Lauren Fischer Stein MD, Presenter: Nothing to Disclose

Kara Gaetke Udager MD, Abstract Co-Author: Nothing to Disclose

Mitra Noroozian MD, Abstract Co-Author: Nothing to Disclose

Caroline Plowden Daly MD, Abstract Co-Author: Nothing to Disclose

Mark Alan Helvie MD, Abstract Co-Author: Institutional grant, General Electric Company Consultant, General Electric Company

To determine the utility and outcome of diagnostic imaging in women with isolated breast pain.

IRB and HIPAA approved study. Computerized records of 500 consecutive women (mean age 47 years, range 21-86) referred to breast imaging for isolated breast pain (2006-2007) were retrospectively reviewed and constitute the study cohort. Subjects with other symptoms indicated by physician or patient (palpable mass, nodularity, swelling, erythema, discharge, ipsilateral cancer, lactation) were excluded. Standard imaging evaluation included age appropriate diagnostic mammography and MD performed ultrasound for focal pain. Pain location, PE findings, and mammographic/sonographic BIRADS assessments were recorded for analysis. Outcomes were established by clinical and imaging follow-up. All cancer cases were reviewed to establish geographic correlation of the cancer and site of pain. Cancers diagnosed within 6 months of imaging were considered “current” and those after 6 months “subsequent”.

8 of 500 (1.6%) women were diagnosed with breast cancer. 3/8 (37.5%) cancers were current and 5/8 (62.5%) subsequent. 5/8 (62.5%) cancers geographically correlated to site of pain, 2/8 (25%) were remote, and 1/8 (12.5%) women had non-focal pain. Diagnostic mammography was true positive in 3/3 current cases (one cancer only apparent by diagnostic views). Ultrasound was positive in 1/3 current cases. All 3 had focal pain. Of women with subsequent cancer, 4/5(80%) were detected by mammographic screening and 1/5 (20%) had palpable finding with positive mammogram. Review of subsequent cases confirmed negative initial imaging. The 8 cancers were invasive ductal(5) or lobular(1) and DCIS(2). Mean size was 1.4 cm (range 0.6-2.2 cm). Mean age was 53 years (range 41-70 years). Diagnostic imaging detected 25/500 (5%) simple cysts, 8/500 (1.6%) complicated cysts, and 6/500 (1.2%) benign solid masses. 5 lesions had benign CNB and 10 benign FNA. There were no infected cysts.

Although unusual, breast cancer may present with pain in the absence of other signs and symptoms. Current recommendations for diagnostic mammography remain appropriate to assess breast pain.

Current ACR recommendations for age appropriate diagnostic mammography for patients with focal breast pain are supported.

Stein, L, Udager, K, Noroozian, M, Daly, C, Helvie, M, Breast Pain: Is Diagnostic Imaging Necessary?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007560.html