Approach to Diagnostic Imaging
Procedure of choice for determining whether a palpable mass is unequivocally benign (e.g., calcified fibroadenoma, intramammary lymph node, oil cyst, lipoma) or probably malignant, thus avoiding any unnecessary workup. In young women (under age 30) the initial assessment of a palpable breast mass should be done with ultrasound; if a cyst is detected, no imaging with radiation exposure is needed.
If the palpable mass is suspicious for malignancy, the primary purpose of mammography is to assess the affected breast for the extent of disease and the contralateral breast for clinically occult but mammographically suspicious abnormalities that should be biopsied concurrently. Mammography is also needed to assist in determining whether needle biopsy should be done using stereotaxis or sonography for guidance. Additionally, if stereotaxis is indicated, mammography it is useful to decide on the approach to the lesion.
Indicated as a confirming procedure if physical examination or mammography suggests that the palpable mass may repre sent a simple cyst or intramammary lymph node. Can be diagnostic of a simple (benign) cyst or intramammary lymph node if rigid interpretive criteria are used. When biopsy is indicated, ultrasound is needed to determine whether needle biopsy can be done under sonographic, rather than mammographic (i.e., stereotactic) guidance.
Can be used instead of needle aspiration to determine a palpable mass, which cannot be characterized by mammo graphy, is a simple cyst.
Fine-needle aspiration biopsy
Provides material for definitive cytologic examination.Limited by a high insufficient sampling rate and best done with a cytologist present to determine the adequacy of the sample. Inadequate samples and suspicious cytologic results require repeat biopsy.
Provides material for definitive histologic examination.Repeat biopsy done surgically is required if the diagnosis is ductal atypia. Many also believe this should be done with lobular carcinoma in situ, lobular atypia, and radial scar. Ductal carcinoma in situ found at core biopsy may have an invasive component at surgery.
KeywordsCore Biopsy Invasive Lobular Carcinoma Contralateral Breast Palpable Mass Nipple Discharge
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