Skip to main content

Advertisement

SpringerLink
Log in

Magnetic resonance imaging in patients with nipple discharge: should we recommend it?

  • Breast
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Comparing the sensitivity of Contrast-Enhanced Magnetic Resonance Imaging (CEMRI), mammography and ultrasonography in patients with nipple discharge (ND).

Methods

We retrospectively evaluated 38 women with ND who underwent mammography, ultrasound and 1.5 T CEMRI between March 2007 and July 2009. Imaging findings, pathological diagnosis and follow-up data (mean follow-up: 20 months) were compared. Sensitivity and specificity values were reckoned. Statistical differences in sensitivity were assessed.

Results

5/38 malignancies (13.2%; 3 invasive, 2 intraductal; 4 ipsilateral, 1 contralateral to ND), and 14/38 High-Risk Lesion (HRL—36.8%; 11 intraductal papillomas, 1 papilloma with LCIS, 1 sclerosing papilloma and 1 atypical intraductal hyperplasia, all ipsilateral) were found. CEMRI identified 5/5 cancers and 13/14 HRL (Overall Sensitivity—OSS = 94.7%; Overall Specificity—OSP = 78.9%). 3/5 cancers (1 invasive, 1 in-situ; 1 invasive contralateral) and 2/14 HRL were detected by CEMRI only. Mammography found 2/5 cancer and 3/14 HRL (OSS = 26.3%; OSP = 94.7%). Ultrasound identified 1/5 cancer and 11/14 HRL (OSS = 63.2%; OSP = 84.2). 1/14 HRL was detected by ultrasound only. Compared with mammography and ultrasound, CEMRI showed statistically significantly higher OSS values (p < 0.0001, p = 0.042 respectively).

Conclusion

In women with ND, CEMRI should be recommended when conventional imaging is negative. Unexplained ND could be considered an indication for CEMRI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Hussain AN, Policarpio C, Vincent MT (2006) Evaluating nipple discharge. Obstet Gynecol Surv 61:278–283

    Article  PubMed  Google Scholar 

  2. Newman HF, Klein M, Northrup JD et al (1983) Nipple discharge: frequency and pathogenesis in an ambulatory population. NY State J Med 83:928–933

    CAS  Google Scholar 

  3. Murad TM, Contesso G, Mouriesse H (1982) Nipple discharge from the breast. Ann Surg 195:259–264

    Article  PubMed  CAS  Google Scholar 

  4. Sauter ER, Schlatter L, Lininger J et al (2004) The association of bloody nipple discharge with breast pathology. Surgery 136:780–785

    Article  Google Scholar 

  5. Simmons R, Adamovich T, Brennan M et al (2003) Nonsurgical evaluation of pathologic nipple discharge. Ann Surg Oncol 10:113–116

    Article  PubMed  Google Scholar 

  6. Falkenberry SS (2002) Nipple discharge. Obstet Gynecol Clin North Am 29:21–29

    Article  PubMed  Google Scholar 

  7. Kilgore AR, Fleming R, Ramos MM (1953) The incidence of cancer with nipple discharge and the risk of cancer in the presence of papillary disease of the breast. Surg Gynecol Obstet 96:649–660

    PubMed  CAS  Google Scholar 

  8. Morrogh M, Morris EA, Liberman L et al (2007) The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol 14:3369–3377

    Article  PubMed  Google Scholar 

  9. Sickles EA (2000) Galactography and other imaging investigations of nipple discharge. Lancet 356:1622–1623

    Article  PubMed  CAS  Google Scholar 

  10. Cardenosa G, Eklund GW (1991) Benign papillary neoplasms of the breast: mammographic findings. Radiology 181:751–55

    PubMed  CAS  Google Scholar 

  11. Piccoli CW, Feig SA, Vala MA (1998) Benign intraductal papilloma with focal atypical papillomatous hyperplasia. Radiographics 18:783–786

    PubMed  CAS  Google Scholar 

  12. Tabar L, Dean PB, Pentek Z (1983) Galactography: the diagnostic procedure of choice for nipple discharge. Radiology 149:31–38

    PubMed  CAS  Google Scholar 

  13. Orel SG, Dougherty CS, Reynolds C et al (2000) MR imaging in patients with nipple discharge: initial experience. Radiology 216:248–254

    PubMed  CAS  Google Scholar 

  14. Schwab SA, Uder M, Schulz-Wendtland R et al (2008) Direct MR galactography: feasibility study. Radiology 249:54–61

    Article  PubMed  Google Scholar 

  15. Hirose M, Nobusawa H, Gokan T (2007) MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics 27:S183–S196

    Article  PubMed  Google Scholar 

  16. Kuhl CK (2007) The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356–378

    Article  PubMed  Google Scholar 

  17. Kuhl CK (2007) Current status of breast MR imaging. Part II. Clinical applications. Radiology 244:672–691

    Article  PubMed  Google Scholar 

  18. Kuhl CK, Schrading S, Bieling HB et al (2007) MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 370:485–492

    Article  PubMed  Google Scholar 

  19. Linda A, Zuiani C, Londero V et al (2008) Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: distribution according to patient history of breast cancer and lesion size. Breast 17:53–59

    Google Scholar 

  20. Bazzocchi M, Zuiani C, Bendini M et al (1994) US-guided breast biopsy with an automated cutting needle. Eur Radiol 4:360–363

    Article  Google Scholar 

  21. ACR breast imaging reporting and data system (2003) Breast imaging atlas. American College of Radiology, Reston

    Google Scholar 

  22. D’Orsi CJ, Bassett WA, Berg WA et al (2003) Breast Imaging Reporting and Data System, BI-RADS: mammography. American College of Radiology, Reston

    Google Scholar 

  23. Mendelson EB, Baum JK, Berg WA et al (2003) Breast Imaging Reporting and Data System, BI-RADS: ultrasound. American College of Radiology, Reston

    Google Scholar 

  24. Morris EA, Harms S (2004) ACR practice guideline for the performance of magnetic resonance imaging (MRI) of the breast. American College of Radiology, Reston

    Google Scholar 

  25. NHSB (1994) Guidelines for cytology procedures and reporting on fine needle aspirates of the breast. Cytology Subgroup of the National Coordinating Committee for Breast Cancer Screening Pathology. Cytopathology 4:316–334

    Google Scholar 

  26. NHSBSP (2001) Non-operative Diagnosis Subgroup of the National Coordinating Group for Breast Screening Pathology. Publication No 50

  27. Perry N, Broeders M, de Wolf C et al (2008) European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition—summary document. Ann Oncol 19:614–622

    Article  PubMed  CAS  Google Scholar 

  28. Kramer SC, Rieber A, Görich J et al (2000) Diagnosis of papillomas of the breast: value of magnetic resonance mammography in comparison with galactography. Eur Radiol 10:1733–1736

    Article  PubMed  CAS  Google Scholar 

  29. Daniel BL, Gardner RW, Birdwell RL et al (2003) Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging 21:887–892

    Article  PubMed  Google Scholar 

  30. LaTrenta LR, Menell JH, Morris EA et al (2003) Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology 227:856–861

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Radiology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le Santa Maria della Misericordia n. 15, 33100, Udine, Italy

    Michele Lorenzon, Chiara Zuiani, Anna Linda, Viviana Londero, Rossano Girometti & Massimo Bazzocchi

Authors
  1. Michele Lorenzon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara Zuiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Linda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Viviana Londero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rossano Girometti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Bazzocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Lorenzon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lorenzon, M., Zuiani, C., Linda, A. et al. Magnetic resonance imaging in patients with nipple discharge: should we recommend it?. Eur Radiol 21, 899–907 (2011). https://doi.org/10.1007/s00330-010-2009-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-010-2009-y

Keywords

Search

Navigation