Mastodynia: is imaging necessary in young patients?

Abstract

Objective: Mastalgia is the most frequent symptom seen in patients who undergo breast imaging. There are various medical treatment methods in the literature. However, malignancy should be excluded before starting treatment. This is a prospective study, evaluating the necessity of imaging in patients who have applied for cyclic or non-cyclic breast pain, with normal physical examination, and without a family history. Material and Methods:Two hundred women, younger than 30 years of age, who applied to Iğdır State Hospital general surgery department with complaint of cyclic or non-cyclic breast pain, were prospectively studied. Patients with nipple discharge, complaint of lump in their breast, who were pregnant or lactating, who had breast cancer history in their family and those who were found to have lumps on examination were excluded from the study. All patients underwent ultrasound imaging and the same radiologist evaluated them. Results:The breast examination was normal in all patients. Ultrasound imaging results were completely normal in 98 (48%) patients. 47 (23.5%) patients were found to have fibroadenoma, with a mean diameter of 9.6 mm (5 mm-14 mm). 45 (22.5%) patients had simple cysts with a mean diameter of 7.8 mm (3 mm-11 mm). 6 (3%) patients were found to have intraductal papillomas and 4 (2%) to have lipomas. All patients were classified as either BI-RADS 1 or BI-RADS 2. Conclusion:It is recommended that malignancy should be eliminated before starting treatment in patients with breast pain. In this study, the necessity of imaging in patients younger than 30 years and who applied to the general surgery department for only breast pain, was investigated. None of the patients with a normal breast examination were found to have any lesions considered suspicious for malignancy. We believe that if breast examination is normal, the patient is equal to or younger than 30 years of age and there is no family history, imaging is not necessary and that medical therapy can be started directly after the patient is informed.

ACR Appropriateness Criteria® Breast Pain

“…In a retrospective review of 236 patients with breast pain, authors found no mammographic or sonographic correlate in the 10 patients who had cyclical breast pain [8]. A prospective study of 76 patients younger than age 30 who presented with cyclical breast pain as their only complaint and underwent US found no malignancy [35]. A limitation of this study was the lack of follow-up.…”

“…The literature regarding the efficacy of US in evaluation of breast pain is somewhat limited by lack of age-group-specific results. Most authors have found that cancer is a rare cause of focal, clinically significant breast pain [12,35], and that US has a high negative predictive value (NPV), sensitivity, and specificity for evaluation of breast pain. Leddy et al [11] performed a retrospective review of 257 patients who underwent US after presenting with focal breast pain and found cancer in 1.2% of patients, with a sensitivity of 100%, specificity of 92.5%, positive predictive value of 13.6%, and NPV of 100%.…”

Cyst of Montgomery: An uncommon adolescent breast lump

“…[ 4 ] Fortunately, most breast pathologies that occur in childhood and adultescence tend to be benign. [ 3 5 6 ] We gathered studies from the earliest to the latest 48 cases of reported cysts of Montgomery summarized in Table 1 .…”

“…Depending on the findings, age, and family history, the physician can determine if there is a need for radiological assessment. [ 5 6 9 ] Ultrasonography is the first choice and the most ideal examination to confirm the diagnosis of cystic changes in the breast of children and adolescents as well as adults. [ 3 ] The most common indication for sonographic examination is when there are symptoms such as pain or pyrexia with redness of breast, which are signs of inflammation and infection, as well as palpable mass in the breast.…”

Breast pain and ultrasound: If normal result, exploring the uterus is a good reflex

“…Ultrasonography is indicated as first line and proposed in the exploration of these pains to reassure the anxious patients, but in the case of their bilaterality and their cyclical character, the indications of these have no place. [ 1 2 ]…”