Sivarajah Rebecca, Welkie Janelle, Mack Julie, Casas Rachel S, Paulishak Melody, Chetlen Alison L
Penn State Health-Hershey Medical Center, Department of Radiology, Hershey, PA.
Penn State College of Medicine, Hershey, PA.
J Breast Imaging. 2020 Mar 25;2(2):101-111. doi: 10.1093/jbi/wbz082.
Over two-thirds of women will experience breast pain in their lifetime. As one of the leading breast symptoms for which women seek medical attention, breast pain is suspected to be underreported and under-studied. Cyclical breast pain is related to hormonal changes. Noncyclical breast pain is independent of the menstrual cycle and can be idiopathic and related to chronic pain syndromes, infections, ill-fitting bras, musculoskeletal abnormalities, pregnancy, perimenopause, and postsurgical causes. Breast pain can also present in transgender patients and may require additional considerations as to the underlying cause. Imaging of mastalgia depends upon the suspected etiology. Inappropriate imaging for breast pain is associated with significant utilization of health care resources. Cyclical breast pain does not require an imaging work-up. The work-up of focal, noncyclical breast pain includes ultrasound for women aged younger than 40 years, and mammography and ultrasound for women aged 40 years and older. Management of breast pain is often supportive, as most breast pain resolves spontaneously. If pain persists, imaging and management should follow a step-wise approach. If conservative measures fail, second-line therapy is topical nonsteroidal anti-inflammatory drugs. If breast pain is severe and resistant to conservative methods, additional third-line therapies can be added by breast care specialists with specific knowledge of the potential deleterious side effects of these medications. While the causes of mastalgia are overwhelmingly benign, breast pain can significantly impact quality of life, and the breast radiologist should be familiar with causes, management, and treatment recommendations from a multidisciplinary approach.
超过三分之二的女性在其一生中会经历乳房疼痛。作为女性寻求医疗关注的主要乳房症状之一，乳房疼痛被认为存在报告不足和研究不足的情况。周期性乳房疼痛与激素变化有关。非周期性乳房疼痛与月经周期无关，可能是特发性的，也可能与慢性疼痛综合征、感染、胸罩不合适、肌肉骨骼异常、怀孕、围绝经期和手术后原因有关。乳房疼痛也可能出现在 transgender 患者中，可能需要对潜在病因进行额外考虑。乳房疼痛的影像学检查取决于可疑病因。对乳房疼痛进行不恰当的影像学检查会导致大量医疗资源的利用。周期性乳房疼痛不需要进行影像学检查。对于 40 岁以下的女性，局灶性非周期性乳房疼痛的检查包括超声检查；对于 40 岁及以上的女性，则包括乳房 X 光检查和超声检查。乳房疼痛的治疗通常是支持性的，因为大多数乳房疼痛会自行缓解。如果疼痛持续，影像学检查和治疗应采取逐步的方法。如果保守措施失败，二线治疗是局部使用非甾体抗炎药。如果乳房疼痛严重且对保守方法有抵抗性，乳房护理专家可以添加额外的三线治疗方法，但要了解这些药物潜在的有害副作用。虽然乳房疼痛的原因绝大多数是良性的，但乳房疼痛会对生活质量产生重大影响，乳房放射科医生应该从多学科方法中熟悉其原因、管理和治疗建议。
