title: Role of breast ultrasound and mammography in evaluating patients presenting with focal breast pain in the absence of a palpable lump.
abstract: To determine if ultrasound and/or mammography is helpful in detecting breast cancers in patients presenting with focal breast pain. Patients who presented between February 2008 and April 2011 with focal breast pain without a lump were included in the study. The mammographic and US findings were retrospectively reviewed. BIRADS 0, 4, and 5 were considered positive on mammogram while BIRADS 4 and 5 were considered positive on US. The efficacy of mammogram-alone, ultrasound-alone, and in combination to detect breast cancer was evaluated. The performance of mammography for detecting any mass lesions that were present on subsequent US was also evaluated. A total of 257 patients were evaluated with US and 206 (80.1%) of these also had mammograms prior to the US. Cancer incidence was 1.2% (n = 3). The sensitivity, specificity, PPV, and NPV of mammogram-alone and US-alone for detection of breast cancer in these patients were 100%, 87.6%, 10.7%, 100% and 100%, 92.5%, 13.6%, and 100%, respectively, while for combined mammogram and US was 100%, 83.7%, 8.3%, and 100%. The sensitivity, specificity, PPV, and NPV of mammogram for identifying an underlying suspicious mass lesion that was subsequently detected by US was 58%, 91%, 39%, and 95%. The NPV of a BIRADS 1 mammogram for any underlying mass lesion was 75%. Addition of an ultrasound to a mammogram did not detect additional cancers; likely due to low cancer incidence in these patients. However, US detected underlying mass lesions in 25% cases with a BIRADS 1 mammogram result.
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Leddy
authors.forename: Abid
authors.initials: A
authors.lastname: Irshad
authors.forename: Emily
authors.initials: E
authors.lastname: Zerwas
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mayes
authors.forename: Kent
authors.initials: K
authors.lastname: Armeson
authors.forename: Maham
authors.initials: M
authors.lastname: Abid
authors.forename: Abbie
authors.initials: A
authors.lastname: Cluver
authors.forename: Amy
authors.initials: A
authors.lastname: Campbell
authors.forename: Susan
authors.initials: S
authors.lastname: Ackerman
authors.forename: Madelene
authors.initials: M
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000175:diagnosis*; D002648:Child; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary
keywords: breast cancer; breast pain; breast ultrasound; mammography