically suspicious mass whether the mammogram is suspicious or not. Management of the patient with a nonpalpable mammographic abnormality requires a close working relationship among the surgeon, pathologist, and radiologist. Thoughtful clinical judgement and interdisciplinary cooperation promote an acceptable benign to malignant ratio for breast biopsies.