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October 17, 1990

Biopsy of Occult Breast Lesions and Professional Liability

JAMA. 1990;264(15):1948. doi:10.1001/jama.1990.03450150046025

To the Editor.—  The idea of using more stringent mammographic criteria and second opinions before obtaining biopsy specimens from all occult breast lesions is a good one. Unfortunately, it may not be entirely practical in today's medicolegal environment.By using more stringent and specific mammographic criteria, Meyer et al1 were able to identify many innocuousappearing lesions that had a very low incidence of malignancy. They quote a 1 of 100 or less chance of cancer and state that this alone is not adequate justification for a biopsy. Unfortunately, a 1 to 100 chance of cancer must be an indication for biopsy. Consider that making a wrong diagnosis, missing an occult malignancy, and deciding not to obtain a biopsy specimen could easily result in a million-dollar judgment against the physician who made that call. One would be very unlikely to ignore a 100 to 1 shot when a million