The role of breast ultrasound has gradually increased in this evaluation due to advances in the technology and improvement of interpretation of ultrasound findings by breast radiologists. Biopsy is performed when needed according to various national guidelines. Although the exact fraction of these women that is referred to a breast clinic is unknown, roughly 70.000 women (1/3rd) with focal breast complaints present at a radiology department in the Netherlands annually.įor women over 30, the baseline examination includes mammography (and digital breast tomosynthesis in most hospitals) followed by targeted ultrasound at the spot of the focal breast complaint. The highest incidence of focal breast complaints is found in women aged 25 to 44 years (). The majority of visits is due to a palpable mass, but also skin changes, nipple changes, nipple excretion and focal pain are included. In the Netherlands per 1000 women, 29.7 women with focal breast symptoms visit a general practitioner per year. Mammography could be performed on indication only. Our results suggest that initial targeted ultrasound is a more appropriate initial tool for the evaluation of focal breast complaints. Additional findings are most common in patients with symptomatic breast cancer. The contribution of mammography for cancer detection in women with focal breast complaints is very low when targeted ultrasound is performed. In only one patient with symptoms caused by a benign finding, an incidental malignancy was detected on mammography outside the area of complaint (detection rate 2.2/1000 examinations). Additional findings on mammography were significantly more often malignant when the symptomatic lesion was also malignant (3.8% vs 70%, P < 0.05). The negative predictive value of targeted ultrasound was very high (99.8%). In 49 women (9.9%), symptomatic breast cancer was diagnosed, all visible during targeted ultrasound. ResultsĪ total of 494 women were included (mean age 46.5, range 30 to 93). We retrospectively collected the following data: date of birth, indication of imaging, visibility on mammography/ultrasound, whether biopsy was taken, additional findings, BI-RADS-classification, pathology and follow-up results. Women with symptomatic breast disease who were evaluated by breast imaging (mammography/digital breast tomosynthesis and ultrasound) between January 2016 and December 2016 in the Radboud University Medical Centre were included. To determine the added value of mammography in women with focal breast complaints and the utility of initial targeted ultrasound in this setting.
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