Michael Scott Portillo 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

Franklin Liu MD, Abstract Co-Author: Nothing to Disclose

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

For women aged 30-39 with focal breast signs or symptoms, mammography is typically performed to complement targeted ultrasound (US) of the area of concern and to screen the remaining breast for cancer. The purpose of this study was to determine the added value of mammography in women 30-39 years of age undergoing breast US for evaluation of focal breast signs or symptoms.

Following IRB approval, retrospective review of our radiology database identified all breast US examinations performed from 1/1/02-8/31/06 in women 30-39 years of age. Medical records were reviewed to identify those evaluations performed for a focal breast sign or symptom such as lump or pain. Each area of focal clinical concern evaluated with US was included and designated a study case. Imaging results including modalities used (US and mammography vs. US alone) and imaging findings on each modality were recorded. Benign versus malignant outcomes were determined by biopsy or 24 months of follow-up imaging and through linkage with the Cancer Surveillance System (CSS) tumor registry. The sensitivities and specificities of mammography and US were calculated.

From 1577 US examinations in the study interval, 1327 cases in 1032 patients comprised the analysis set. Outcomes were benign in 1301/1327 (98%) and malignant in 26/1328 (2%) cases. All cancers at the site of clinical concern were identified by US and none by mammography alone. In the 1207/1327 (91%) cases evaluated with both US and mammography, the sensitivity of US at the area of clinical concern was 100% and of mammography was 64%. Specificities of US and mammography were 89% and 94%, respectively. Mammography resulted in detection of one additional malignancy in an asymptomatic area of the breast in a 32 year old subsequently found to have a BRCA2 gene mutation.

Diagnostic breast imaging is warranted in women 30-39 years of age presenting with focal signs or symptoms due to the small (2%) but real risk of malignancy. US has a high sensitivity (100%) in this setting, while the added value of mammography is less evident. Further investigation is warranted to support continued use of mammography in this patient population.

In women 30-39 years of age with focal breast signs or symptoms, US has a high sensitivity while the added value of mammography is less evident.

Portillo, M, Demartini, W, Eby, P, Gutierrez, R, Liu, F, Lehman, C, Contribution of Mammography to Ultrasound Evaluation of Women 30 to 39 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/2009/8001966.html