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Breast Imaging

E3313. In the Setting of Negative Mammogram, Is Additional Ultrasound Evaluation Necessary for Breast Pain?

Ryu Y,  Cho E,  Desperito E,  Taback B,  Ha R. Columbia University Medical Center, New York, NY

Address correspondence to R. Ha (rh2616@columbia.edu)

Objective: In the setting of negative screening mammogram, we investigated whether patients who indicate breast pain should be recalled for additional ultrasound evaluation. We also evaluated if, in the setting of negative diagnostic mammogram for breast pain, additional ultrasound is necessary.

Materials and Methods: Retrospective institutional review board–approved review of our database identified 8085 women who underwent ultrasound evaluation for breast pain from January 1, 2013, to December 31, 2013. Of 8085 women, 559 women had mammogram evaluations preceding the ultrasound and these women comprise the basis of this study. The patient’s age, type of mammogram examination (screening or diagnostic), BI-RADS breast density, type of breast pain (focal, diffuse, cyclical, unilateral, diffuse), additional breast symptoms (palpable concern, nipple discharge, skin changes, others), mammogram and ultrasound findings and final BI-RADS assessment, follow-up imaging, and follow-up biopsy results were reviewed and recorded.

Results: The median age of patients was 46 years (range, 27–97 years). Patients recalled from negative screening mammogram were 29.9% (167/559). Patients with preceding negative diagnostic mammogram were 70.1% (392/559). The BI-RADS breast density (BD) distribution was BD1, 5.5%; BD2, 39.9%; BD3, 46.0%; BD4, 8.6%. Final BI-RADS assessments were BI-RADS category 1/2 (79%), BI-RADS category 3 (12.9%), BI-RADS category 4 (8.1%), and BI-RADS category 5 (0%). A majority (66.9%, 374/559) of patients had breast pain alone. Additional breast symptoms of palpable concern (24%), nipple discharge (3.9%), skin changes/other (5.2%) were also noted. On follow-up evaluation, 26 findings were recommended for tissue sampling yielding two malignancies (0.4%, 2/559) in two patients. In the setting of negative mammogram and clinical symptom of breast pain alone yielded no malignancies (negative predictive value, 100%, 374/374) and was not impacted by breast density. In patients with additional symptoms accompanying pain, malignancies were present despite a negative mammogram in two patients, one with nipple discharge (1/22 [4.5%]), and one palpable concern (1/134 [0.7%]).

Conclusion: In the setting of a 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.