Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population

Mehmet Berksun Tutan; Duygu Tutan; Osman Nuri Koyun

Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population

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.

Keywords

Ethical Statement

This study was conducted in accordance with the amendments to the Declaration of Helsinki. This study was approved by the Hitit University Clinical Research Ethics Committee (Approval Date: 04.11.2025, Approval No: 2025-195). Due to the retrospective and anonymized nature of the study, informed consent and consent for publication were waived in accordance with local regulations and institutional guidelines.

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Details

Primary Language

English

Subjects

General Surgery, Internal Diseases

Journal Section

Research Article

Authors

Mehmet Berksun Tutan ^*
0000-0003-1834-7355
Türkiye

Duygu Tutan
0000-0003-0440-1146
Türkiye

Osman Nuri Koyun
0000-0002-0583-3656
Türkiye

Publication Date

June 25, 2026

Submission Date

March 19, 2026

Acceptance Date

June 12, 2026

Published in Issue

Year 2026 Volume: 7 Number: 3

IZ

https://izlik.org/JA88UG48EE

Cite

RIS / Bibtex

APA

Tutan, M. B., Tutan, D., & Koyun, O. N. (2026). Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population. Journal of Medicine and Palliative Care, 7(3), 569-574. https://izlik.org/JA88UG48EE

AMA

1.Tutan MB, Tutan D, Koyun ON. Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population. J Med Palliat Care / JOMPAC / jompac. 2026;7(3):569-574. https://izlik.org/JA88UG48EE

Chicago

Tutan, Mehmet Berksun, Duygu Tutan, and Osman Nuri Koyun. 2026. “Clinical Triage of Mastalgia: A Risk Score for Predicting Suspicious Breast Imaging in a Rural Population”. Journal of Medicine and Palliative Care 7 (3): 569-74. https://izlik.org/JA88UG48EE.

EndNote

Tutan MB, Tutan D, Koyun ON (June 1, 2026) Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population. Journal of Medicine and Palliative Care 7 3 569–574.

IEEE

[1]M. B. Tutan, D. Tutan, and O. N. Koyun, “Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 3, pp. 569–574, June 2026, [Online]. Available: https://izlik.org/JA88UG48EE

ISNAD

Tutan, Mehmet Berksun - Tutan, Duygu - Koyun, Osman Nuri. “Clinical Triage of Mastalgia: A Risk Score for Predicting Suspicious Breast Imaging in a Rural Population”. Journal of Medicine and Palliative Care 7/3 (June 1, 2026): 569-574. https://izlik.org/JA88UG48EE.

JAMA

1.Tutan MB, Tutan D, Koyun ON. Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population. J Med Palliat Care / JOMPAC / jompac. 2026;7:569–574.

MLA

Tutan, Mehmet Berksun, et al. “Clinical Triage of Mastalgia: A Risk Score for Predicting Suspicious Breast Imaging in a Rural Population”. Journal of Medicine and Palliative Care, vol. 7, no. 3, June 2026, pp. 569-74, https://izlik.org/JA88UG48EE.

Vancouver

1.Mehmet Berksun Tutan, Duygu Tutan, Osman Nuri Koyun. Clinical triage of mastalgia: a risk score for predicting suspicious breast imaging in a rural population. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Jun. 1;7(3):569-74. Available from: https://izlik.org/JA88UG48EE