Diagnostic Performance of MRI Versus Galactography in Women With Pathologic Nipple Discharge: A Systematic Review and Meta-Analysis

Berger, Nicole; Luparia, A.; Leo, Giovanni Di; Carbonaro, Luca A.; Trimboli, Rubina Manuela; Ambrogi, Federico; Sardanelli, Francesco

doi:10.2214/ajr.16.16682

Cited by 62 publications

(40 citation statements)

References 30 publications

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“…A meta‐analysis conducted in 2015, which included 10 studies performed between 2000 and 2015, compared the performance of DCE‐MRI with that of ductography in detecting any lesion, benign or malignant. The pooled sensitivity and specificity for DCE‐MRI (92% and 76%, respectively) was greater than that for ductography (69% and 39%, respectively) . However, precise localization of the entire discharging duct, which may contain additional, microscopic papillary lesions besides the imaging‐evident lesion may not be possible using DCE‐MRI.…”

Section: Discussionmentioning

confidence: 94%

Is Ductography Still Warranted in the 21st century?

et al. 2019

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Objective To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple‐modality evaluation. Materials and Methods We retrospectively reviewed the medical records of patients who had presented with pathologic nipple discharge and had undergone mammography and/or ultrasound and ductography between January 1, 2005, and October 31, 2010. We tested the diagnostic sensitivity, specificity and accuracy of combined triple‐modality evaluation as well as of MRI performed in addition to these imaging techniques. We used the gold standard of image‐guided biopsies, surgical excision, or long‐term clinical and imaging follow‐up. Results Among 94 study patients, benign papillomas were identified in 42 (44.7%), abscess in one (1%), duct ectasia in four (4.3%), and malignancy (invasive ductal carcinoma or ductal carcinoma in situ) or high‐risk lesion (atypical ductal hyperplasia) in 10 (10.6%). Forty‐six patients (49%) underwent surgical excision; 89.1% of which had presurgical planning with ductography. In 35 (37.2%) with negative imaging, resolution of nipple discharge was confirmed on median clinical and imaging follow‐up of 36 months. Two patients with negative imaging were lost to follow‐up. Sensitivity, specificity, PPV, and NPV for accurately demonstrating the etiology of pathologic nipple discharge were 13%, 97%, 89%, and 37% respectively for mammography; 73%, 97%, 98%, and 64% respectively for ultrasound; 76%, 72%, 84%, and 61% respectively for ductography; 86%, 70%, 85%, and 72% respectively for combined ultrasound and ductography; and 75%, 100%, 100% and 67% respectively for DCE‐MRI. Conclusion The combination of mammography, ultrasound and ductography is highly accurate for identifying the etiology of pathologic nipple discharge. DCE‐MRI can be used as an alternate to ductography if necessary.

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Section: Discussionmentioning

confidence: 94%

Is Ductography Still Warranted in the 21st century?

et al. 2019

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“…As many as one‐third of all women present with nipple discharge at some point in their life . Pathologic nipple discharge is usually persistent, unilateral, bloody or serous, and arises from a single duct . The most common cause of pathologic nipple discharge is papilloma (35%‐56%) or benign ductal ectasia (6%‐59%).…”

Section: Introductionmentioning

confidence: 99%

“…The most common cause of pathologic nipple discharge is papilloma (35%‐56%) or benign ductal ectasia (6%‐59%). However, nipple discharge can also be the first sign of underlying malignancy (5%‐23%) . A majority of women with nipple discharge have a benign disease (reportedly as many as 80%), but currently there is no clear consensus about what differentiates a benign cause from a malignancy based on clinical and radiographic assessment …”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have shown that MRI is a valuable tool in the evaluation of nipple discharge . Berger et al performed a meta‐analysis that showed MRI to have stronger diagnostic performance than ductography for any type of lesion, recommending that MRI be the preferred next step if mammography and ultrasound results are negative . However, the use of breast MRI to solve clinical problems in the setting of nipple discharge is still limited.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective statistical analysis on the diagnostic value of ductography based on lesion pathology in patients presenting with nipple discharge

et al. 2019

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Purpose To compare sensitivities and specificities of ductography to noninvasive imaging studies in determining the cause of nipple discharge and assess the value of ductography on the basis of pathologic results. Methods In this retrospective review of women with nipple discharge who underwent ductography between January 1, 2005 and October 30, 2015, at our institution, we compared ductography with noninvasive imaging results (mammography, ultrasound, MRI) to determine its relative diagnostic sensitivity, specificity, and relative accuracy. Diagnosis was defined from pathology results, clinical notes, and minimum of 1‐year follow‐up monitoring. The primary endpoints include accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. The analyses were carried out in different configurations to compare results by the following pathologic categories: cancer, high‐risk lesion, intraductal papilloma (IP) without atypia, and benign pathology and/or normal imaging results. Results In patients with breast cancer, ductography and noninvasive breast imaging had similar sensitivities. In patients with a high‐risk lesion, ductography was significantly more sensitive than noninvasive imaging modalities. In patients with intraductal papilloma without atypia, ductography was more sensitive than noninvasive imaging, but the difference was of only borderline significance. For women with benign pathology and/or normal imaging, noninvasive imaging showed a significantly higher specificity than ductography. Conclusion In the absence of standard diagnostic algorithm for patients presenting with nipple discharge, the clinician has numerous options to choose a diagnostic approach that will yield the most accurate information with the least disruption to the patient. Our results indicate the value of ductography compared to value of noninvasive imaging modalities when cancer is suspected and when high risk lesion is suspected. While we show the sensitivity of ductography is similar to noninvasive imaging modalities in the setting of cancer, the sensitivity of ductography is statistically valuable for diagnosing high‐risk lesions. Our hope is that this study will emphasize more research and more understanding in clinical utility and management of high‐risk lesions, leading to patient‐focused algorithm for diagnosing the etiology of abnormal nipple discharge.

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“…Another issue regards the calculation of confidence intervals. The preferred method should be the profile likelihood, as remarked by Stijnen, Hamza, & Özdemir (2010) for the odds ratio, but even for this issue there is need of further investigations.A recently published meta-analysis about diagnostic accuracy of MRI in women with pathologic nipple discharge (Berger et al, 2017), is an example of sparse data. Data were retrieved from nine studies.…”

mentioning

confidence: 99%