Recent trends in the management of breast cancer. 2. Occult breast lesions: when and how to perform a biopsy for mammographic abnormalities.

In 1989 the Canadian Cancer Society recommended that women over 50 years of age should undergo mammography as a test for breast cancer in centres dedicated to such programs. This recommendation and others by American societies have increased the number of mammographies done for screening purposes. As a result many mammographic abnormalities are reported by radiologists, who recommend biopsy. The surgeon should review the films with the radiologist and ensure that the anomaly is real. Attention should be given to specific signs of cancer, such as spiculated lesions; however, nonspecific signs of cancer, such as microcalcifications, microlobulation and architectural distortion, should be evaluated carefully before biopsy is carried out. Stereotaxic fine-needle aspiration can decrease the number of surgical biopsies needed. The surgical biopsy should be a one-step, segmental mastectomy done for diagnosis and treatment. The specimen should be oriented, inked and x-rayed and a definitive diagnosis made on paraffin blocks. Frozen sections should not be made of microcalcifications.