pPerelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. qPanel Chair, Emory University Hospital, Atlanta, Georgia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Breast Pain Discussion of Procedures by Variant Discussion of Procedures by Variant Variant 1: Female with clinically insignificant breast pain (nonfocal [greater than one quadrant], diffuse, or cyclical) without other suspicious clinical finding. Any age. Initial imaging. Mammography There is very limited literature specifically evaluating the use of imaging in patients with nonfocal or cyclical 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]. Given that this type of breast pain is not associated with malignancy, the use of mammography beyond the usual screening recommendations is not expected to result in increased cancer detection. Some argue that imaging may be helpful in order to reassure the patient of the absence of malignancy [14,32]. One study found patients with breast pain reported a decreased level of pain and anxiety after sonography [33]. However, the assumption that negative imaging reassures the patient or clinician is challenged by a retrospective cohort study that found that imaging women with breast pain at the time of the initial clinical visit increased the odds of subsequent clinical visits [34]. DBT DBT There is no relevant literature regarding the specific use of DBT in the evaluation of nonfocal or cyclical breast pain.
Breast Pain. pPerelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. qPanel Chair, Emory University Hospital, Atlanta, Georgia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Breast Pain Discussion of Procedures by Variant Discussion of Procedures by Variant Variant 1: Female with clinically insignificant breast pain (nonfocal [greater than one quadrant], diffuse, or cyclical) without other suspicious clinical finding. Any age. Initial imaging. Mammography There is very limited literature specifically evaluating the use of imaging in patients with nonfocal or cyclical 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]. Given that this type of breast pain is not associated with malignancy, the use of mammography beyond the usual screening recommendations is not expected to result in increased cancer detection. Some argue that imaging may be helpful in order to reassure the patient of the absence of malignancy [14,32]. One study found patients with breast pain reported a decreased level of pain and anxiety after sonography [33]. However, the assumption that negative imaging reassures the patient or clinician is challenged by a retrospective cohort study that found that imaging women with breast pain at the time of the initial clinical visit increased the odds of subsequent clinical visits [34]. DBT DBT There is no relevant literature regarding the specific use of DBT in the evaluation of nonfocal or cyclical breast pain.