Additionally, Tumyan et al [38] in a retrospective study of mammography in combination with US found a NPV of 100%, though the study was limited by a significant number of patients being lost to follow-up. DBT DBT While there is no literature specifically evaluating the use of DBT in the workup of focal and noncyclical breast pain, DBT can be useful in the diagnostic setting. It is known to improve lesion characterization in noncalcified lesions and cancer detection when compared to conventional mammographic workup [28-30,39-41]. US Breast While there are few studies evaluating US independently of mammography in the setting of focal and noncyclical breast pain, the existing literature suggests that US may be useful to exclude malignancy in these cases. A retrospective review of 110 cases of focal breast pain evaluated by US found no imaging abnormality in 85 cases (77.3%) [12] and there were no malignancies. In 15 cases (13.6%), cysts were identified, and 3 patients (2.7%) had solid masses, all of which were benign. Fluid collections and edema were seen in the remaining cases. Several studies have evaluated the usefulness of US in addition to mammography in cases of focal, noncyclical breast pain and concluded that in the setting of a negative mammogram, US may not be indicated, especially in patients with nondense breasts. A retrospective study of 206 patients with focal breast pain as their only symptom evaluated with US after a mammogram found that US resulted in 8 additional biopsies and 14 additional 6-month follow-up examinations without detecting any additional cancers [11]. Another retrospective study found 76 imaging abnormalities in 413 cases of focal pain, with 46 (61%) seen on US alone, for a specificity of 82%. While there were no malignancies, US found a benign lesion in 40 of 56 cases in which mammography was negative in patients with dense breasts and found a benign lesion in 6 of 20 cases with a negative mammogram and nondense breasts.
Breast Pain. Additionally, Tumyan et al [38] in a retrospective study of mammography in combination with US found a NPV of 100%, though the study was limited by a significant number of patients being lost to follow-up. DBT DBT While there is no literature specifically evaluating the use of DBT in the workup of focal and noncyclical breast pain, DBT can be useful in the diagnostic setting. It is known to improve lesion characterization in noncalcified lesions and cancer detection when compared to conventional mammographic workup [28-30,39-41]. US Breast While there are few studies evaluating US independently of mammography in the setting of focal and noncyclical breast pain, the existing literature suggests that US may be useful to exclude malignancy in these cases. A retrospective review of 110 cases of focal breast pain evaluated by US found no imaging abnormality in 85 cases (77.3%) [12] and there were no malignancies. In 15 cases (13.6%), cysts were identified, and 3 patients (2.7%) had solid masses, all of which were benign. Fluid collections and edema were seen in the remaining cases. Several studies have evaluated the usefulness of US in addition to mammography in cases of focal, noncyclical breast pain and concluded that in the setting of a negative mammogram, US may not be indicated, especially in patients with nondense breasts. A retrospective study of 206 patients with focal breast pain as their only symptom evaluated with US after a mammogram found that US resulted in 8 additional biopsies and 14 additional 6-month follow-up examinations without detecting any additional cancers [11]. Another retrospective study found 76 imaging abnormalities in 413 cases of focal pain, with 46 (61%) seen on US alone, for a specificity of 82%. While there were no malignancies, US found a benign lesion in 40 of 56 cases in which mammography was negative in patients with dense breasts and found a benign lesion in 6 of 20 cases with a negative mammogram and nondense breasts.