Recommendations Indications I. Indications for performance of fine-needle aspiration (FNA) or core biopsies in palpable breast lesions A. Sufficiently defined palpable breast masses of clinical or patient concern should be aspirated regardless of imaging findings where experienced FNA services are available. B. Masses that can be clinically explained by normal anatomy and physiology, especially in young women, can be observed over the course of two menstrual cycles. C. Any persistent or suspicious masses (asymmetry, fixed, not round, hard) or masses in patients with increased family risk factors should be biopsied regardless of the imaging findings. II. Indications for performance of image-guided needle biopsy [FNA/core needle biopsy (CNB)] in nonpalpable breast lesions A. The recommendations for performing imageguided needle biopsy (IGNB) of a nonpalpable breast lesion detected by breast imaging are based on the availability of high-quality breast imaging performed by a physician qualified to interpret these images. The physician performing the biopsy should determine which type of needle biopsy and image guidance is most appropriate on a case-by-case basis. B. Prior to IGNB of nonpalpable breast lesions, the following steps are indicated: 1. A complete evaluation of the lesion with the appropriate imaging studies. 2. A careful physical examination of the breast, with special emphasis on the area detected by imaging to ascertain if the lesion is in fact nonpalpable. C. Lesions that may be subjected to IGNB include those that are highly suggestive of malignancy, suspicious for malignancy, and some lesions at low risk for malignancy but for which the recommended follow-up with imaging is not feasible or accepted by the patient. D. All imaging findings and key steps of the IGNB should be documented and recorded. A report of the procedure should be available. E. The results of the imaging studies and (cyto)pathologic interpretation should be concordant. If not, further workup is needed (see Post-FNA Recommendations), and the physician who performed the IGNB should make appropriate recommendations.
F. Communication between the physician who performed the IGNB and the referring physician and/or the patient should be documented. G. Follow-up of all IGNB should be done to record false-positive and false-negative results. III. The accessibility of the lesion to stereotactic or ultrasound-guided biopsy is left to the judgment of the clinician performing the biopsy. IV. The decision to resort to an excisional, needle localization biopsy without a prior attempt at an image-guided aspiration or core biopsy and the determination of the need for an excisional biopsy in spite of a benign cytologic and/or histologic