What are the biopsy planning steps when a lesion is visible on mammography and ultrasound but not palpable?

• A. Ensure concordance between imaging modalities; plan ultrasound-guided biopsy if visible on ultrasound; if not clearly visualizable on ultrasound, plan stereotactic (mammography-guided) biopsy; coordinate with surgical planning.
• B. Plan exclusively MRI-guided biopsy regardless of ultrasound visibility.
• C. Biopsy is unnecessary if visible on mammography and ultrasound.
• D. Randomly select biopsy method without plan.

Answer: (A)

Nonpalpable lesions that appear on both mammography and ultrasound require careful imaging concordance and targeted sampling. First, verify that the lesion seen on mammography matches the area identified on ultrasound so you’re sampling the same abnormality. If ultrasound clearly visualizes the lesion, use ultrasound-guided biopsy because it provides real-time targeting, is usually quickest, and avoids radiation. If the ultrasound image is not clearly showing the lesion, switch to a stereotactic (mammography-guided) biopsy, which uses precise mammographic localization to guide the needle to the correct area. Throughout, coordinate with surgical planning to ensure pathology findings align with imaging features and to plan any future excision or marker placement as needed. MRI-guided biopsy is not routinely required when the lesion is visible on ultrasound or mammography; reserve MRI guidance for cases where MRI shows a suspicious area not seen on other modalities.