La radiologia medica

, Volume 113, Issue 2, pp 249–264 | Cite as

Role of breast Magnetic Resonance Imaging (MRI) in patients with unilateral nipple discharge: preliminary study

  • L. Ballesio
  • C. Maggi
  • S. Savelli
  • M. Angeletti
  • C. De Felice
  • M. L. Meggiorini
  • L. Manganaro
  • L. M. Porfiri
Breast Radiology Senologia

Abstract

Purpose

This study was performed to assess the role of magnetic resonance imaging (MRI) in patients with unilateral nipple discharge.

Materials and methods

Forty-four patients with bloody or serosanguineous nipple discharge and negative mammographic findings (35/44 cases) underwent MRI for evaluation of breast ducts. Ultrasonography, negative in 18 patients, identified 26 cases of ductal ectasia (12 simple, nine with solid intraductal echoes and wall thickening, five with inhomogeneous parenchyma). Galactography was negative in three patients and positive in nine. Nineteen patients were followed up by clinical examination, ultrasonography, and cytological evaluation of nipple discharge (6–12 months); three patients underwent excisional biopsy, ten core biopsy and 12 cytological biopsy (followed by excisional biopsy).

Results

MRI identified 25 enhancing lesions Breast Imaging Reporting and Data Systems (BI-RADS) 3 or 4) and confirmed the galactographic findings (ductal ectasia, intraluminal filling defects). Five papillomatoses appeared as patchy, homogeneous enhancing areas, 15 intraductal papillomas as areas with well-defined margins and type II time-intensity curves, and two atypical ductal hyperplasias as diffuse nodular enhancement. One micropapillary ductal carcinoma in situ (DCIS), one papillary carcinoma and one infiltrating ductal carcinoma (IDC) were visualised as two segmental areas of enhancement and one mass-like enhancement with poorly defined margins (BI-RADS 4). The follow-up was negative, showing no pathological enhancement (BI-RADS 1) in 12 patients and benign enhancement (BI-RADS 2) in seven.

Conclusions

Breast MRI can be considered a valuable examination in the diagnosis of suspected ductal disease and an alternative to galactography when the latter cannot be used.

Keywords

Nipple discharge Breast MRI Diagnosis Ductal disease 

Ruolo della risonanza magnetica mammaria nello studio delle pazienti con secrezione mammaria monolaterale dal capezzolo: studio preliminare

Riassunto

Obiettivo

Valutare il ruolo della risonanza magnetica (RM) in pazienti con secrezione monorifiziale dal capezzolo.

Materiali e metodi

Quarantaquattro pazienti con secrezione ematica/sieroematica dal capezzolo, mammografia negativa (35/44 casi) si sottoponevano allo studio dei dotti con RM. L’ecografia negativa in 18 casi, identificava ectasia duttale in 26: semplici in 12, con proliferazione solida intraduttale ed ispessimento parietale in 9 e con disomogeneità ghiandolare in 5; la galattografia negativa in 3 e positiva in 9. Diciannove pazienti effettuavano follow-up clinico, radiologico, citologico della secrezione (6–12 mesi), 3 biopsia chirurgica, 10 core-biopsy e 12 prelievo citologico (seguite da biopsia chirurgica).

Risultati

RM identificava 25 aree di potenziamento classificate BI-RADS 3 o 4. Nelle pazienti sottoposte a galattografia, la RM riconosceva i reperti galattografici (ectasia o difetti di riempimento). Cinque papillomatosi duttali si identificavano come potenziamento lineare ed omogeneo; 15 papillomi: enhancement a margini netti e curva intensità-tempo di tipo II, 2 iperplasie duttali atipiche: potenziamento nodulare diffuso. Un carcinoma papillare, 1 CDIS con aspetto micropapillare e 1 CDI si evidenziavano come 2 aree di potenziamento segmentale e un’area di potenziamento nodulare a margini irregolari (BI-RADS4). Follow-up negativo in 12 pazienti senza potenziamento patologico (BI-RADS1) e in 7 con potenziamento benigno (BIRADS2).

Conclusioni

La RM può essere considerata valida metodica diagnostica nello studio della sospetta patologia duttale con secrezione, in alternativa alla galattografia quando questa metodica non sia utilizzabile.

Parole chiave

Secrezione dal capezzolo Mammella Risonanza magnetica Diagnosi Patologia duttale 

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References/Bibliografia

  1. 1.
    Dinkel HP, Trusen A, Gassel AM et al (2000) Predictive value of galactographic patterns for benign and malignant neoplasm of the breast in patients with nipple discharge. Br J Radiol 73:706–714PubMedGoogle Scholar
  2. 2.
    Sickles EA (2000) Galactography and other imaging investigations of nipple discharge. Lancet 356:1622–1623PubMedCrossRefGoogle Scholar
  3. 3.
    Bazzocchi M, Berra I, Francescutti GE et al (2001) Lesioni papillari della mammella. Diagnosi per immagini ed apporto dell’agobiopsia percutanea con ago da 14 gauge. Radiol Med 101:424–431Google Scholar
  4. 4.
    Hirose M, Otsuki N, Hayano D et al (2006) Multi-volume fusion imaging of MR ductography and MR mammography for patients with nipple discharge. Magn Reson Med Sci 5:105–112PubMedCrossRefGoogle Scholar
  5. 5.
    Orel SG, Dougherty CS, Reynolds C et al (2000) MR Imaging in patients with nipple discharge: initial experience. Radiology 216:248–254PubMedGoogle Scholar
  6. 6.
    Carty NJ, Mudan SS, Ravichandran D et al (1994) Prospective study of outcome in women presenting nipple discharge. Ann R Coll Surg Engl 76:387–389PubMedGoogle Scholar
  7. 7.
    Fung A, Rayter Z, Fischer C et al (1990) Preoperative cytology and mammography in patients with single-duct nipple discharge treated by surgery. Br J Surg 77:1211–1212PubMedCrossRefGoogle Scholar
  8. 8.
    Yang WT, Suen M, Metreweli C (1997) Sonographic features of benign papillary neoplasms of the breast: review of 22 patients. J Ultrasound Med 16:161–168PubMedGoogle Scholar
  9. 9.
    Taylor KJ, Merritt C, Piccoli C et al (2002) Ultrasuond as a complement to mammography and breast examination to characterize breast masses. Ultrasound Med Biol 28:19–26PubMedCrossRefGoogle Scholar
  10. 10.
    Woods ER, Helvie MA, Ikeda DM et al (1992) Solitary breast papilloma: comparison of mammographic, galactographic and patholigic findings. AJR Am J Roentgenol 159:487–491PubMedGoogle Scholar
  11. 11.
    Cardenosa G, Doudna C, Eklund GW (1994) Ductography of the breast: technique and findins. AJR Am J Roentgenol 162:1081–1087PubMedGoogle Scholar
  12. 12.
    Baker KS, Davey DD, Stelling (1994) Ductal abnormalities detected with galactography: frequency of adeguate excisional biopsy. AJR Am J Roentgenol 162:821–824PubMedGoogle Scholar
  13. 13.
    Cardenosa G, Eklund GW (1991) Benign papillary neoplasm of the breast. Radiology 181:751–755PubMedGoogle Scholar
  14. 14.
    Han BK, Choe YH, Ko YH et al (1999) Benign papillary lesions of the breast: sonographic-pathologic correlation. J Ultrasound Med 18:217–223PubMedGoogle Scholar
  15. 15.
    Francis A, England D, Rowlands D, Bradley S (2002) Breast papilloma: mammogram, ultrasound and MRI appearances. Breast 11:394–397PubMedCrossRefGoogle Scholar
  16. 16.
    Orel SG, Schnall MD (2001) MR Imaging of the breast for the detection, diagnosis and staging of breast cancer. Radiology 220:13–30PubMedGoogle Scholar
  17. 17.
    Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperatorive contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888PubMedGoogle Scholar
  18. 18.
    Liberman L, Morris EA, Dershaw DD et al (2003) Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol 181:519–525PubMedGoogle Scholar
  19. 19.
    Yoshimoto M, Kasumi F, Iwase T et al (1997) Magnetic resonance galactography for a patient with nipple discharge. Breast Cancer Res Treat 42:87–90PubMedCrossRefGoogle Scholar
  20. 20.
    Daniel BL, Gardner RW, Birdwell RL et al (2003) Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging 21:887–892PubMedCrossRefGoogle Scholar
  21. 21.
    Kramer SC, Rieber A, Gorich J et al (2000) Diagnosis of papillomas of the breast: value of magnetic resonance mammography in comparison with galactography. Eur Rad 216:831–837Google Scholar
  22. 22.
    Rovno HDS, Siegelman ES, Reynolds C et al (1999) Solitary intraductal papilloma: findings at MR imaging and MR galactography. AJR Am J Roentgenol 172:151–155PubMedGoogle Scholar
  23. 23.
    American College of Radiology (1998) Breast Imaging Reporting And Data System (BI-RADS), 3nd ed. American College of Radiology, Reston VAGoogle Scholar
  24. 24.
    Ramsay DT, Kent JC, Owens RA, Hartmann PE (2004) Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics 113:361–367PubMedCrossRefGoogle Scholar
  25. 25.
    Scneider JA (1989) Invasive papillary breast carcinoma: mammographic and sonographic appearance. Radiology 171:377–379Google Scholar
  26. 26.
    Cillotti A, Bagnolesi P, Napoli V et al (1991) Papilloma intraduttale solitario della mammella. Radiol Med 82:617–620Google Scholar
  27. 27.
    Sardanelli F, Imperiale A, Zandrino F et al (1997) Breast intraductal masses: US-guided fine needle aspiration after galactography. Radiology 204:143–148PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • L. Ballesio
    • 1
  • C. Maggi
    • 1
  • S. Savelli
    • 1
  • M. Angeletti
    • 1
  • C. De Felice
    • 1
  • M. L. Meggiorini
    • 1
  • L. Manganaro
    • 1
  • L. M. Porfiri
    • 1
  1. 1.Dipartimento di Scienze RadiologicheUniversità di Roma “La Sapienza”RomaItaly

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