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%. Loving et al [37] found a 100% NPV and sensitivity in their retrospective study of 830 patients less than 30 years of age with focal breast signs or symptoms (not limited to but including breast pain). Some authors suggest that, despite the low incidence of malignancy, US may be useful in that it could potentially find treatable causes of breast pain, such as cysts [9]. On the other hand, a prospective, observational follow-up study of 987 patients with breast pain alone found benign findings in 8.6% of cases, which consisted mostly of Breast Pain small cysts [14]. The authors argued that in the absence of a palpable abnormality, any cyst that may be found by US would be unlikely to be large enough to cause pain or benefit from aspiration. MRI Breast There is no relevant literature regarding the use of MRI in the evaluation of focal and noncyclical breast pain. Sestamibi MBI There is no relevant literature regarding the use of MBI in the evaluation of focal and noncyclical breast pain. Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging. Mammography Though the incidence is low, mammography may be used to exclude malignancy in cases of focal and noncyclical breast pain. Mammography was found to have a high sensitivity (100%) and NPV (100%) in a retrospective review of 206 patients with focal breast pain [11]. While this study found specificity to be slightly lower at 87.6%, another retrospective study of focal, noncyclical pain calculated a specificity of mammography of 97% for nondense breasts and 96% for dense breasts [9].
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%. Loving et al [37] found a 100% NPV and sensitivity in their retrospective study of 830 patients less than 30 years of age with focal breast signs or symptoms (not limited to but including breast pain). Some authors suggest that, despite the low incidence of malignancy, US may be useful in that it could potentially find treatable causes of breast pain, such as cysts [9]. On the other hand, a prospective, observational follow-up study of 987 patients with breast pain alone found benign findings in 8.6% of cases, which consisted mostly of Breast Pain small cysts [14]. The authors argued that in the absence of a palpable abnormality, any cyst that may be found by US would be unlikely to be large enough to cause pain or benefit from aspiration. MRI Breast There is no relevant literature regarding the use of MRI in the evaluation of focal and noncyclical breast pain. Sestamibi MBI There is no relevant literature regarding the use of MBI in the evaluation of focal and noncyclical breast pain. Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging. Mammography Though the incidence is low, mammography may be used to exclude malignancy in cases of focal and noncyclical breast pain. Mammography was found to have a high sensitivity (100%) and NPV (100%) in a retrospective review of 206 patients with focal breast pain [11]. While this study found specificity to be slightly lower at 87.6%, another retrospective study of focal, noncyclical pain calculated a specificity of mammography of 97% for nondense breasts and 96% for dense breasts [9].