Rationale and Objectives
Radiologists frequently image women with the sole complaint of mastalgia (breast pain). We hypothesized that whereas the vast majority of women ultimately have no imaging explanation for their breast pain, a small percentage of patients may have a correlative imaging finding and confirm the current American College of Radiology Appropriateness Criteria recommendations.
Materials and Methods
In this Health Insurance Portability and Accountability Act (HIPAA)-compliant, institutional review board-approved retrospective review, we evaluated 236 women between the ages of 18 and 83 years who presented to our Breast Care Center in 2013 with the sole complaint of breast pain or tenderness. Patients’ clinical presentation, diagnostic imaging work-up, and clinical and radiographic follow-up were documented. Outcomes of the diagnostic work-up were compared with the American College of Radiology Appropriateness Criteria recommendations.
Results
Of the 236 patients, 10 women had cyclical breast pain, 116 had noncyclical, nonfocal breast pain, and 110 had noncyclical, focal breast pain. No imaging correlates were discovered to explain the etiology of cyclical pain, supporting the American College of Radiology Appropriateness Criteria rating values. A definitive imaging correlate for breast pain was identified in seven women (3%) with noncyclical, focal pain, one of which was a cancer diagnosis (0.4%), which correlates with the American College of Radiology Appropriateness Criteria ratings. No imaging correlates were found in women with noncyclical, nonfocal pain, supporting the American College of Radiology Appropriateness Criteria ratings.
Conclusion
There was no radiological imaging finding to explain the etiology of mastalgia in most women. Diagnostic imaging may be an appropriate diagnostic evaluation in patients with noncyclical, focal breast pain, supporting the American College of Radiology Appropriateness Criteria recommendations.
Introduction
Breast pain is a common problem that affects 70–80% of women at some point in their lives , most frequently noted in premenopausal women . The incidence of cancer in patients presenting with breast pain is reported to be 0–3.2% and in one study up to 7% . Breast pain is usually self-limited and is not typically a symptom of malignant pathologic disease. Most breast pain symptomatology can be treated with reassurance, over-the-counter pain medications, or structural support .
As breast cancer awareness has increased, a concern that breast pain may indicate malignancy contributes to the trend of breast pain being the most common breast symptom causing a woman to consult her primary care physician or a breast surgeon . If patients are not treated based on symptoms and physical examination alone, they may be referred for reassurance to a breast imaging facility . These studies report that after initial imaging, most women require no intervention after reassurance that their diagnostic imaging work-up is normal. The negative predictive value of mammography and ultrasound for patients with breast pain has been reported to be 100% in three studies . However, a 2012 study showed that women who received initial imaging were more likely to have subsequent imaging, biopsies, additional visits, and higher clinical services utilization than women who did not , suggesting that these modalities should be judiciously performed.
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Materials and Methods
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Diagnostic Evaluation
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Follow-up of Our Cohort
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Results
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Cyclical Breast Pain (American College of Radiology Appropriateness Criteria [ACRAC] Variants 1 and 2)
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Noncyclical, Focal Breast Pain (ACRAC Variants 3 and 4)
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Noncyclical, Nonfocal/Diffuse Breast Pain (ACRAC Variants 5 and 6)
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Discussion
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Cyclical Breast Pain (Variants 1 and 2)
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Noncyclical, Focal Breast Pain (Variants 3 and 4)
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Noncyclical, Nonfocal/Diffuse Breast Pain (Variants 5 and 6)
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Limitations
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Conclusion
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