To understand the suspected low yield of malignant neoplasms from biopsies guided by needle localization, we reviewed 122 biopsies performed from January 1985 to November 1986 at University Hospital and Arkansas Baptist Medical Center, Little Rock. The positive biopsy rates were 3.5% and 10.6%, respectively. After review of these cases, the following guidelines for biopsy were developed: (1) Do not perform a biopsy on a low-density mass less than 1 cm in diameter. (2) Do not perform a biopsy for asymmetric density or questionable mass. (3) Do not perform a biopsy for secondary signs of malignancy such as skin thickening or asymmetric vasculature. (4) Biopsy is indicated for clustered calcifications, a dominant mass greater than 1 cm in diameter, stellate lesions, or interval change from a previous mammogram. These changes resulted in a positive biopsy rate of 15% for the period from November 1986 through April 1987.
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