Cho Michael W, Grimm Lars J, Johnson Karen S
Division of Breast Imaging, Department of Radiology, Duke University Medical Center, Box 3808, Erwin Road, Durham, NC 27710.
Division of Breast Imaging, Department of Radiology, Duke University Medical Center, Box 3808, Erwin Road, Durham, NC 27710.
Acad Radiol. 2017 Jan;24(1):53-59. doi: 10.1016/j.acra.2016.09.004. Epub 2016 Oct 13.
This study aimed to determine the utility of directed ultrasound and digital mammogram for evaluating focal breast pain in women with different mammographic breast densities.
This institutional review board-approved and Health Insurance Portability and Accountability Act-compliant retrospective study included 413 cases of focal breast pain in 369 women (mean age 53 years). All cases were evaluated with both mammogram and ultrasound and had at least 2 years of imaging follow-up. Exclusion criteria were non-focal, axillary, or radiating pain; palpable or skin changes; pregnancy or lactation; and history of trauma or infection. Breast density, imaging findings, and biopsy results were recorded. Specificity, positive predictive values, and negative predictive values were calculated.
Eighteen percent (76 of 413) of cases demonstrated an imaging correlate. Of these, 74% (56 of 76) occurred in dense breasts and 26% (20 of 76) in nondense breasts. Seventy percent (14 of 20) of lesions in nondense breasts were seen with mammography and ultrasound, whereas 30% (6 of 20) were detected only with ultrasound. Of lesions detected in dense breasts, 29% (16 of 56) were seen with mammography and ultrasound, whereas 71% (40 of 56) were detected only with ultrasound. Thirty-one percent (24 of 76) of cases were biopsied, 42% (10 of 24) of which were detected by ultrasound only. No cancer was detected in initial workup. At 2-year follow-up, three women, all with dense breasts, developed cancer in the same quadrant as the initial pain.
Directed ultrasound, when performed in conjunction with digital mammography for the evaluation of focal breast pain in women with nondense breasts, is of low utility and may contribute to unnecessary intervention as a result of incidental findings.
本研究旨在确定定向超声和数字化乳腺钼靶在评估不同乳腺钼靶密度女性的局灶性乳腺疼痛方面的效用。
这项经机构审查委员会批准且符合《健康保险流通与责任法案》的回顾性研究纳入了369名女性（平均年龄53岁）的413例局灶性乳腺疼痛病例。所有病例均接受了乳腺钼靶和超声检查，且至少有2年的影像学随访。排除标准为非局灶性、腋窝或放射性疼痛；可触及或皮肤改变；妊娠或哺乳期；以及创伤或感染史。记录乳腺密度、影像学表现和活检结果。计算特异性、阳性预测值和阴性预测值。
18%（413例中的76例）的病例显示有影像学关联。其中，74%（76例中的56例）发生在致密型乳腺中，26%（76例中的20例）发生在非致密型乳腺中。非致密型乳腺中70%（20例中的14例）的病变在乳腺钼靶和超声检查中均可见，而30%（20例中的6例）仅在超声检查中被发现。在致密型乳腺中检测到的病变，29%（56例中的16例）在乳腺钼靶和超声检查中可见，而71%（56例中的40例）仅在超声检查中被发现。76例病例中有31%（24例）接受了活检，其中42%（24例中的10例）仅通过超声检测到。初始检查未发现癌症。在2年的随访中，三名女性均为致密型乳腺，在与初始疼痛相同的象限发生了癌症。
对于评估非致密型乳腺女性的局灶性乳腺疼痛，将定向超声与数字化乳腺钼靶结合使用时，效用较低，可能会因偶然发现而导致不必要的干预。
