When do breast nodules need to be treated (biopsy)? With increased health awareness and the widespread use of screening tools (mammography, ultrasound, MRI), a large number of abnormalities have been detected that were not clinically detected, which is what we are talking about today. What is a breast nodule? Nowadays, breast nodules are often mentioned by doctors and patients, but from a professional point of view, there is no clear definition of breast nodules, and we have learned from reviewing relevant information that lesions that can be palpated by patients or clinicians are called lumps (dominant masses); in contrast, lesions that cannot be palpated by patients or physicians but can only be detected by imaging are often referred to as nodules (hidden masses). Breast imaging: mammography, color ultrasound, ductoscopy, magnetic resonance imaging, treatment of all nodules detected by imaging will inevitably lead to overtreatment, resulting in a waste of resources, and if not treated, it will lead to missed diagnoses and medical disputes, so how can we screen out the nodules that require surgical biopsy from the multiple nodules given by imaging? First of all, let’s look at the classification criteria given by imaging for detected lesions BI-RADS classification Mammography, color ultrasound BI-RADS category 3 Probable benign lesions Malignant probability 0% – 2% Mammography, color ultrasound BI-RADS category 4 Malignant probability 2% – 95% 4a Malignant probability 2% – 10% 4b Malignant probability 10% – 50% 4c Malignant probability 50% – -95% MRI BI-RADS category 2 Malignant probability – 95% 4a Malignant probability 2% – 10% 4b Malignant probability 10% – 50% 4c Malignant probability 50% – – 95% -95% MRI BI-RADS category 3 Probable benign lesion 3 months follow-up 6 months review category 4 Malignant probability 2% – 95% How to identify patients who need surgical biopsy in the BI-RADS category 3 4a imaging data? Our experience is to determine whether a nodule requires biopsy from the following aspects: patient’s age, existing symptoms, past medical history, family history and imaging characteristics of the lesion. 1. Therefore, if a new nodule is found within 1 year for female patients above 40 years old, regardless of size, one or more, surgical excision is recommended for pathological examination; 2. For patients between 35 and 39 years old, if a single (single solid nodule >1 cm) or multiple breast nodules are found, we should communicate with the patient and choose whether to operate or follow up and observe according to the patient’s wish. If the patient has heavy ideological concerns and difficulties in regular review, minimally invasive surgery can be considered; 3. For patients with family history of breast cancer, history of breast cancer, breast ductal tumor, history of surgery for ductal epithelial atypical hyperplasia, regardless of nodule size, close attention and early surgery are needed to rule out malignancy 4. Multiple nodules in any age group: surgery is also recommended when imaging is not certain that all nodules are benign. It is difficult for doctors to determine the nature of all nodules based on imaging alone. 1 out of several nodules may be cancerous, so surgical pathology is needed to confirm the diagnosis; 5. If patients plan to get pregnant, surgery is recommended before pregnancy. Because pregnancy and breastfeeding may lead to tumor growth or even malignant transformation, surgery is recommended to avoid difficulties in diagnosis and treatment of breast lumps during pregnancy. If the nodule is <1 cm, it is judged to be benign, and the nodule can also be rechecked with ultrasound in the third month of pregnancy to understand the growth of the nodule, but the patient should be fully informed of what is at stake. For breast nodules that require a definitive diagnosis, surgical biopsy is usually performed: imaging-guided insertion of a fine wire for localization, ultrasound-guided vacuum-assisted breast biopsy machine for puncture biopsy, and preoperative mammography ultrasound for skin localization for surgical excisional biopsy. If the biopsy result is benign, minimally invasive rotational excision or open surgery is used; if it is malignant, it is treated as breast cancer surgery.