The presence of spiculation arising from a mass detected at mammography makes malignancy a probable diagnosis. This is confirmed by this review of the first 8 years of screening in East Sussex where only 3.6% of masses with spiculation were benign at excision (24 out of 668), compared with 33.3% of masses without spiculation (102 out of 306).

The mammographic appearances of screen-detected lesions were prospectively recorded at the time of assessment. Features recorded for masses were the presence or absence of spiculation and microcalcification. Those undergoing excision were entered onto the former South East Thames Screening database. The mammographic features and type of lesion are presented in Table 1.

Most of these lesions were excised during the era when we performed fine needle aspiration rather than the core biopsies we use today and it was our policy to excise all mass lesions showing spiculation. The very small number of benign surgical biopsies in this group shows that the policy was justified.