Value of breast imaging in women with painful breasts: observational follow up study

Objectives To determine the value of breast imaging in patients with locali sed or diffuse pain in the breast in whom physical examination shows no abn ormalities. Design Observational follow up study. Setting Radiology department of a teaching hospital in the Netherlands. Subjects Altogether 987 women referred for radiological breast imaging beca use of pain alone and a control group of 987 asymptomatic women referred fo r a screening mammogram. Main outcome measures Correlation of the radiological findings rath clinica l and pathological findings over two years of follow up. Results Radiological examination of the painful breast(s) showed the follow ing: normal findings in 854 (86.5%) women, benign abnormalities in 85 (8.6% ; mainly small cysts or mastopathy), abnormalities that were probably benig n in 36 (3.6%), suspicious findings in 8 (0.8%), and malignancy in 4 (0.4%) , Biopsy of the painful area was performed in 10 of the 939 women with norm al findings or benign abnormalities, in two of 36 women with radiological a bnormalities that were probably benign, and in all women with suspicious or malignant findings. Only the four lesions that had been classified radiolo gically as malignant were found to be malignant at surgery, The prevalence of breast cancer was similar in symptomatic and control women. Conclusions Breast imaging in women who present with pain alone is of value only in providing reassurance-no abnormalities are usually found in the pa inful area, radiological abnormalities classified as benign do not generall y have any clinical consequences, and the prevalence of cancer is low in th ese women, Biopsy of the painful area should be performed only where radiol ogical findings are suspicious.