Breast MRI in Patients with Unilateral Bloody and Serous-Bloody Nipple Discharge: A Comparison with Galactography

Manganaro, Lucia; D'Ambrosio, Ilaria; Gigli, Silvia; Pastena, Francesca Di; Giraldi, G; Tardioli, Stefano; Framarino, Marialuisa; Porfiri, L. M.; Ballesio, Laura

doi:10.1155/2015/806368

Cited by 31 publications

(21 citation statements)

References 31 publications

(31 reference statements)

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“…Our results are consistent with the pooled sensitivity reported in a recent meta-analysis [29]. Our specificity (90%, [45/50]) and PPV (84.3%, [27/32]) were higher than the values reported previously with the exception of findings reported by Manganaro, et al [19]. In part the excellent diagnostic performance achieved in our study can be ascribed to the use of a 3.0 Tesla magnet rather than a 1.5 Tesla magnet for which sensitivity and specificity values in patients with ND have ranged from 60-95% and 44-79%, respectively [7,10,22,31].…”

Section: Discussionsupporting

confidence: 93%

“…As noted by Mann, et al [30] whereas unenhanced MRI can differentiate lesions and abnormalities of the breast, administration of a gadolinium-containing contrast material is needed to accurately diagnose or exclude a cancer. In our study MRI showed high sensitivity (93.1%, 27/29) for breast lesion detection and diagnosis, supporting numerous previous studies that have confirmed dynamic contrast enhancement MRI as the most sensitive diagnostic approach for breast cancer detection [7,8,19]. Our results are consistent with the pooled sensitivity reported in a recent meta-analysis [29].…”

Section: Discussionsupporting

confidence: 92%

“…Of the various approaches to non-invasively diagnosing the cause of PND, MR imaging (MRI) has proven more reliable and accurate than galactography for patient workup particularly when conventional mammography and ultrasound exams are negative or non-diagnostic [4,[6][7][8][9][14][15][16][17][18][19][20]. MRI has demonstrated superior diagnostic performance both for the detection of otherwise occult disease and for its accurate characterization as benign or malignant.…”

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confidence: 99%

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2018

Int J Biol Instrum

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Purpose: To determine the role and the diagnostic accuracy of breast Magnetic Resonance Imaging in the evaluation of patients with suspicious discharge from the nipple. Methods: 79 patients with suspicious nipple discharge underwent 3 Tesla MRI. Images were acquired with T2-IDEAL sequences, diffusion-weighted sequences as well as 3D T1-weighted sequences before and after the administration of 0.1 mmol/kg of gadobenate dimeglumine. MRI findings were classified according to Breast Imaging Reporting and Data System criteria as benign (BIRADS 1-2-3) or malignant (BIRADS 4-5). Reference diagnoses were based on histologic samples obtained at surgery for 51 patients and on clinical and instrumental follow-up over 24 months for 28 patients. Results: MRI identified 32 cases of BIRADS 4-5, 27 of which were found to be malignant at histological examination. In the 47 cases classified as BIRADS 1-2-3, 17 lesions were confirmed as benign by definitive histological examination, 2 lesions were found to be a malignant tumor and 28 patients had negative follow-up at 24 months. Sensitivity, specificity and diagnostic accuracy of MRI were respectively 93.1%, 90% and 91.1% with a positive predictive value of 84.3% and negative predictive value of 95.7%. The performance of MRI was also evaluated in comparison of positive cases of mammography and ultrasound. Conclusion: Breast MRI is an accurate method in the evaluation of patients with suspicious nipple secretion. A negative MRI can direct patients to follow-up rather than surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

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confidence: 99%

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2018

Int J Biol Instrum

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“…In general, MRI should be considered in cases in which other approaches have failed to identify an underlying cause of pathologic nipple discharge [3,23,24,[53][54][55]. The sensitivities of breast MRI for detection of underlying cause of pathologic nipple discharge are 86% to 100% for invasive cancer and 40% to 100% for noninvasive disease [3,24,46,53,55,56]. Bahl et al [56] reported the sensitivity, specificity, PPV, and NPV of MRI for detection of malignancy in patients with pathologic nipple discharge to be 100%, 68%, 37%, and 100%, respectively.…”

Section: Mbi and Fdg-pem If Patient History And Physical Examinationmentioning

confidence: 99%

“…☢☢ Image-guided core biopsy breast 1 See references [5,10,12,24,31,40,41,49,58,59,63]. [3,8,23,24,35,46,[51][52][53][54][55]. B…”

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ACR Appropriateness Criteria ® Evaluation of Nipple Discharge

Lee

Trikha

Moy³

et al. 2017

Journal of the American College of Radiology

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Appropriate imaging evaluation of nipple discharge depends the nature of the discharge. Imaging is not indicated for women with physiologic nipple discharge. For evaluation of pathologic nipple discharge, multiple breast imaging modalities are rated for evidence-based appropriateness under various scenarios. For women age 40 or older, mammography or digital breast tomosynthesis (DBT) should be the initial examination. Ultrasound is usually added as a complementary examination, with some exceptions. For women age 30 to 39, either mammogram or ultrasound may be used as the initial examination on the basis of institutional preference. For women age 30 or younger, ultrasound should be the initial examination, with mammography/DBT added when ultrasound shows suspicious findings or if the patient is predisposed to developing breast cancer. For men age 25 or older, mammography/DBT should be performed initially, with ultrasound added as indicated, given the high incidence of breast cancer in men with pathologic nipple discharge. Although MRI and ductography are not usually appropriate as initial examinations, each may be useful when the initial standard imaging evaluation is negative. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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