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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Breast Oncology

Evaluation of Pathologic Nipple Discharge: What is the Added Diagnostic Value of MRI?

Authors: Manisha Bahl, MD, MPH, Jay A. Baker, MD, Rachel A. Greenup, MD, MPH, Sujata V. Ghate, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Purpose

To determine the diagnostic value of magnetic resonance imaging (MRI) for the evaluation of patients with pathologic nipple discharge.

Methods

We performed a retrospective review of women with nipple discharge who underwent breast MRI between January 1, 2004, and December 31, 2013. Radiographic findings, pathology results, and clinical notes were reviewed. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated.

Results

Over a 10-year period, 103 women (mean age 46 years, range 25–72 years) underwent MRI for evaluation of nipple discharge. Ninety-one patients (88 %) underwent surgical excision or had clinical and/or radiographic follow-up at least 2 years after presentation and thus comprise the study population. Eleven (30 %) of 37 patients with MRIs coded as American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) 4 of 5 were diagnosed with ductal carcinoma in situ (n = 6) or invasive adenocarcinoma (n = 5). Seven (64 %) of 11 patients diagnosed with malignancy had a negative mammographic and sonographic workup. None of the patients with MRIs coded as BI-RADS 1, 2, or 3 was diagnosed with malignancy immediately after presentation or during the 2-year follow-up period. The sensitivity and specificity of MRI for the detection of malignancy were 100 % (11 of 11) and 68 % (54 of 80), respectively. The positive predictive value and negative predictive value were 37 and 100 %, respectively.

Conclusions

MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge when conventional imaging is negative. A negative MRI in this symptomatic population may obviate the need for duct exploration and excision.
Literature
1.
Kooistra BW, Wauters C, van de Ven S, Strobbe L. The diagnostic value of nipple discharge cytology in 618 consecutive patients. Eur J Surg Oncol. 2009;35:573–7.PubMedCrossRef
2.
Lorenzon M, Zuiani C, Linda A, Londero V, Girometti R, Bazzocchi M. Magnetic resonance imaging in patients with nipple discharge: should we recommend it? Eur Radiol. 2011;21:899–907.PubMedCrossRef
3.
Fisher CS, Margenthaler JA. A look into the ductoscope: its role in pathologic nipple discharge. Ann Surg Oncol. 2011;18:3187–91.PubMedCrossRef
4.
Hussain AN, Policarpio C, Vincent MT. Evaluating nipple discharge. Obstet Gynecol Surv. 2006;61:278–83.PubMedCrossRef
5.
Rissanen T, Reinikainen H, Apaja-Sarkkinen M. Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. J Ultrasound Med. 2007;26:1031–9.PubMed
6.
Sabel MS, Helvie MA, Breslin T, Curry A, Diehl KM, Cimmino VM, et al. Is duct excision still necessary for all cases of suspicious nipple discharge? Breast J. 2012;18:157–62.PubMedCrossRef
7.
Bahl M, Baker JA, Greenup RA, Ghate SV. Diagnostic value of ultrasound in female patients with nipple discharge. AJR Am J Roentgenol. 2015;205:203–8.PubMedCrossRef
8.
Gray RJ, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg. 2007;194:850–4.PubMedCrossRef
9.
Morrogh M, Park A, Elkin EB, King TA. Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg. 2010;200:73–80.PubMedCrossRef
10.
Orel SG, Dougherty CS, Reynolds C, Czerniecki BJ, Siegelman ES, Schnall MD. MR imaging in patients with nipple discharge: initial experience. Radiology. 2000;216:248–54.PubMedCrossRef
11.
Morrogh M, Morris EA, Liberman L, Borgen PI, King TA. The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 2007;14:3369–77.PubMedCrossRef
12.
Lubina N, Schedelbeck U, Roth A, Weng AM, Geissinger E, Hönig A, et al. 3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail. Eur Radiol. 2015;25:1285–93.PubMedCrossRef
13.
Nakahara H, Namba K, Watanabe R, Furusawa H, Matsu T, Akiyama F, et al. A comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer. 2003;10:320–9.PubMedCrossRef
14.
van Gelder L, Bisschops RH, Menke-Pluymers MB, Westenend PJ, Plaisier PW. Magnetic resonance imaging in patients with unilateral bloody nipple discharge; useful when conventional diagnostics are negative? World J Surg. 2015;39:184–6.PubMedCrossRef
15.
Ballesio L, Maggi C, Savelli S, Angeletti C, De Felice ML, Manganaro ML, et al. Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol Med. 2008;113:249–64.PubMedCrossRef
16.
Manganaro L, D’Ambrosio I, Gigli S, Di Pastena F, Giraldi G, Tardioli S, et al. Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography. Biomed Res Int. 2015;2015:806368.PubMedPubMedCentralCrossRef
17.
Simmons R, Adamovich T, Brennan M, Christos P, Schultz M, Eisen C, et al. Nonsurgical evaluation of pathologic nipple discharge. Ann Surg Oncol. 2003;10:113–6.PubMedCrossRef
18.
Sakorafas GH. Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 2001;27:275–82.PubMedCrossRef
19.
20.
Tokuda Y, Kuriyama K, Nakamoto A, Choi S, Yutani K, Kunitomi Y, et al. Evaluation of suspicious nipple discharge by magnetic resonance mammography based on breast imaging reporting and data system magnetic resonance imaging descriptors. J Comput Assist Tomogr. 2009;33:58–62.PubMedCrossRef
21.
Ohlinger R, Stomps A, Paepke S, Blohmer J-U, Grunwald S, Hahndorf W, et al. Ductoscopic detection of intraductal lesions in cases of pathologic nipple discharge in comparison with standard diagnostics: the German multicenter study. Oncol Res Treat. 2014;37:628–32.PubMedCrossRef
22.
Yang X, Li H, Gou J, Tan Q, Wang L, Lin X, et al. The role of breast ductoscopy in evaluation of nipple discharge: a Chinese experience of 419 patients. Breast J. 2014;20:388–93.PubMedCrossRef
23.
Kamali S, Harman Kamali G, Akan A, Simsek S, Bender O. Use of ductoscopy as an additional diagnostic method and its applications in nipple discharge. Minerva Chirurgica. 2014;69:65–73.PubMed
24.
Sarica O, Ozturk E, Demirkurek HC, Uluc F. Comparison of ductoscopy, galactography, and imaging modalities for the evaluation of intraductal lesions: a critical review. Breast Care. 2013;8:348–54.PubMedPubMedCentralCrossRef
25.
Balci FL, Feldman SM. Interventional ductoscopy for pathological nipple discharge. Ann Surg Oncol. 2013;20:3352–4.PubMedCrossRef
26.
Albrecht C, Thele F, Grunwald S, Kohlmann T, Hegenscheid K, Utpatel K, et al. Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests. Onkologie. 2013;36:12–6.PubMedCrossRef
27.
Kamali S, Bender O, Kamali GH, Aydin MT, Karatepe O, Yuney E. Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer. 2014;21:154–61.PubMedCrossRef
28.
Kamali S, Bender O, Aydin MT, Yuney E, Kamali G. Ductoscopy in the evaluation and management of nipple discharge. Ann Surg Oncol. 2010;17:778–83.PubMedCrossRef
Metadata
Title
Evaluation of Pathologic Nipple Discharge: What is the Added Diagnostic Value of MRI?
Authors
Manisha Bahl, MD, MPH
Jay A. Baker, MD
Rachel A. Greenup, MD, MPH
Sujata V. Ghate, MD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4792-9

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