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If a nonpalpable mammographic lesion has a low index of suspicion, mammographic follow-up in 3–6 months is reasonable. Workup of indeterminate and suspicious lesions has been rendered more complex by the advent of stereotactic biopsies. Morrow and colleagues have suggested that these procedures are indicated for lesions that require biopsy but are likely to be benign—that is, for cases in which the procedure probably will eliminate additional surgery. When a lesion is more probably malignant, open biopsy should be performed with a needle localization technique. Others have proposed more widespread use of stereotactic core biopsies for nonpalpable lesions on. | Chapter 086. Breast Cancer Part 4 If a nonpalpable mammographic lesion has a low index of suspicion mammographic follow-up in 3-6 months is reasonable. Workup of indeterminate and suspicious lesions has been rendered more complex by the advent of stereotactic biopsies. Morrow and colleagues have suggested that these procedures are indicated for lesions that require biopsy but are likely to be benign that is for cases in which the procedure probably will eliminate additional surgery. When a lesion is more probably malignant open biopsy should be performed with a needle localization technique. Others have proposed more widespread use of stereotactic core biopsies for nonpalpable lesions on economic grounds and because diagnosis leads to earlier treatment planning. However stereotactic diagnosis of a malignant lesion does not eliminate the need for definitive surgical procedures particularly if breast conservation is attempted. For example after a breast biopsy with needle localization i.e. local excision of a stereotactically diagnosed malignancy reexcision may still be necessary to achieve negative margins. To some extent these issues are decided on the basis of referral pattern and the availability of the resources for stereotactic core biopsies. A reasonable approach is shown in Fig. 86-4. Figure 86-4 Approaches to abnormalities detected by mammogram. f u follow-up. Breast Masses in the Pregnant or Lactating Woman During pregnancy the breast grows under the influence of estrogen progesterone prolactin and human placental lactogen. Lactation is suppressed by progesterone which blocks the effects of prolactin. After delivery lactation is promoted by the fall in progesterone levels which leaves the effects of prolactin unopposed. The development of a dominant mass during pregnancy or lactation should never be attributed to hormonal changes. A dominant mass must be treated with the same concern in a pregnant woman as any other. Breast cancer develops in 1 in every .
