乳房不适是初级保健或乳房诊所就诊的常见原因。乳房疼痛、乳房肿块和乳头溢液是最常见的症状。皮肤变化和腋窝异常等不太常见的症状也需要特定的诊断方法。对有症状的乳房进行成像应由经过适当培训的乳腺放射科医生遵循最佳实践指南和质量标准进行。全视野数字乳房X线摄影（FFDM）、数字乳房断层合成（DBT）和乳房超声（US）是该主要环境中使用的主要方式。选择取决于患者的年龄和症状。 30 岁以下的女性首先接受 US 成像，而 40 岁以上的女性通常需要 FFDM 或 DBT 和 US 进行成像。对于30岁到40岁之间的女性，美国是首选方式，如果需要也可以进行FFDM或DBT。对于有明显病变或乳头溢液的孕妇或哺乳期妇女，首先采用超声检查；也可以根据怀疑程度进行 FFDM 或 DBT，因为对胎儿的剂量很小，屏蔽甚至可能进一步减少剂量。更先进的技术，如乳房磁共振成像或对比增强乳房X线照相术，不适用于首次诊断设置，而是保留用于已确诊的恶性肿瘤（局部分期）的病例或未通过其他方式解决的模棱两可的罕见病例或炎症性乳腺癌。最后但并非最不重要的一点是，男性乳房症状也应通过超声和​​/或 FFDM 来解决。临床相关性声明：正确诊断潜在的恶性肿瘤并避免误报同样重要，否则会导致不必要的活检、增加费用和患者焦虑。正确使用成像方式可确保最佳诊断方法并最大限度地减少假阴性。要点：超声、全视野数字化乳房X线摄影或数字化乳腺断层摄影是诊断环境中的主要成像方式，而MRI或对比增强乳房X线摄影应保留给特定病例。初始成像方式包括超声结合乳房X线照相术或数字乳房断层合成，具体取决于女性的年龄以及是否存在不确定的结果。当体检中发现高度可疑的发现时，阴性影像学评估不应阻止活检。© 2024。作者，获得欧洲放射学会的独家许可。

Breast complaints are frequent reasons for consultations in primary care or breast clinics. Breast pain, breast lumps, and nipple discharge are the most common complaints. Less common symptoms such as skin changes and axillary abnormalities also require specific diagnostic approaches. Imaging the symptomatic breast should be performed by appropriately trained breast radiologists following the best practice guidelines and quality standards. Full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and breast ultrasound (US) are the main modalities used in this primary setting. The choice depends on the patient's age and symptoms. Women younger than 30-years-old are first imaged by US, whereas women over 40-years-old usually require both FFDM or DBT and US. For women between 30-years-old and 40-years-old, the US is the modality of choice, whereas FFDM or DBT might also be performed if needed. Pregnant or lactating women with palpable lesions or nipple discharge are imaged with US as the first method; FFDM or DBT can also be performed depending on the degree of suspicion as the dose to the fetus is minimal, and shielding may even further reduce the dose. More advanced techniques such as breast magnetic resonance imaging or contrast-enhanced mammography are not indicated in this first diagnostic setting and are reserved for cases of established malignancy (local staging) or rare cases of equivocal findings not otherwise resolved or inflammatory breast cancer. Last, but not least, male breast symptoms should also be addressed with US and/or FFDM. CLINICAL RELEVANCE STATEMENT: It is equally important to correctly diagnose an underlying malignancy and to avoid false positives that would lead to unnecessary biopsies, increased costs, and anxiety for the patient. Proper use of imaging modalities ensures optimal diagnostic approach and minimizes false negatives. KEY POINTS: Ultrasound, full-field digital mammography, or digital breast tomosynthesis are the main imaging modalities in the diagnostic setting, while MRI or contrast-enhanced mammography should be reserved to selected cases. Initial imaging modality includes ultrasound combined with mammography or digital breast tomosynthesis depending on women's age and the presence (or not) of inconclusive findings. A negative imaging evaluation should not deter biopsy when a highly suspicious finding is found on physical examination.© 2024. The Author(s), under exclusive licence to European Society of Radiology.