Evaluation of abnormal mammography results and palpable XXXX .

@entity1 @entity1558 @entity5 @entity0
BACKGROUND: Because approximately 1 in 10 @entity1 with a breast lump or abnormal mammography result will have @entity0 , a series of decisions must be taken by a primary care practitioner to exclude or establish a diagnosis of @entity0 among these @entity1 . PURPOSE: To determine the most accurate and least invasive means to evaluate an abnormal mammography result and a palpable @entity1558 . DATA SOURCE: MEDLINE search (January 1966 to March 2003) for articles and reviews describing the accuracy of clinical examination, biopsy procedures, and radiographic examination for @entity1 with abnormal mammography results or palpable @entity1558 . STUDY SELECTION: The authors reviewed abstracts and selected articles that provided relevant primary data. Studies were included if 1) mammography, fine-needle aspiration biopsy, or core-needle biopsy was performed before a definitive diagnosis was obtained; 2) the study sample included 100 or more @entity1 ; and 3) @entity0 status was determined from histopathology review of excisional biopsy specimens, from linkage with a state @entity5 registry or the Surveillance, Epidemiology, and End Results program, or from clinical follow-up of 95% or more of the study sample. DATA EXTRACTION: One investigator abstracted results. Methods were evaluated for major potential biases, but methodologic scoring was not performed. DATA SYNTHESIS: Likelihood ratios for first screening mammography were 0.1 for the Breast Imaging Reporting and Data System (BI-RADS) assessment category "negative or benign finding," 1.2 for "probably benign finding," 7 for "need additional imaging evaluation," 125 for "suspicious abnormality," and 2200 for "highly suggestive of @entity5 ." For fine-needle aspiration biopsy of a palpable lump performed by formally trained physicians, the likelihood ratio was infinity for an assessment of "malignant," 2.6 for "atypical/suspicious," and 0.02 for "benign." When diagnostic mammography was used to evaluate a palpable lump or nonpalpable @entity1558 were 5.6 and 9.4, and the negative likelihood ratios were 0.15 and 0.19, respectively. CONCLUSIONS: @entity1 whose screening mammography results are interpreted as "suspicious abnormality" or "highly suggestive of @entity5 " have a high risk for @entity0 and should undergo core-needle biopsy or needle localization with surgical biopsy. @entity1 whose screening mammography results are interpreted as "need additional imaging evaluation" have a moderate risk for @entity0 and should undergo diagnostic mammography or ultrasonography to decide whether a nonpalpable @entity1558 should be biopsied. @entity1 whose screening mammography results are interpreted as "probably benign finding" have a low risk for @entity0 and can undergo follow-up mammography in 6 months. Either fine-needle aspiration biopsy or ultrasonography is recommended as the first diagnostic test of a palpable @entity1558 to distinguish simple cysts from solid masses. Fine-needle aspiration biopsy also allows characterization of a solid mass. Diagnostic mammography does not help determine whether a palpable breast mass should be biopsied and should not affect the decision to perform a biopsy.
