Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implication

Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implications
Vilert A. Loving, Wendy B. DeMartini, Peter R. Eby, Robert L. Gutierrez, Sue Peacock, and Constance D. Lehman
AJR 2010; 195:1472-1477

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Among 830 study patients, lesions were assessed as BI-RADS category 1 or 2 in 526 (63.4%), BI-RADS category 3 in 140 (16.9%), BI-RADS category 4 in 163 (19.6%), and BI-RADS category 5 in one (0.1%) patient. Three malignancies were detected, for a cancer yield of 0.4%. No BI-RADS category 3 lesions, two BI-RADS category 4 lesions, and the single BI-RADS category 5 lesion were malignant. Ultrasound sensitivity was 100%, specificity was 80.5%, NPV was 100%, PPV2 was 1.8%, and PPV3 was 1.9%.

Women younger than 30 years with focal breast signs or symptoms have a very low (0.4%) incidence of malignancy. The 100% sensitivity and NPV of targeted ultrasound in our study substantiates its use as an accurate primary imaging test in this clinical setting. We found no malignancies in BI-RADS category 3 lesions, supporting ultrasound surveillance over biopsy in this patient population.