The finding is a dense spiculated mass in the upper outer quadrant.
With this obviously suspicious mass, do you still need spot magnification views?
Yes No
Yes
Yes. Spot compression magnification views are important in the work-up of extent of disease (see Case 3). Even when you have already decided to biopsy the lesion, it is important that you make sure there are no subtle calcifications elsewhere in the breast, especially in the segment between the mass and the nipple. Being thorough here helps to determine the definitive surgical procedure. Many times we will identify extensive disease precluding breast conservation, and spare the patient unneccessary surgery.
Is ultrasound indicated?
Yes No
No
Ultrasound will only help in that it may allow you to perform a core needle biopsy with ultrasound-guidance. A benign sonographic appearance would not dissuade you from recommending biopsy, because the lesion is suspicious mammographically.
This mass is predominantly hypoechoic with irregular margins and marked posterior acoustic shadowing. Doppler also shows arterial blood flow within it. All of these findings should further convince you that this mass is malignant. Again, if there were none of these findings, you would still recommend biopsy, but the probability that it would yield cancer would be somewhat lower.
