General Practice

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

Lucien E M Duijm, radiologist, ^a Gerard L Guit, radiologist, ^a Jan H C L Hendriks, radiologist, ^b Joost O M Zaat, general practitioner, ^c Willem P T M Mali, professor. ^d

^a Department of Radiology, Kennemer Gasthuis Locatie Elisabeth Gasthuis, 2035 RC Haarlem, Netherlands, ^b Department of Radiology, Radboud University Hospital, 6500 HB Nijmegen, Netherlands, ^c Institute for Research in Extramural Medicine, Vrije Universiteit, 1081 BT Amsterdam, Netherlands, ^d Department of Radiology, University Hospital Utrecht, 3584 CX Utrecht, Netherlands

Correspondence to: Dr Duijm, Department of Radiology, Catharina Hospital, 5602 ZA Eindhoven, Netherlands atielbeek{at}knmg.nl

Objectives: To determine the value of breast imaging in patients with localised or diffuse pain in the breast in whom physical examination shows no abnormalities.
Design: Observational follow up study.
Setting: Radiology department of a teaching hospital in the Netherlands.
Subjects: Altogether 987 women referred for radiological breast imaging because of pain alone and a control group of 987 asymptomatic women referred for a screening mammogram.
Main outcome measures: Correlation of the radiological findings with clinical and pathological findings over two years of follow up.
Results: Radiological examination of the painful breast(s) showed the following: normal findings in 854 (86.5%) women, benign abnormalities in 85 (8.6%; mainly small cysts or mastopathy), abnormalities that were probably benign 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 normal findings or benign abnormalities, in two of 36 women with radiological abnormalities that were probably benign, and in all women with suspicious or malignant findings. Only the four lesions that had been classified radiologically 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 reassuranceno abnormalities are usually found in the painful area, radiological abnormalities classified as benign do not generally have any clinical consequences, and the prevalence of cancer is low in these women. Biopsy of the painful area should be performed only where radiological findings are suspicious.