Radiologic recommendation for breast biopsy on screening mammography reports
Geelhoed, G.W.; Barr, H.M.; Curtis, D.J.; Olmsted, W.W.
American Surgeon 57(7): 419-424
1991
ISSN/ISBN: 0003-1348 PMID: 2058848 Document Number: 380813
Radiologic reports on screening mammography findings often obligate breast biopsy. Ready recommendation for biopsy of nonpalpable lesions imaged by x ray is a conservative radiologic policy but is unsettling for patients and creates an imperative bind for surgeons. Like the decision to send the patient with right lower quadrant abdominal pain home rather than to the operating room, the diagnosis that requires clinical confidence and precision is nonappendicitis. Noncancer of the breast is a similar diagnosis that can usually be made on clinical and mammographic findings rather than passing such patients through to invasive diagnosis. A series of 84 patients was referred for needle localization of nonpalpable mammographically detected lesions called suspicious on screening examination. Of these 84 patients, new radiographic reports reinterpreting the findings without biopsy were written on the original mammogram in 15 patients. This is a cancellation rate of 21 per cent. In 69 patients needle localization was carried out with the finding of cancer in 28 per cent, compared with the national average of 15 per cent. This higher than average yield caused concern whether any unbiopsied cancers had been followed, and a review of these patients was undertaken. In the log of patients referred for needle localization, the prereading by the mammographer performing the needle localization was recorded in advance of biopsy confirmation, and specificity proved to be 94 per cent and sensitivity 96 per cent. Of the cancers that were detected, 39 per cent were proven in patients older than 50 years. The diagnosis of benign breast conditions that are imaged on screening patients without clinical findings can be made with confidence, and radiologically directed biopsy recommendation should be reserved for mammographically suspicious lesions. Following this policy, the positive biopsy rate on needle localization of mammographically detected findings can be safely doubled.