AI Summary & Key Takeaways
AI InsightExternal validation is required before routine clinical use.
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Abstract
Aims: This study aimed to evaluate the diagnostic yield of breast ultrasonography in women aged 18-40 years presenting with mastalgia, to identify clinical predictors of suspicious imaging findings, and to develop a simple clinical risk score to support triage in a rural healthcare setting. Methods: This retrospective observational study included 418 women aged 18-40 years who underwent breast ultrasonography for mastalgia between 2020 and 2025 at a rural secondary-care hospital. Clinical variables, including mastalgia type (cyclic vs non-cyclic), focality, laterality, family history, and physical examination findings, were analyzed. Imaging outcomes were categorized using BIRADS, with BIRADS 4-5 defined as suspicious. Multivariable logistic regression was performed to identify independent predictors. A three-point clinical risk score was constructed based on non-cyclic pain, focal pain, and abnormal physical examination. Results: Ultrasonographic abnormalities were detected in 42.34% of patients, predominantly benign. Suspicious imaging findings (BI-RADS 4-5) were identified in 7.9% of cases. Non-cyclic mastalgia (81.8% vs. 23.4%, p<0.001), focal pain (72.7% vs. 20.8%, p<0.001), and abnormal physical examination (60.6% vs. 11.2%, p<0.001) were independently associated with suspicious imaging. The clinical risk score demonstrated a stepwise increase in risk, with rates of suspicious imaging rising from 0.8% at score 0 to 37.8% at score 3 (p<0.001). Each one-point increase in score was associated with a 3.72-fold increase in odds of suspicious imaging (OR 3.72, 95% CI 2.56-5.40; p<0.001). Conclusion: Mastalgia in young women was associated with a low prevalence of suspicious ultrasonographic findings; however, clinically meaningful heterogeneity was observed among patients who underwent imaging. A simple risk score incorporating non-cyclic pain, focal symptoms, and abnormal physical examination findings showed apparent risk-stratification performance for BIRADS 4–5 findings in this retrospective, already imaged cohort. External validation is required before routine clinical use.