Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge

Bahl, Manisha; Baker, Jay A.; Greenup, Rachel A.; Ghate, Sujata V.

doi:10.2214/ajr.14.13354

Cited by 51 publications

(59 citation statements)

References 19 publications

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“…Ashfaq et al and Bahl et al emphasized the variability across institutions and no solid data in the clinical or radiological information to distinguish malignant lesions from benign etiology . Ashfaq et al, concluded evidence‐based evaluation and treatment algorithm for patients can stratify patients into low‐risk and high‐risk categories and that low‐risk patients can be safely followed clinically.…”

Section: Discussionmentioning

confidence: 99%

“…institutions and no solid data in the clinical or radiological information to distinguish malignant lesions from benign etiology. 18,19 Ashfaq et al, concluded evidence-based evaluation and treatment algorithm for patients can stratify patients into lowrisk and high-risk categories and that low-risk patients can be safely followed clinically. Our study reconfirms the variability in patient management in management of nipple discharge and given the low rate of malignancy in low-risk patients (defined as ones undergoing negative noninvasive imaging) that emphasis should be made to streamline a more patient-focused management based on risk stratification.…”

Section: Ashfaq Et Al and Bahl Et Al Emphasized The Variability Acrossmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Ashfaq Et Al and Bahl Et Al Emphasized The Variability Acrossmentioning

confidence: 99%

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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“…The most common cause of pathologic nipple discharge is an intraductal neoplastic lesion (ie, papilloma or papillomatosis, accounting for 35%‐56% of cases), followed by secretory breast disease such as plasma cell mastitis with duct ectasia (17%‐36%) and fibrocystic change . Cancer is a less common etiology, ranging from 5% to 23% in patients presenting with pathologic nipple discharge in single institution studies . The most common type of cancer that presents with pathologic nipple discharge is ductal carcinoma in situ (DCIS)…”

Section: Introductionmentioning

confidence: 99%

“…According to the American College of Radiology's (ACR) Appropriateness Criteria, diagnostic mammography is the standard initial step in evaluating pathologic nipple discharge in patients 30 years of age or older . Since mammography has a low sensitivity (7%‐10%) for the detection of malignancy in this setting, ultrasound complements diagnostic evaluation by allowing for detailed evaluation of the sub‐areolar ducts and providing guidance for subsequent needle biopsy, if needed . In the setting of a negative mammogram and ultrasound, ductography or dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) may be performed to further evaluate the etiology of pathologic nipple discharge.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13] Cancer is a less common etiology, ranging from 5% to 23% in patients presenting with pathologic nipple discharge in single institution studies. [10][11][12][13][14][15] The most common type of cancer that presents with pathologic nipple discharge is ductal carcinoma in situ (DCIS). 16 According to the American College of Radiology's (ACR) Appropriateness Criteria, diagnostic mammography is the standard initial step in evaluating pathologic nipple discharge in patients 30 years of age or older.…”

Section: Introductionmentioning

confidence: 99%

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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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Diagnostic performance of digital breast tomosynthesis in female patients with nipple discharge

Ostojić

Grbanovic

Tonklin³

et al. 2022

Cancer Reports

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Background Nipple discharge is one of the most common symptoms related to the breast, but it is a presenting feature of breast cancer in 5%–12% of women. Aims The purpose of this study was to determine the diagnostic performance of digital breast tomosynthesis (DBT) in the evaluation of patients with nipple discharge and to compare it with mammography (MMG), ultrasound (US), and magnetic resonance imaging (MRI). Methods and Results This retrospective study included 53 patients with nipple discharge. All patients underwent DBT, and results were compared to MMG, breast US, and MRI. Radiological findings for each method were categorized according to BI‐RADS classification: categories 1–2 were considered negative and categories 3–5 positive. If a tissue specimen was obtained, the final diagnosis was established based on the results of histopathological analysis; otherwise, a clinical follow‐up was required for at least 2 years to confirm benign radiological findings. Measures of diagnostic accuracy of DBT, MMG, US, and MRI were calculated and compared. Results Final histopathological analysis revealed six malignant breast lesions, all of which were detected in patients with pathologic nipple discharge. DBT and MRI exhibited high sensitivity (100%) and high negative predictive value (100%) for the detection of breast cancer in patients with nipple discharge. DBT showed higher specificity compared to MRI (82.9% vs. 61.9%). Sensitivity and specificity of MMG were 83.3% and 76.6%, respectively. Breast US was determined to have a sensitivity of 66.7% and specificity of 57.5%. Conclusion DBT exhibited higher specificity than MRI at the same level of sensitivity and negative predictive value. Therefore, the use of DBT should be considered as an alternative to MRI in the assessment of patients with nipple discharge.

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Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge

Abstract: For females presenting with pathologic nipple discharge, ultrasound is a useful diagnostic tool and may be worth including in the routine evaluation.

Cited by 51 publications

References 19 publications

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

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

Is Ductography Still Warranted in the 21st century?

Diagnostic performance of digital breast tomosynthesis in female patients with nipple discharge

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