Suspicious Nipple Discharge and Breast Magnetic Resonance Imaging

Tjalma, Wiebren; Verslegers, I.

doi:10.1111/j.1524-4741.2004.10103.x

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…Unlike the study by Sauter et al [18], we found no relation between age and invasive cancer/CIS. Previous invasive cancer significantly increased the risk of invasive cancer/CIS as underlying cause of nipple discharge in both studies.…”

Section: Discussioncontrasting

confidence: 99%

“…For the patient, blood is a more visible problem compared to clear discharge and might increase the patient´s wish to get rid of the problem. Furthermore, bloody or red/brown discharge is known to be associated with an increased risk of underlying breast cancer [18], which leads the surgeon to suggest surgery in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…Ductography and ductoscopy have been used in cases with an actively discharging duct, but has not proven to be reliable to distinguish between benign and malignant causes of discharge [16,17]. Magnetic resonance imaging (MRI) is able to identify occult pathologies and may have a future role in the evaluation of patients, but the current role of MRI as a diagnostic tool in nipple discharge patients is not yet established [18].…”

Section: Introductionmentioning

confidence: 99%

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Nipple discharge: Follow-up in operated versus non-operated patients - A single center experience

Røpcke¹,

Bokmand²,

Flyger³

2018

J Med Therap

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Introduction: Patients with nipple discharge are often treated surgically and pose a diagnostic and therapeutic challenge. The objective of the present study was to investigate if clinical predictors of underlying malignancy could be identified. Material and methods:We retrospectively identified 400 patients with nipple discharge as primary complaint at referral in our institution from 2007 to 2015. Two hundred patients were surgically treated, and two hundred were observed. Patient charts, national health registries, radiology findings and pathology findings were evaluated. The two groups were compared, and the patients with invasive cancer / carcinoma in situ (CIS) was characterized.Results: In the operated group, patients were significantly older, and more patients had bloody discharge (p < 0.001). In the operated group, invasive cancer was found in 2%, and CIS was found in 9% of cases. No radiologic finding had indicated this preoperatively. Recurrent bloody nipple discharge was seen more frequently in the invasive cancer group. During follow-up, one case of invasive cancer emerged in each group. A history of previous breast cancer significantly increased the risk of an underlying invasive cancer in nipple discharge patients (p < 0.05). Conclusion:Current clinical stratification identifies patients with pathological nipple discharge requiring surgery, but over-treatment is a concern. According to existing literature, and partially supported by the current study findings, all women aged 50 years or more presenting with recurrent, bloody nipple discharge should be offered duct excision, which remains the diagnostic gold standard, especially in case of a medical history with previous breast cancer.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nipple discharge: Follow-up in operated versus non-operated patients - A single center experience

Røpcke¹,

Bokmand²,

Flyger³

2018

J Med Therap

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“…Magnetic resonance imaging (MRI) is a valuable adjunctive means of detecting and diagnosing ID papillomas and malignancies, especially in cases when the other three modalities are normal. In recent years, MRI has increased in importance in patients with suspicious nipple discharge or in high-risk patients with nipple discharge and it has been recommended in many studies (5,10,11,12,13). In order to increase the sensitivity and specificity of MRI in patients with PND, new techniques and different sequences from routine of breast MRI have recently been reported in several studies (14,15,16,17).…”

mentioning

confidence: 99%

Diagnosis of Nipple Discharge: Value of Magnetic Resonance Imaging and Ultrasonography in Comparison with Ductoscopy

Yılmaz¹,

Bender²,

Yabul³

et al. 2017

Balkan Med J

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Background:Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found.Aims:To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies.Study Design:Diagnostic accuracy study.Methods:Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery.Results:Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis.Conclusion:Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.

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