Vilert Alon Loving MD, Presenter: Nothing to Disclose

Wendy Burton Demartini MD, Abstract Co-Author: Nothing to Disclose

Peter R. Eby MD, Abstract Co-Author: Research grant, General Electric Company, Milwaukee, WI Research grant, Johnson & Johnson, Cincinnati, OH

Robert Lee Gutierrez MD, Abstract Co-Author: Nothing to Disclose

Sue Peacock MSC, Abstract Co-Author: Nothing to Disclose

Constance D. Lehman MD, PhD, Abstract Co-Author: Instructor, General Electric Company

For women under 30 years of age with focal breast signs or symptoms, targeted ultrasound (US) is typically performed. There are sparse outcomes data in this setting, and questions remain regarding the need for concurrent mammography and the safety of US surveillance versus biopsy. The purpose of this study was to determine the imaging and malignancy outcomes in women under 30 years of age undergoing US evaluation for focal areas of clinical concern.

Following IRB approval, retrospective review of medical records identified all breast US examinations performed from 2/1/02 to 8/30/06 in women under 30 years of age. Individual records were reviewed to identify evaluations performed for a focal breast sign or symptom such as lump or pain. Final BI-RADS assessments of 4 or 5 were considered positive, and final BI-RADS assessments of 1, 2, or 3 were considered negative. Outcomes were determined by biopsy, 24 months of imaging follow-up, and/or linkage with the Cancer Surveillance System (CSS) tumor registry. The overall cancer yield, sensitivity, specificity, and positive biopsy rate of US were calculated.

From 1123 US examinations in the study interval, 1091 lesions in 830 patients comprised the analysis set. The mean patient age was 24 (range 12-29) years. Biopsy was recommended in 174 patients and performed in 168 patients. Three of the 168 patients who underwent biopsy were diagnosed with cancer, for a positive biopsy rate of 1.8%. Aside from these three BI-RADS 4 or 5 US detected malignancies, no additional cancers were identified with imaging follow-up or CSS linkage. The overall cancer yield was 0.4% (3/830). Sensitivity of US was 100% (3/3) and specificity was 79.3% (656/827).

Women under 30 years of age with focal breast signs or symptoms have an exceedingly low (0.4%) incidence of malignancy. All cancers were detected with US, suggesting that mammography is not indicated in this setting. The cancer yield from biopsy was extremely low at 1.8%. Therefore, close US surveillance may be a preferred alternative to tissue sampling in this patient population.

Women under 30 years of age with focal breast signs or symptoms should be evaluated by targeted US. If a mass is identified, surveillance may be preferred over biopsy.

Loving, V, Demartini, W, Eby, P, Gutierrez, R, Peacock, S, Lehman, C, Outcomes of Targeted Ultrasound Evaluation in Women Under 30 Years of Age with Focal Breast Signs or Symptoms.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8001788.html