A comparison of mr imaging, galactography and ultrasonography in patients with nipple discharge

Abstract

Among the three modalities, contrast-enhanced three-dimensional MR imaging demonstrated the location and distribution of the lesions most clearly, especially in cases of ductal carcinoma in situ. It has the potential to be a useful diagnostic tool for patients with nipple discharge.

Suspicious Nipple Discharge Diagnostic Evaluation

“…Rissanen et al (2007) reported that in 52 patients with unilateral nipple discharge, 80% of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive, and among the 6 cases in which duct dilatation was the only sonographic finding, 3 (50%) were malignant lesions and the other 3 (50%) were papillomas and other benign lesions. In a study of 55 patients with bloody ND, Nakahara et al (2003) reported that of all findings, only the hypoechoic masses with smooth margins (NPV = 90.9%) and hypoechoic masses with irregular margins (positive predictive value (PPV) = 85.7%) were statistically significant.…”

“…However, US has limitations with respect to depicting causative lesions of small masses and ductal carcinomas in situ (DCIS), especially those in peripheral regions without ductal dilatation or those in high adipose-containing breasts (Berg & Gilbreath., 2000;Nakahara et al, 2003citing Chung et al, 1995.…”

“…Ductographic findings suggestive of carcinoma include irregular filling defects, ductal irregularities (distortion, displacement, complete obstruction of contrast flow, and noniatrogenic contrast extravasation), and a deeper position of the lesion (Cardenosa et al, 1994;Ciatto et al, 1998;Tabar et al, 1983). Smooth intraductal filling defects, complete ductal obstruction, ductal expansion with apparent distortion, and irregularity of the ductal wall are more common ductographic features obsreved for solitary papillomas (Cardenosa et al, 1994;Nakahara et al, 2003). Unfortunately, evidence for a predictive role for DG is less convincing because a positive study does not differentiate between malignant and benign causes of discharge and a negative study does not exclude the presence of an underlying carcinoma.…”

“…However, the available data are limited (Nakahara et al, 2003;Orel et al, 2000;Tjalma & Verslebers, 2004). Therefore, the gold standard diagnostic and therapeutic approach for patients with pathological ND is surgical duct excision (Morrogh et al, 2010citing Nelson & Hoehn, 2006.…”

“…There is evidence in the literatures that CEMRI offers high diagnostic performance for detecting lesions in patients with suspicious ND, even when no lesions are identified by conventional imaging and when DG is not feasible or inconclusive (Sardanelli et al, 2008citing Daniel et al, 2003Hirose et al, 2006;Nakahara et al, 2003;Orel et al, 2000). Lorenzon et al (2011) found that CEMRI could identify 5/5 cancers (sensitivity = 100%) and 13/14 high-risk lesions (sensitivity = 92.9%) (overall sensitivity, 94.7%; overall specificity, 78.9%).…”