title: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications.
abstract: OBJECTIVE
  The purpose of this article is to assess the accuracy of targeted breast ultrasound in women younger than 30 years presenting with focal breast signs or symptoms.
  
  
  METHODS
  Retrospective review of the electronic medical records identified all ultrasound examinations from January 1, 2002, through August 30, 2006, performed for focal breast signs or symptoms in women younger than 30 years. BI-RADS assessments were recorded. Outcomes were determined by biopsy, 24 months of ultrasound surveillance, and linkage with the regional tumor registry. The overall cancer yield, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) 2, and PPV3 of ultrasound were calculated.
  
  
  RESULTS
  Among 830 study patients, lesions were assessed as BI-RADS category 1 or 2 in 526 (63.4%), BI-RADS category 3 in 140 (16.9%), BI-RADS category 4 in 163 (19.6%), and BI-RADS category 5 in one (0.1%) patient. Three malignancies were detected, for a cancer yield of 0.4%. No BI-RADS category 3 lesions, two BI-RADS category 4 lesions, and the single BI-RADS category 5 lesion were malignant. Ultrasound sensitivity was 100%, specificity was 80.5%, NPV was 100%, PPV2 was 1.8%, and PPV3 was 1.9%.
  
  
  CONCLUSIONS
  Women younger than 30 years with focal breast signs or symptoms have a very low (0.4%) incidence of malignancy. The 100% sensitivity and NPV of targeted ultrasound in our study substantiates its use as an accurate primary imaging test in this clinical setting. We found no malignancies in BI-RADS category 3 lesions, supporting ultrasound surveillance over biopsy in this patient population.
authors.affiliation: Seattle Cancer Care Alliance, 825 Eastlake Ave. E, G3-200, Seattle, WA 98109-1023, USA.
authors.forename: Vilert A
authors.initials: VA
authors.lastname: Loving
authors.forename: Wendy B
authors.initials: WB
authors.lastname: DeMartini
authors.forename: Peter R
authors.initials: PR
authors.lastname: Eby
authors.forename: Robert L
authors.initials: RL
authors.lastname: Gutierrez
authors.forename: Sue
authors.initials: S
authors.lastname: Peacock
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*