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3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail

  • Breast
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Abstract

Objectives

To compare 3.0 Tesla breast magnetic resonance imaging (MRI) with galactography for detection of benign and malignant causes of nipple discharge in patients with negative mammography and ultrasound.

Methods

We prospectively evaluated 56 breasts of 50 consecutive patients with nipple discharge who had inconspicuous mammography and ultrasound, using 3.0 Tesla breast MRI with a dedicated 16-channel breast coil, and then compared the results with galactography. Histopathological diagnoses and follow-ups were used as reference standard. Lesion size estimated on MRI was compared with the size at histopathology.

Results

Sensitivity and specificity of MRI vs. galactography for detecting pathologic findings were 95.7 % vs. 85.7 % and 69.7 % vs. 33.3 %, respectively. For the supposed concrete pathology based on MRI findings, the specificity was 67.6 % and the sensitivity 77.3 % (PPV 60.7 %, NPV 82.1 %). Eight malignant lesions were detected (14.8 %). The estimated size at breast MRI showed excellent correlation with the size at histopathology (Pearson’s correlation coefficient 0.95, p < 0.0001).

Conclusions

MRI of the breast at 3.0 Tesla is an accurate imaging test and can replace galactography in the workup of nipple discharge in patients with inconspicuous mammography and ultrasound.

Key Points

• Breast MRI is an excellent diagnostic tool for patients with nipple discharge.

• MRI of the breast reveals malignant lesions despite inconspicuous mammography and ultrasound.

• MRI of the breast has greater sensitivity and specificity than galactography.

• Excellent correlation of lesion size measured at MRI and histopathology was found.

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Abbreviations

BI-RADS®:

Breast Imaging Reporting and Data System

DCIS:

Ductal carcinoma in situ

DTPA:

Diethylene triamine pentaacetic acid

EUSOMA:

European Society of Breast Cancer Specialists

Hp.:

Histopathology

MHz:

Megahertz

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

ROI:

Region of interest

SD:

Standard deviation

SPAIR:

Spectrally adiabatic inversion recovery

TE:

Echo time

TR:

Repetition time

TSE:

Turbo spin-echo

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Acknowledgments

We would like to thank Andrew McLeod for careful review of the manuscript as native speaker. The scientific guarantor of this publication is Prof. Thorsten Alexander Bley. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors, Dr. Andreas Max Weng, has significant statistical expertise. Institutional review board approval was obtained from the ethics committee of the Medical Faculty of the University of Würzburg. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany

    Nóra Lubina, Ulla Schedelbeck, Andreas Max Weng, Dietbert Hahn & Thorsten Alexander Bley

  2. Centre of Radiology Würzburg, Höchberg, Eichhornstrasse 21, 97070, Würzburg, Germany

    Anne Roth

  3. Institute of Pathology, University of Würzburg, Josef Schneider Strasse 2, 97080, Würzburg, Germany

    Eva Geissinger

  4. Department of Obstetrics and Gynecology, Catholic Clinical Centre Mainz, An der Goldgrube 11, 55131, Mainz, Germany

    Arnd Hönig

Authors
  1. Nóra Lubina
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  2. Ulla Schedelbeck
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  3. Anne Roth
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  4. Andreas Max Weng
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  5. Eva Geissinger
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  6. Arnd Hönig
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  7. Dietbert Hahn
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  8. Thorsten Alexander Bley
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Corresponding author

Correspondence to Ulla Schedelbeck.

Additional information

Nóra Lubina and Ulla Schedelbeck contributed equally to this work.

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Lubina, N., Schedelbeck, U., Roth, A. et al. 3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail. Eur Radiol 25, 1285–1293 (2015). https://doi.org/10.1007/s00330-014-3521-2

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  • DOI: https://doi.org/10.1007/s00330-014-3521-2

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