Abstract
BACKGROUND:
Generally, nipple discharge represents a benign etiology. In the case where the discharge is unilateral, uniductal, spontaneous, persistent, serous or bloody, and in the case where it occurs in conjunction with a mass, the risk of malignancy is increased. Ductal ectasia and papilloma are the most common causes of pathological nipple discharges. Malignancy is a possibility, most often ductal carcinoma in situ.
OBJECTIVE:
To determine the value regarding dynamic contrast improved magnetic resonance imaging (MRI) in diagnosing suspicious nipple discharge.
METHOD AND PATIENTS:
Dynamic contrast MRI was used to assess 35 patients who have pathological nipple discharges. The features of MRI have been studied and associated to the histo-pathology.
RESULTS:
Histopathology indicated 11 high-risk, 17 benign, and 7 malignant lesions. The presence of non-mass and mass enhancements, as well as T2 weighted MRI images, had statistical significance in distinguishing malignant from benign causes of the pathological nipple discharges (Pvalue=0.004 and0.008) (0.018,0.008,0.004).
94.1% specificity and 94.4% sensitivity in distinguishing benign from malignant pathological nipple discharge causes, and 94.3% accuracy in diagnosing breast lesions, with positive predictive value of 94.4% as well as a negative predictive value of 94.1%.
CONCLUSION:
MRI is a powerful technique for determining the cause of pathological nipple discharge.
Keywords
1.Lippa N, Hurtevent-Labrot G, Ferron S, et al. Les écoulements mamelonnaires. Journal de Radiology Diagnostique et Interventionnelle. 2015;96:434–450. [Google Scholar].
2.Chen L, Zhou WB, Zhao Y, et al. Bloody nipple discharge is a predictor of breast cancer risk: a meta-analysis. Breast Cancer Res Treat. 2012;132:9–14. [PubMed] [Google Scholar].
3.van Gelder L, Bisschops RH, Menke-Pluymers MB, et al. Magnetic resonance imaging in patients with unilateral bloody nipple discharge: useful when conventional diagnostic are negative? World J Surg. 2015;39:184–186. [PubMed] [Google Scholar].
4.Çetin K, Sıkar HE. Evaluation and management of pathological nipple discharges without using intraductal imaging methods. Ir J Med Sci. 2020 May;189(2):451-460. [PubMed].
10.Morrogh M, Morris EA, Liberman L, et al. The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 2017;14:3369–3377. [PubMed] [Google Scholar]
11.Grainger RG, Allison DJ, Dixon AK, et al. Grainger & Allisons diagnostic radiology: a textbook of medical imaging. Edinburgh: Churchill livingstone/Elsevier; 2015.
13.Sharma U, Sah RG, Agarwal K, et al. Potential of Diffusion-Weighted Imaging in the Characterization of Malignant, Benign, and Healthy Breast Tissues and Molecular Subtypes of Breast Cancer. Frontiers in Oncology. 2016; 6.
14.M. Lorenzon, C. Zuiani, A. Linda, V. Londero, R. Girometti, M. BazzocchiMagnetic resonance imaging in patients with nipple discharge: should we recommend it?
Eur Radiol, 2011;21:899-907 CrossRefView Record in ScopusGoogle Scholar
15.Prince JL, Links JM. Medical imaging signals and systems. Upper Saddle River, NJ: Pearson Prentice Hall; 2006.
16.Yılmaz R, Bender O, Yabul FC et al (2017) Diagnosis of nipple discharge: value of magnetic resonance imaging and ultrasonography in comparison with ductoscopy. Balkan Med J 34:119–126
17.Zaky, Mona M., Asmaa Hafez, Marwa M. Zaky, Ashraf Shoma, Nermin Y. Soliman, and Ali H. Elmokadem. “MRI for Assessment of Pathologic Nipple Discharge: Is It Mandatory?” Egyptian Journal of Radiology and Nuclear Medicine 50, no. 1 (December 17, 2019): 92. https://doi.org/10.1186/s43055-019-0105-9
18.Yang, Shih-Neng, Fang-Jing Li, Jun-Ming Chen, Geoffrey Zhang, Yen-Hsiu Liao, and Tzung-Chi Huang. “Kinetic Curve Type Assessment for Classification of Breast Lesions Using Dynamic Contrast-Enhanced MR Imaging.” PLoS ONE 11, no. 4 (April 7, 2016). https://doi.org/10.1371/journal.pone.0152827
20 Breast Imaging Reporting & Data System | American College of Radiology.” Accessed April 11, 2021. https://www.acr.org/Clinical- Resources/Reporting-and-Data-Systems/Bi-Rads.
22.Uematsu T, KasamiM.High-spatial-resolution3 Breast MRI of nonmass like enhancement lesions: An analysis of their feature sassing if I can't predictors of malignancy. AJRAmJRoentgenol 2012; 198:1223–30.
23.Kuhl C. The current status of breast MR imaging part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer toclinical practice. Radiology. 2007; 244:356-78.
24.Zaky, Mona M., Asmaa Hafez, Marwa M. Zaky, Ashraf Shoma, Nermin Y. Soliman, and Ali H. Elmokadem. “MRI for Assessment of Pathologic Nipple Discharge: Is It Mandatory?” Egyptian Journal of Radiology and Nuclear Medicine 50, no. 1 (December 17, 2019): 92. https://doi.org/10.1186/s43055-019-0105-9.
27.Giovanna, Panzironi, Galati Francesca, Marzocca Flaminia, Kirchin Miles, and Pediconi Federica. “Diagnostic Accuracy of Breast MRI Compared with Conventional Imaging, in the Evaluation of Patients with Suspicious Nipple Discharge.” International Journal of Biological Instrumentation 1, no. 1 (December 31, 2018). https://doi.org/10.35840/2631-5025/5103.
)
