Clinically palpable breast abnormalities with normal imaging: is clinically guided biopsy still required?

Area of Science:

• Radiology
• Oncology
• Surgical Pathology

Background:

• Palpable breast abnormalities with negative imaging require further investigation.
• Clinically guided biopsy (CGB) is an option for evaluating such cases.
• The diagnostic yield of CGB in this specific scenario is not well-established.

Purpose of the Study:

• To assess the necessity of fine-needle or core biopsy for palpable breast abnormalities with negative mammographic and sonographic findings.
• To evaluate the malignancy rate in palpable breast lesions despite negative imaging.
• To determine if CGB can be reserved for clinically suspicious cases without missing malignancies.

Main Methods:

• Retrospective analysis of 251 clinically guided biopsies (CGB) performed over 12 years.
• Patients presented with palpable breast abnormalities and negative mammogram/ultrasound.
• Physical findings were categorized (normal, benign, probably benign, suspicious, malignant).

Main Results:

• Only 1.2% (3/251) of CGBs revealed malignancy, with 0.8% being invasive.
• All malignancies were identified within the clinically suspicious or malignant categories.
• 18.3% of cases were clinically suspicious or malignant; 81.7% were benign or probably benign.

Conclusions:

• Negative mammography and ultrasound do not entirely exclude breast cancer in palpable abnormalities, but the risk is low (1.2%).
• Reserving CGB for clinically suspicious or malignant palpable findings could have avoided 81.7% of biopsies without missing any cancers.
• This suggests a more selective approach to biopsy in palpable breast abnormalities with negative imaging.