Management of non-palpable and small lesions found in mass breast screening

INTRODUCTION HIGH QUALITY mammographic screening programmes allow detection of a number of small, non-palpable abnormalities within the breast. Whether benign or malignant, these lesions present problems for radiologists, clinicians and pathologists of a different nature to those produced by the presentation of palpable breast lesions, resulting from consultations of women with symptomatic lesions. The balance and range of pathologies so found will be different from palpable lesions, and the various skills and decision-making processes required subsequently more complex. This paper aims to outline as far as possible the necessary steps to be taken to maximise accuracy of diagnosis and treatment of such cases. We do not intend to give a dogmatic view of the management of small lesions but rather identify areas where a consensus has been reached, areas of controversy, and fields of research suitable for further investigations. A diagnostic balance must be struck between the desire to recognise as many small tumours as possible, minimising the number of false negatives, while avoiding unnecessary examinations, investigations and biopsies resulting in high anxiety and cost for both the women and health services involved [l-3]. In order to maximise sensitivity and specificity, there are a number of quality measures that must be taken at both technical and professional level, with appropriate performance indicators. These are outlined in the European Guidelines for Quality