Benign circumscribed breast masses. Mammographic and sonographic appearance

Mammography is an excellent screening tool for the detection of breast masses. One of the goals of the radiologist is to separate benign breast masses warranting no intervention from the indeterminate and malignant masses that require histologic evaluation. Thorough mammographic and sonographic work-up of lesions detected at screening will reduce the number of biopsies performed and increase the true positive biopsy rate. By systematically evaluating a breast mass as to its density location, size, margins, and interval change, one can separate benign lesions from those requiring additional work-up and those that will require a biopsy diagnosis. Any features suggesting malignancy should prompt histologic assessment. For many women, FNAB or large-core needle biopsy, guided either stereotactically or sonographically, will not only reduce the morbidity associated with excisional biopsy but also decrease the cost of evaluating questionable lesions found at screening. Ultrasound examination will further reduce the number of biopsies by separating cysts from solid and indeterminate lesions that require further evaluation. What rate of carcinoma in biopsy specimens should be the mammographer's guideline? Ciatto et al found in his series a 30% positive predictive value for mammography in detecting carcinoma. In the author's opinion, a goal to strive for should be in the range of 40%. The mammographer's experience and confidence as well as patient's compliance with follow-up recommendations will help the mammographer reach this goal.