AJR:193, December 2009 1723 excluded from the study, later clarification confirmed that they had been [5]. Of note, the third edition of BI-RADS [6], published in 1998, did not address whether in the as- signment of assessment category 3, probably benign finding, lesion management would differ depending on the palpable or nonpal- pable nature of the lesion. Regarding the use of BI-RADS category 3, the third edition stated, “At the present time, most approaches are intuitive. These will likely undergo fu- ture modification as more data accrue as to the validity of an approach, the interval re- quired, and the type of findings that should be followed.” It was not until publication of the fourth edition of BI-RADS [1] in 2003 that a distinction was made for management of palpable lesions. The fourth edition of BI- RADS states that “all published studies ex- Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women Jennifer A. Harvey 1 Brandi T. Nicholson 1 Alexander P. LoRusso 1,2 Michael A. Cohen 1 Viktor E. Bovbjerg 3,4 Harvey JA, Nicholson BT, LoRusso AP, Cohen MA, Bovbjerg VE 1 Department of Radiology, University of Virginia, Box 800170, Charlottesville, VA 22908. Address correspon- dence to J. A. Harvey. 2 Present address: X-Ray Associates of New Mexico, Santa Fe, NM. 3 Department of Public Health Sciences, University of Virginia, Charlottesville, VA. 4 Present address: College of Health and Human Sciences, Oregon State University, Corvallis, OR. Women’s฀Imaging฀•฀Original฀Research AJR 2009; 193:1723–1730 0361–803X/09/1936–1723 © American Roentgen Ray Society T he indications for short-term fol- low-up of nonpalpable breast le- sions are well established. BI- RADS calls for initial short-term follow-up (BI-RADS assessment category 3, probably benign finding) of solid well-de- fined masses, focal asymmetries, and grouped punctate calcifications on a baseline mammo- gram or when previous mammograms cannot be obtained [1]. In the early 1990s, Sickles [2] and Varas et al. [3] found short-term fol- low-up of these lesions a reasonable alterna- tive to biopsy because the incidence of breast cancer was less than 2% and cancer subse- quently diagnosed was at an early stage. Can- cer incidence later was reported to be inde- pendent of lesion size and patient age [4]. Although Sickles [2] did not explicitly state that women with palpable findings were Keywords: breast neoplasms, mammography, ultrasound DOI:10.2214/AJR.09.2811 Received March 26, 2009; accepted after revision May 21, 2009. WOMEN’S IMAGING OBJECTIVE. The purpose of this study was to evaluate the feasibility of short-term fol- low-up of palpable masses that have benign imaging features. MATERIALS฀AND฀METHODS. The cases of all women with round, oval, or lobu- lar palpable masses with circumscribed margins and homogeneous ultrasound echotexture for which short-term follow-up was recommended from July 1997 through December 2003 were retrospectively identified. Evaluation was by ultrasound and/or mammography and fo- cused clinical examination. Outcome was assessed with imaging or clinical follow-up lasting at least 12 months. The cancer incidence for palpable lesions was compared with that for non- palpable lesions recommended for short-term follow-up. RESULTS. In 379 women, 443 palpable masses with benign features for which short- term follow-up was recommended were identified. Outcome data were available on 375 mass- es in 320 women. Lesions were evaluated with mammography and ultrasound (n = 186) or ultrasound alone (n = 189). Masses were typically identified only with ultrasound (n = 258, 68.8%); were oval (n = 275, 73.3%), of equal density to normal breast tissue on mammograms (n = 95 on 117 mammograms, 81.2%), and hypoechoic (n = 336 in 372 ultrasound examina- tions, 90.3%); and were prospectively believed to be fibroadenoma (n = 304, 81.1%). Eighty- five lesions (22.7%) were biopsied soon after evaluation, and one 1.5-mm ductal carcinoma in situ was diagnosed. At follow-up (mean, 2.7 years), 26 lesions (6.9%) had grown. Twenty- four of the 26 lesions were biopsied, and no cancer was diagnosed. The overall cancer preva- lence was similar for palpable (0.3%) and nonpalpable (1.6%) masses. The cost of short-term follow-up was less than that of biopsy. CONCLUSION. Short-term follow-up is a reasonable alternative to biopsy of palpa- ble breast lesions with benign imaging features, particularly for young women with prob- able fibroadenoma. Harvey et al. Follow-Up Imaging of Palpable Breast Lesions Women’s Imaging Original Research