American Board of Internal Medicine (ABIM) Certification Practice Exam

What mammography findings typically necessitate a biopsy?

1. Mass lesions

2. Microcalcifications or spiculations

3. Simple cysts

4. Dense breast tissue

The correct answer is: Microcalcifications or spiculations

The presence of microcalcifications or spiculations on a mammogram often raises concern for possible malignancy, which is why they typically warrant a biopsy. Microcalcifications can appear as small deposits of calcium in the breast tissue and can indicate early-stage breast cancer, particularly ductal carcinoma in situ (DCIS). Their pattern, size, and distribution can guide radiologists in making further recommendations for biopsy. Spiculated masses, characterized by irregular, star-like projections, are also associated with higher likelihoods of cancer. They suggest that there may be an infiltrative process occurring in the breast tissue, which often necessitates a closer look through biopsy. While mass lesions may also require biopsy based on their characteristics, not all mass lesions will necessitate further evaluation; some may be benign, such as cysts. In contrast, simple cysts and dense breast tissue are generally not indicators for biopsy on their own. Dense breast tissue can obscure mammographic findings but does not inherently indicate malignancy. In sum, microcalcifications and spiculated masses are significant findings that usually trigger the need for a biopsy to rule out or confirm the presence of breast cancer.