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Is additional breast imaging needed after a negative mammogram?

Researchers from the Columbia University Medical Center have discovered additional breast imaging with ultrasound know-how could also be pointless after a affected person receives a negative mammogram and has skilled signs of breast ache alone, in response to a current research revealed in Current Problems in Diagnostic Radiology. 

“Our study aimed to determine the diagnostic value of added ultrasound following a normal mammogram in the initial investigation of breast pain; we hypothesized that the annual mammogram is sufficient to rule out malignancy and further ultrasound investigation is unnecessary,” stated lead writer of the research Eralda Mema, MD, from the division of radiology at Columbia University Medical Center. “Our aim was to provide a balanced approach to the imaging of mastalgia with the goal of identifying the small number of cancers present in patients with breast pain, while avoiding overuse.”  

Mema and her colleagues asserted that if additional signs happen with breast ache (mastalgia), additional ultrasound testing must be thought-about for figuring out mammographically occult tumors.  

In complete, eight,085 women have been recruited for the research and underwent ultrasound analysis for breast ache in 2013. The median age of the members was 46 years previous. Additionally, of the eight,085 women, 559 had mammograms earlier than the ultrasound examination.  

The affected person’s age, sort of mammogram (screening or diagnostic), breast density, sort of breast, additional breast signs, mammogram/ultrasound findings, remaining breast imaging reporting and knowledge system (BIRADS) evaluation and follow-up imaging and biopsy outcomes have been recorded, in response to research strategies.  

Study outcomes after ultrasound testing included the next:  

  • 29.eight % of sufferers have been recalled from negative screening mammogram. 
  • 70.2 % of sufferers had a previous negative diagnostic mammogram. 
  • The BIRADS breast density (BD) distribution was BD1: 5.5 %, BD2: 39.9 %, BD3: 46.zero %, BD4: eight.6 %.  
  • Final BIRADS assessments have been BIRADS 1/2 (79 %), BIRADS3 (12.9 %), BIRADS four (eight.1 %), BIRADS 5 (zero %).  
  • Majority (66.9 %) of the affected person had breast ache alone.  
  • Additional breast signs have been additionally famous as follows: palpable concern (24 %), nipple discharge (three.9 %), kin modifications/different (5.2 %).  
  • On follow-up analysis, 26 findings have been beneficial for tissue sampling, which yielded malignancies in two sufferers. 
  • A negative mammogram with medical signs of breast ache alone yielded no malignances (NPV, 100 %) and was not impacted by breast density. 
  • In sufferers with additional signs accompanying ache, malignancies have been current regardless of negative mammogram in two sufferers; nipple discharge (four.5 %) and palpable concern (zero.7 %).  

“Justification for this approach include the improved ability of ultrasound to identify additional benign lesions, which may theoretically identify malignant findings in a larger representative sample, as well as value in reassurance to the patient and referring physicians,” Mema concluded. “We believe that obtaining an ultrasound examination in these patients may increase the number of follow-ups of probably benign (BIRADS 3) lesions and subsequently increase the rate of benign biopsies.”  


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