Early experience with needle localization and biopsy of mammographic lesions

Increasing awareness of the value of mammography by both physicians and the public has resulted in women presenting more commonly with impalpable breast lesions. This study reviews the radiology and pathology of 58 such lesions biopsied by the Monash Medical Centre Breast Unit between August 1987 and October 1988. Abnormal mammograms were reported by one of two independent radiologists in the normal course of practice and placed into one of five categories according to the radiological appearance. Those lesions scoring greater than or equal to 3 were then needle localized, excised and examined histologically. All mammograms were later reported as unknowns by the other radiologist and similarly scored. Sixteen (28%) of these lesions were invasive or in situ carcinoma and of these a significant number were scored differently by the two radiologists. The results indicate that needle localization biopsy of suspicious mammographic lesions is a safe, accurate method for the diagnosis of early breast cancer. The results also show significant variation between radiologists and demonstrate the need for double reading of screening mammographic films. It is suggested that doubtful lesions require more extensive work-up with compression/magnification and other special views, the aim being more accurate radiological assessment and a reduction in the benign biopsy rate.