RSNA 2017: Are EDs utilizing breast ultrasound too often?

An abscess is one of the few breast-specific emergencies that require urgent treatment in emergency departments (EDs). A new study, presented at RSNA 2017 in Chicago, found that ED environments generate unnecessary exams in addition to some that incompletely identify malignancies.

The purpose of their study was to assess the clinical utility of breast ultrasound performed in the ED for suspected breast abscess and to determine factors associated with confirmed abscess. A retrospective analysis of more than 500 consecutive breast US exams performed in the ED over a 15-month period was conducted. Patients were categorized as either having an abscess or not having one.

Imaging results, demographics, laboratory data, lactation status, smoking history, physical exam findings including clinical exam, maximum recorded temperature in the ED, first recorded pulse, blood pressure, white blood cell count and absolute neutrophil count were collected as part of the analysis.

Of the patient data studied:

  • 150 patients had a diagnosis of abscess.
  • 27 patients had a diagnosis of malignancy.
  • 31 patients had a diagnosis of granulomatous mastitis.
  • 122 patients had a diagnosis of normal.
  • 251 patients had a diagnosis of other (including mastitis, hematoma, cyst, lactational changes and so on).
  • 6 breast cancers were either not demonstrated on US images or not diagnosed on US performed in the ED.

“Breast ultrasound in the emergency department is over-utilized and has limited clinical value given the relatively low positivity rate, the need to repeat exams and the risk of missed cancers,” said lead author Jessica Porembka, MD, assistant professor of radiology at the University of Texas Southwestern Medical Center in Dallas. “The use of both clinical findings and patient demographics can improve patient selection for and diagnostic utility of breast ultrasound to reduce unnecessary exams. Patients with a low likelihood of abscess should be imaged in a more optimal setting.”