Nonpalpable breast lesions: association of mammographic abnormalities with diagnosis after needle-directed biopsy.

We reviewed the experience with needle-directed breast biopsies (NDBB) in a military medical center. In 195 patients, 207 NDBBs were done; 49 of these biopsies (24%) rendered a diagnosis of malignancy. The majority of patients (78%) had invasive cancer; 44% of them were found to have associated malignant axillary adenopathy. Mammographic indications were examined; 65% of the biopsies were done for microcalcifications with or without an associated mass/density. Approximately one third of these lesions harbored malignancy or high-risk hyperplasia. Discrete nodular densities had a low rate of malignancy (7%), while spiculated/stellate masses proved almost uniformly to be invasive cancer. NDBB should be considered in all women with mammographic abnormalities. The associated risk of malignancy may vary depending on the specific mammographic appearance of the lesion. Unfortunately, a significant number of women may have relatively advanced malignancy when first seen, despite having nonpalpable disease.