ARRS: What types of breast pain need imaging workup?

2019 05 03 19 57 9383 Honolulu 20190503193859

Referring physicians need a better understanding of what kinds of breast pain should prompt imaging workup and what imaging to order, according to research presented at the American Roentgen Ray Society (ARRS) annual meeting in Honolulu.

The findings highlight the need for more education for referring doctors in this area, wrote a team led by Dr. Karen Zheng of Emory University in Atlanta.

"Although most clinicians believe that there is a weak correlation between breast pain and breast cancer, many still order imaging studies to exclude malignancy or reassure the patient," the team wrote.

Previous research has shown agreement according to guidelines in imaging decisions among breast radiologists for patients presenting with breast pain, Zheng and colleagues noted. But whether the approach among referring physicians is congruent with guidelines has been unclear.

Zheng's group conducted an online survey that included 11 questions addressing the preferred imaging evaluation of breast pain based on patient age, pain location, and whether the pain was constant or sporadic. There were 111 referring physician respondents.

The survey found the following:

  • 72% of participants believed in a weak correlation between breast pain and breast cancer; 23% believed in a neutral correlation.
  • 48% said they order imaging to rule out malignancy, 26% to reassure the patient, and 25% to evaluate the tissue to determine the cause of pain.
  • More than 66% believed that imaging was required in patients with diffuse unilateral pain, single-quadrant pain, and focal pain, with increasing percentages as the area of pain decreased.
  • 23% of clinicians would order imaging for patients younger than 30 years with diffuse bilateral intermittent pain, while only 12% of radiologists would.
  • For patients over 40 with focal, constant pain, 35% of referring clinicians (compared with 71% of radiologists) would order combined mammogram and focused ultrasound. But 80% of referring physicians order imaging for single-quadrant and focal pain.

Understanding the differences in approach to the imaging evaluation of breast pain can help radiologists work with clinicians to optimize patient care and minimize unnecessary imaging, according to Zheng and colleagues.

"The study results indicate a general understanding of the significance and imaging of breast pain across specialties, but more education is needed for clinicians in the types of breast pain that warrant an imaging workup and what type of imaging to order," the group concluded.

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