Debra Somers Copit MD, Abstract Co-Author: Consultant, Johnson & Johnson

David Lee MD, Abstract Co-Author: Nothing to Disclose

Julia Rose Peoples MD, Presenter: Nothing to Disclose

 Ultrasound of the breast is an essential tool in evaluating many patients with breast symptoms. Although there are specific indications for its use, the role of breast ultrasound (BUS) in women with breast pain is less clearly defined. Because it has been our experience that BUS in women with pain is typically normal, we sought to evaluate its true utility in our practice by performing a retrospective review of our data.

Our study was approved by the IRB. We performed a retrospective review of data between December 2001 and May 2007 on  patients who had a complaint of breast pain and who were evaluated with breast ultrasound. All patients over the age of thirty had a diagnostic mammogram preceding the ultrasound. The ultrasounds were performed by Radiologists with at least 3 years experience in breast imaging. The ultrasound reports were reviewed to determine whether or not they were normal or abnormal. The abnormal studies were further divided into BI-RADS categories. Pathology results were obtained from patients who were either given a biopsy recommendation or preferred to have a biopsy.

There were a total of 257 areas of pain in 211 patients. Two hundred thirty six areas of pain were focal while 21 were diffuse. Two hundred nineteen areas of pain had a normal ultrasound (BI-RADS 1). Thirty eight areas of pain demonstrated an abnormality on ultrasound. Twenty three of these were BI-RADS 2. Six were assessed as BI-RADS 3 and of these patients 2 have had a stable study for more than 2 years, one for 15 months and 3 were lost to follow up. Of the remaining patients, 9 underwent biopsy with benign results. No patient was diagnosed with carcinoma.

 Although an ultrasound is often ordered and/or performed in patients presenting with breast pain, our data show that breast ultrasound is typically negative. While a benefit of performing an ultrasound is that it gives the Radiologist an opportunity to discuss results and symptom management directly with the patient, our results suggest that BUS may not be necessary. In the context of a negative mammogram,  particularly given the current concern over cost-effective medicine, these patients may be better served with reassurance and clinical management.

 Patients who present with breast pain may not need an ultrasound. Our findings are relevant in the current medicolegal and economic environment.

Copit, D, Lee, D, Peoples, J, The Value of Ultrasound in the Evaluation of Breast Pain.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6006707.html