Management of probably benign breast lesions

Several large-scale prospective clinical studies establish the validity of managing probably benign breast lesions with periodic mammographic surveillance as a safe and effective alternative to immediate tissue diagnosis. This approach to mammographic interpretation is now very widely accepted; the American College of Radiology indeed includes "probably benign - short interval follow-up suggested" as one of the five final assessment categories in the Breast Imaging Reporting and Data System (BI-RADS), which all American radiologists are encouraged to use. There is also general consensus that probably benign interpretations should involve (1) cases restricted to nonpalpable lesions; (2) use of the specific imaging criteria described in the prospective clinical studies; and (3) pre-interpretation comparison with prior mammograms, if available, to ensure that new or progressing lesions undergo prompt biopsy (it makes no sense to recommend follow-up for a lesion that has already demonstrated interval progression when the very demonstration of progression during surveillance is what prompts biopsy instead of continued follow-up). As yet unresolved issues concerning probably benign lesions include whether initial full problem-solving imaging should be performed in all cases, whether to use patient age and lesion size (for solitary masses) as additional criteria in deciding between the management alternatives of mammographic follow-up and immediate tissue diagnosis, and what should be the specific timing, frequency, and duration of the follow-up examinations that constitute the surveillance protocol.