Contribution of mammographic imaging after initial ultrasound in women with focal breast complaints-systematic review.

[OBJECTIVES] Breast cancer is the most common cancer among women, making accurate diagnostic imaging essential for evaluating focal breast complaints. Standard breast imaging includes mammography (MG), digital breast tomosynthesis (DBT), and targeted ultrasound (US). Little information is known about the added value of MG/DBT compared to targeted US alone in women with focal breast complaints. This review provides a systematic overview of the (relative) sensitivity of MG/DBT, next to the use of targeted US in women with focal breast complaints, while emphasizing the variations of the reported guidelines.

[MATERIALS AND METHODS] A comprehensive PubMed search was conducted to identify articles published between January 2002 and February 2024 that assessed the diagnostic performance of MG/DBT and targeted US in women presenting with focal breast complaints.

[RESULTS] Of the 985 identified studies, 10 met the inclusion criteria after full-text evaluation. Palpable lumps and focal pain are the more frequent symptoms. Most studies show a high sensitivity (range 84.6-100%, the largest study reported 98.3%) of targeted US alone in relatively young women (30-39 years). Mammograms show added value, particularly when it comes to determining the extent of breast cancer and when confirming a benign abnormality.

[CONCLUSIONS] Targeted US is a reliable initial imaging modality, particularly in younger women (≤ 40). When the US suggests a benign finding in low/average-risk women, the added value of MG is minimal. Routine use should be weighed against the risk of overdiagnosis, unnecessary biopsies, and radiation exposure.

[KEY POINTS] Question The best imaging strategy for women aged 30-40 with focal breast complaints is uncertain, and whether US alone suffices remains unresolved. Findings Initial targeted US shows high accuracy in this diagnostic setting, with MG/DBT adding value mainly in determination of tumor extent and from a screening perspective. Clinical relevance Using US as the primary imaging for women < 40 with focal breast symptoms may reduce MG, radiation, and discomfort, while maintaining cancer detection; however, any discordance between clinical and imaging findings should always prompt further evaluation.