In the Setting of Negative Mammogram, is Additional Breast Ultrasound Necessary for Evaluation of Breast Pain?

Publication date: Available online 9 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Eralda Mema, Emma Cho, Yun-Kyoung Ryu, Priya Jadeja, Ralph Wynn, Brett Taback, Richard Ha
PurposeTo evaluate whether in the setting of negative diagnostic mammogram for breast pain additional ultrasound is necessary.MethodsRetrospective IRB approved review of our database identified 8085 women who underwent ultrasound evaluation for breast pain from 1/1/2013 to 12/31/2013. Of 8085 women, 559 women had mammogram evaluation preceding the ultrasound and these women comprise the basis of this study. The patient′s age, type of mammogram exam (screening or diagnostic), BIRADS breast density, type of breast pain (focal, diffuse, cyclical, unilateral, bilateral), additional breast symptoms (palpable concern, nipple discharge, skin changes, others), mammogram/ultrasound findings and final BIRADS assessment, follow-up imaging and follow-up biopsy results were reviewed and recorded.ResultsThe median age of patients was 46 years old (range 27–97). Patients recalled from negative screening mammogram were 29.8% (167/559). Patients with preceding negative diagnostic mammogram were 70.2% (392/559). The BIRADS breast density (BD) distribution was BD1: 5.5%, BD2: 39.9%, BD3: 46.0%, BD4: 8.6%. Final BIRADS assessments were BIRADS 1/2 (79%), BIRADS3 (12.9%), BIRADS 4 (8.1%), BIRADS 5 (0%). Majority (66.9%, 374/559) of the patient had breast pain alone. Additional breast symptoms were also noted as follows: palpable concern (24%), nipple discharge (3.9%), skin changes/other (5.2%). On follow-up evaluation, 26 findings were recommended for tissue sampling yielding 2 malignancies (0.4%, 2/559) in 2 patients. In the setting of negative mammogram and clinical symptom of breast pain alone yielded no malignances (NPV, 100%, 374/374) and was not impacted by breast density. In patients with additional symptoms accompanying pain, malignancies were present despite negative mammogram in 2 patients; nipple discharge (4.5%, 1/22) and palpable concern (0.7%, 1/134).ConclusionIn the setting of negative mammogram and breast pain alone, additional evaluation with ultrasound is likely low yield and may be unnecessary. However, with additional symptoms such as palpable concern or nipple discharge, ultrasound is likely an important adjunct modality for identifying mammographically occult tumors.



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