0:00

Our next topic is breast pain.

0:03

And again, there's an ACR appropriateness

0:07

criteria to correlate with this.

0:11

So another expert panel giving us

0:15

advice on how to image breast pain.

0:19

The basics are that diagnostic imaging,

0:22

really is not indicated for diffuse,

0:25

bilateral, or cyclical pain.

0:27

Imaging is indicated for focal,

0:30

unilateral, and non-cyclical breast pain.

0:34

This is a very common complaint.

0:37

Most people with breast pain have

0:39

normal imaging, and the imaging

0:41

can be very useful for reassurance.

0:44

We can find a reason for pain,

0:46

such as a cyst or an abscess, but often the

0:49

exam is normal, and the chance of cancer

0:52

is very low, estimated at 0 to 3%.

0:57

So the ACR appropriateness criteria recommend

0:59

that for patients under age 30, we would do breast

1:04

ultrasound, mammogram only if needed, and then

1:08

for age 30 to 39, that intermediate age group.

1:13

Ultrasound or mammogram both get

1:14

the same appropriateness rating,

1:18

so either one could be performed first.

1:20

And then for age 40 and up, diagnostic mammogram

1:23

is recommended, followed by ultrasound.

1:27

Our protocol is just slightly different

1:29

in that for patients age 30 and up,

1:31

we're going to start with a mammogram first.

1:33

So we took that age 30 to 39-year-old

1:37

age group and decided that we would.

1:41

do a mammogram in all of those patients.

1:43

So for age under 30, we'll start

1:45

with ultrasound, age 30 and up,

1:47

mammogram first, and then ultrasound.

1:49

And we do bilateral CC and MLO views.

1:52

If the patient has had a screening

1:54

mammogram within the last six months,

1:56

we don't repeat the mammogram.

1:58

We go straight to ultrasound.

2:00

If it's been more than six months,

2:02

we'll go ahead and repeat a unilateral mammogram.

2:05

And for mammography, we'll mark the

2:07

site of pain with a skin marker,

2:09

and in this case, we use a square.

2:14

Breast pain has a number of different

2:16

causes, some of which we really can't image.

2:20

It can be hormonal, it can be related

2:22

to cysts or multiple cysts, it could

2:25

be nerve-related or musculoskeletal.

2:28

The etiology could be completely unknown,

2:30

and very rarely, as I mentioned before,

2:32

it can be associated with breast cancer.

2:35

I think in over 20 years of breast imaging,

2:38

I've seen about three cases where a

2:40

patient presented with focal breast pain.

2:42

And when we image that area, we found

2:45

a mass, and subsequent biopsy showed a

2:47

breast cancer, but it's pretty unusual.

Breast Pain Overview

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

Our next topic is breast pain.

0:03

And again, there's an ACR appropriateness

0:07

criteria to correlate with this.

0:11

So another expert panel giving us

0:15

advice on how to image breast pain.

0:19

The basics are that diagnostic imaging,

0:22

really is not indicated for diffuse,

0:25

bilateral, or cyclical pain.

0:27

Imaging is indicated for focal,

0:30

unilateral, and non-cyclical breast pain.

0:34

This is a very common complaint.

0:37

Most people with breast pain have

0:39

normal imaging, and the imaging

0:41

can be very useful for reassurance.

0:44

We can find a reason for pain,

0:46

such as a cyst or an abscess, but often the

0:49

exam is normal, and the chance of cancer

0:52

is very low, estimated at 0 to 3%.

0:57

So the ACR appropriateness criteria recommend

0:59

that for patients under age 30, we would do breast

1:04

ultrasound, mammogram only if needed, and then

1:08

for age 30 to 39, that intermediate age group.

1:13

Ultrasound or mammogram both get

1:14

the same appropriateness rating,

1:18

so either one could be performed first.

1:20

And then for age 40 and up, diagnostic mammogram

1:23

is recommended, followed by ultrasound.

1:27

Our protocol is just slightly different

1:29

in that for patients age 30 and up,

1:31

we're going to start with a mammogram first.

1:33

So we took that age 30 to 39-year-old

1:37

age group and decided that we would.

1:41

do a mammogram in all of those patients.

1:43

So for age under 30, we'll start

1:45

with ultrasound, age 30 and up,

1:47

mammogram first, and then ultrasound.

1:49

And we do bilateral CC and MLO views.

1:52

If the patient has had a screening

1:54

mammogram within the last six months,

1:56

we don't repeat the mammogram.

1:58

We go straight to ultrasound.

2:00

If it's been more than six months,

2:02

we'll go ahead and repeat a unilateral mammogram.

2:05

And for mammography, we'll mark the

2:07

site of pain with a skin marker,

2:09

and in this case, we use a square.

2:14

Breast pain has a number of different

2:16

causes, some of which we really can't image.

2:20

It can be hormonal, it can be related

2:22

to cysts or multiple cysts, it could

2:25

be nerve-related or musculoskeletal.

2:28

The etiology could be completely unknown,

2:30

and very rarely, as I mentioned before,

2:32

it can be associated with breast cancer.

2:35

I think in over 20 years of breast imaging,

2:38

I've seen about three cases where a

2:40

patient presented with focal breast pain.

2:42

And when we image that area, we found

2:45

a mass, and subsequent biopsy showed a

2:47

breast cancer, but it's pretty unusual.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Lesson

Sample Lesson

Lesson

Palpable Lumps

Lesson

Breast Pain

Lesson

Nipple Discharge

Lesson

Skin Changes/Inflammation

Lesson

Recall from Screening

Lesson

Surveillance After Breast Cancer Treatment

Lesson

Follow Up Probably Benign Findings - BI-RADS 3

Lesson

Follow up Benign Biopsy

Lesson

Pregnant and Lactating Women

Lesson

Male Patients

Breast Pain Overview