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Objectives: The purpose of this study was to determine the utility of targeted sonography in the management of probably benign breast lesions detected on magnetic resonance imaging (MRI)., Methods: A total of 4370 consecutive contrast-enhanced breast MRI examinations from March 1, 2004, to March 1, 2009, were retrospectively reviewed. The study was Health Insurance Portability and Accountability Act compliant and Institutional Review Board approved. When targeted sonography was recommended for a Breast Imaging Reporting and Data System (BI-RADS) category 3 examination, results of the sonography and any subsequent breast pathologic examinations were recorded. The frequency of identifying the MRI-detected lesions and the rate at which the BI-RADS category was changed by sonography were calculated for mass and non-mass-like lesions., Results: Of the 4370 examinations, 349 (8%) had BI-RADS 3 findings in 346 patients. One hundred eighteen lesions underwent targeted sonography for evaluation of 85 masses and 33 areas of non-mass-like enhancement. Of these 118 lesions, 54 (46%) were seen on sonography. No cancers were detected on sonography in the areas of non-mass-like enhancement. Two of the 85 masses (2.4%) evaluated with targeted sonography had a malignant diagnosis before initiation of follow-up., Conclusions: Selective use of targeted sonography, particularly in masses, may help identify some malignancies before initiating short-interval follow-up for MRI-detected BI-RADS 3 lesions.

Objective: To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred., Methods: We prospectively characterized 844 sonographically visible solid breast masses referred for biopsy. Mammographic and sonographic features of the masses were recorded, and all masses were categorized by American College of Radiology Breast Imaging Reporting and Data System classification before biopsy. Of the 844 masses, 148 were categorized as probably benign (Breast Imaging Reporting and Data System category 3). Sonographically guided biopsy (n = 804) or fine-needle aspiration (n = 40) was performed for pathologic correlation., Results: Of the 148 masses that met the sonographic criteria for probably benign masses, there was 1 malignancy, for a negative predictive value of 99.3%., Conclusions: Follow-up can be an acceptable alternative to biopsy for sonographically probably benign solid masses.

Objective: To determine whether preferential use of sonographic guidance for percutaneous biopsy of breast masses results in a subset of patients with a shorter procedure time and less discomfort compared with patients undergoing stereotactic biopsy., Methods: A prospective observational study was performed on 193 women undergoing percutaneous image-guided breast biopsy between 1997 and 1999. Data were collected on room time, physician time, and patient comfort levels for 122 stereotactic and 71 sonographically guided biopsies. Differences between stereotactic and sonographically guided biopsy for all lesions and for masses were analyzed for statistical significance., Results: Mean room times were 62.2 minutes for stereotactic biopsy and 39.4 minutes for sonographically guided biopsy (P < .0001). Mean physician times were 23.0 minutes for stereotactic biopsy and 15.8 minutes for sonographically guided biopsy (P < .0001). When we limited our analyses to women undergoing biopsy for masses, the difference in physician time largely disappeared, but the difference in room time remained (P < .0001). Women undergoing stereotactic biopsy were more likely to report discomfort due to body positioning than were women undergoing sonographically guided biopsy (P < .001). These differences existed whether we included all lesions or restricted our analyses to masses., Conclusions: Preferential use of sonographically guided breast biopsy for masses results in shorter procedure times and less patient discomfort compared with prone stereotactic biopsy.