1
|
Choi Y, Kim SM, Jang M, Yun BL, Kang E, Kim EK, Park SY, Kim B, Cho N, Moon WK. The Value of Adding Ductography to Ultrasonography for the Evaluation of Pathologic Nipple Discharge in Women with Negative Mammography. Korean J Radiol 2022; 23:866-877. [PMID: 36047541 PMCID: PMC9434737 DOI: 10.3348/kjr.2021.0850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The optimal imaging approach for evaluating pathological nipple discharge remains unclear. We investigated the value of adding ductography to ultrasound (US) for evaluating pathologic nipple discharge in patients with negative mammography findings. Materials and Methods From July 2003 to December 2018, 101 women (mean age, 46.3 ± 12.2 years; range, 23–75 years) with pathologic nipple discharge were evaluated using pre-ductography (initial) US, ductography, and post-ductography US. The imaging findings were reviewed retrospectively. The standard reference was surgery (70 patients) or > 2 years of follow-up with US (31 patients). The diagnostic performances of initial US, ductography, and post-ductography US for detecting malignancy were compared using the McNemar’s test or a generalized estimating equation. Results In total, 47 papillomas, 30 other benign lesions, seven high-risk lesions, and 17 malignant lesions were identified as underlying causes of pathologic nipple discharge. Only eight of the 17 malignancies were detected on the initial US, while the remaining nine malignancies were detected by ductography. Among the nine malignancies detected by ductography, eight were detected on post-ductography US and could be localized for US-guided intervention. The sensitivities of ductography (94.1% [16/17]) and post-ductography US (94.1% [16/17]) were significantly higher than those of initial US (47.1% [8/17]; p = 0.027 and 0.013, respectively). The negative predictive value of post-ductography US (96.9% [31/32]) was significantly higher than that of the initial US (83.3% [45/54]; p = 0.006). Specificity was significantly higher for initial US than for ductography and post-ductography US (p = 0.001 for all). Conclusion The combined use of ductography and US has a high sensitivity for detecting malignancy in patients with pathologic nipple discharge and negative mammography. Ductography findings enable lesion localization on second-look post-ductography US, thus facilitating the selection of optimal treatment plans.
Collapse
Affiliation(s)
- Younjung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Evaluation of Breast Galactography Using Digital Breast Tomosynthesis: A Clinical Exploratory Study. Diagnostics (Basel) 2021; 11:diagnostics11112060. [PMID: 34829407 PMCID: PMC8622426 DOI: 10.3390/diagnostics11112060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: To compare the application value of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in breast galactography. Materials and Methods: A total of 128 patients with pathological nipple discharge (PND) were selected to undergo galactography. DBT and FFDM were performed for each patient after injecting the contrast agent; the radiation dose of DBT and FFDM was calculated, and the image quality was evaluated in consensus by two senior breast radiologists. Histopathologic data were found in 49 of the 128 patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both FFDM- and DBT-galactography were calculated using histopathologic results as a reference standard. Data were presented as percentages along with their 95% confidence intervals (CI). Results: The average age of the 128 patients was 46.53 years. The average glandular dose (AGD) of DBT-galactography was slightly higher than that of FFDM-galactography (p < 0.001). DBT-galactography was 30.7% higher than FFDM-galactography in CC view, while DBT-galactography increased by 21.7% compared with FFDM-galactography in ML view. Regarding catheter anatomic distortion, structure detail, and overall image quality groups, DBT scores were higher than FFDM scores, and the differences were significant for all measures (p < 0.05). In 49 patients with pathological nipple discharge, we found that the DBT-galactography had higher sensitivity, specificity, PPV, and NPV (93.3%, 75%, 97.7%, and 50%, respectively) than FFDM-galactography (91.1%, 50%, 95.3%, and 33.3%, respectively). Conclusions: Compared to FFDM-galactography, within the acceptable radiation dose range, DBT-galactography increases the sensitivity and specificity of lesion detection by improving the image quality, providing more confidence for the diagnosis of clinical ductal lesions.
Collapse
|
3
|
Galactography Combined with Sonogalactography for Improving the Evaluation of Pathological Nipple Discharge. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app11010327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diagnosing patients with pathological nipple discharge (PND) is controversial, and therefore a standardized diagnosis algorithm is needed. The objective of this study was to investigate the usefulness of galactography (GL) combined with sonogalactography (SGL) for the evaluation of PND patients. A retrospective study was conducted of 51 patients with PND who were evaluated with GL and SGL. The findings from the galactograms of the patients in this study were assigned to different categories of the Galactogram Image Classification System. Additionally, the sensitivity, specificity, and the positive predictive values and negative predictive values of the GL and SGL tests were calculated, considering the gold standard of pathology diagnosis. The results obtained show that GL combined with SGL improved the diagnostic efficiency of ductal lesions, especially for borderline and malignant lesions. Papilloma was diagnosed in 19 cases, and ductal carcinoma in situ in 8 patients. Conclusions: To the best of our knowledge, this is the first study in which the combination of GL and SGL improves the diagnostic efficiency of ductal lesions of patients with PND. A diagnosis algorithm is recommended for women with PND.
Collapse
|
4
|
Jiang L, Li X, Kong X, Ma T, Yang Q. Galactogram Grading System for Identifying Breast Cancer With Nipple Discharge. Clin Breast Cancer 2019; 20:e214-e219. [PMID: 31587961 DOI: 10.1016/j.clbc.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Galactography is a primary recommendation in the management of nipple discharge (ND), which may be caused by benign or malignant lesions. We aimed to establish a galactogram grading system (GGS) and investigate its role in identifying breast cancer with ND. PATIENTS AND METHODS A total of 350 patients were included in our study. All patients received preoperative mammographic galactography successfully and underwent surgery at Qilu Hospital of Shandong University between January 2011 and August 2015. We first performed a retrospective study in a consecutive series of 250 patients with ND to establish a GGS. Then the subsequent consecutive series of 100 patients was analyzed to validate the grading system. RESULTS Our data showed that the GGS can well assess the risk of a galactogram's being malignant. Galactograms classified into grade I have a lower risk of being malignant, while those classified into grade III have a higher risk of being malignant. Thus, our GGS was useful for distinguishing malignant from benign lesions. CONCLUSION We established a scoring system for breast disease with ND. This GGS may be a novel approach for identifying breast cancer with ND.
Collapse
Affiliation(s)
- Liyu Jiang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, PR China
| | - Xiaoyan Li
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, PR China
| | - Xiaoli Kong
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, PR China
| | - Tingting Ma
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, PR China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, PR China; Department of Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, PR China.
| |
Collapse
|
5
|
The efficacy of automated breast volume scanning over conventional ultrasonography among patients with breast lesions. Int J Gynaecol Obstet 2015; 131:293-6. [DOI: 10.1016/j.ijgo.2015.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/19/2015] [Accepted: 08/14/2015] [Indexed: 11/22/2022]
|
6
|
Berná-Serna JD, Torres-Ales C, Berná-Mestre JD, Polo L. Role of galactography in the early diagnosis of breast cancer. ACTA ACUST UNITED AC 2014; 8:122-6. [PMID: 24419050 DOI: 10.1159/000350779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the usefulness of galactography (GL) in the early diagnosis of breast cancer in patients with pathologic nipple discharge (PND). PATIENTS AND METHODS We retrospectively studied all galactograms obtained in 117 women with PND, who subsequently had a biopsy. The findings detected in the galactograms of the patients in this study were assigned to different categories of the Galactogram Image Classification System (GICS): GICS 2, benign; GICS 3, probably benign; GICS 4, suspicious for malignancy; and GICS 5, highly suspicious for malignancy. RESULTS The galactograms were classified into GICS 2 (29 cases; 24.7%), GICS 3 (42 cases; 35.8%), GICS 4 (30 cases; 25.6%), and GICS 5 (16 cases; 13.6%). A good correlation was observed between histological diagnosis and GICS categories (p < 0.05). All cases diagnosed with carcinoma (n = 18) were classified in GICS categories 4-5: ductal carcinoma in situ in 14 cases (11.9%) and invasive carcinoma in 4 cases (3.4%). CONCLUSION GL is a useful procedure in the early diagnosis of breast cancer in patients with PND.
Collapse
Affiliation(s)
- Juan D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Hospital, El Palmar (Murcia), Spain
| | - Carolina Torres-Ales
- Department of Radiology, Virgen de la Arrixaca University Hospital, El Palmar (Murcia), Spain
| | - Juan D Berná-Mestre
- Department of Radiology, Virgen de la Arrixaca University Hospital, El Palmar (Murcia), Spain
| | - Luis Polo
- Department of Pathology, Virgen de la Arrixaca University Hospital, El Palmar (Murcia), Spain
| |
Collapse
|
7
|
Zhang Q, Hu B, Hu B, Li WB. Detection of Breast Lesions using an Automated Breast Volume Scanner System. J Int Med Res 2012; 40:300-6. [PMID: 22429369 DOI: 10.1177/147323001204000130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE: This study investigated the clinical utility of an automated breast volume scanner (ABVS) system for the detection of breast lesions. METHODS: The breasts of 81 patients referred for ultrasonographic examination were scanned using the ABVS system and handheld ultrasonography independently by two experienced examiners. The ABVS was used to perform scans of the breast in three directions (anteroposterior, lateral and medial), with the addition of further inferior and superior scans if necessary. The scanning data were then stored and automatically reconstructed. For hand-held ultrasonography the whole breast was scanned radially from the outside to the centre of the nipple. RESULTS: The numbers of lesions reported by the two examiners were 89 and 99, respectively, using the ABVS (not statistically significant), compared with 60 and 85, respectively, using handheld ultrasonography (statistically significant). CONCLUSIONS: The ABVS system is an operator-independent method for automated breast scanning. It detected more breast lesions and provided additional information for the diagnosis of intraductal and malignant lesions compared with hand-held ultrasonography.
Collapse
Affiliation(s)
- Q Zhang
- Department of Medical Ultrasound, Shanghai Institute of Ultrasound in Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
- Department of Medical Ultrasound, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China
| | - B Hu
- Department of Medical Ultrasound, Shanghai Institute of Ultrasound in Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - B Hu
- Department of Medical Ultrasound, Shanghai Institute of Ultrasound in Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - WB Li
- Department of Medical Ultrasound, Shanghai Institute of Ultrasound in Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
8
|
Torres-Alés C, Berná-Serna JDD, Berná-Mestre JDD, Sola-Pérez J. Inter- and intra-observer assessment of the Galactogram Imaging Classification System (GICS). Acta Radiol 2011; 52:829-33. [PMID: 21724840 DOI: 10.1258/ar.2011.110118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A new system for the classification of galactograms is reported. To date, there is no universally accepted classification system. PURPOSE To evaluate inter- and intra-observer agreement of the Galactogram Imaging Classification System (GICS) MATERIAL AND METHODS: Six observers with different levels of experience retrospectively evaluated 30 galactograms using the GICS. Images were reviewed independently twice within a four-week period. The kappa statistic was calculated for intra- and inter-observer variability. RESULTS The kappa for inter-observer agreement was moderate to substantial (range 0.41-0.72). Overall, the intra-observer kappa values were excellent (range 0.80-0.94). CONCLUSION The present study shows a good to very good inter- and intra-observer agreement with the GICS. We believe the GICS can be incorporated into daily practice.
Collapse
Affiliation(s)
| | | | | | - Joaquín Sola-Pérez
- Department of Patology, Virgen de la Arrixaca University Hospital, El Palmar (Murcia), Spain
| |
Collapse
|
9
|
Hahn M, Fehm T, Solomayer EF, Siegmann KC, Hengstmann AS, Wallwiener D, Ohlinger R. Selective microdochectomy after ductoscopic wire marking in women with pathological nipple discharge. BMC Cancer 2009; 9:151. [PMID: 19445720 PMCID: PMC2689244 DOI: 10.1186/1471-2407-9-151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/17/2009] [Indexed: 12/05/2022] Open
Abstract
Background To investigate the diagnostic reliability of selective microdochectomy after direct ductoscopic wire marking of suspect lesions in patients with pathological nipple discharge. Methods Selective microdochectomy due to pathological discharge was performed in 33 patients with mean age of 51.7 years. Ductoscopes of 0.9 and 1.1 mm in diameter with a channel for wire marking were used. Only patients without sonographic or mammographic correlation for the discharge were included. The pathologic mammary duct was wire marked and extirpated under direct visual guidance via the ductoscope. The histological results were compared with cytology, galactography and ductoscopy. Results In 24 out of 33 cases (72%) an intraductal, epithelial proliferation was found histologically. The following sensitivities for intraductal, epithelial proliferations could be determined: cytology 4%, galactography 74%, and ductoscopy 78%. Conclusion The method allows selective microdochectomy of the pathological duct and the intraductal proliferation under visual guidance. The resection volume can be reduced in contrast to the unselective ductectomy after injection of methylene blue.
Collapse
Affiliation(s)
- M Hahn
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Tuebingen, Germany.
| | | | | | | | | | | | | |
Collapse
|
10
|
Megalooikonomou V, Barnathan M, Kontos D, Bakic PR, Maidment ADA. A representation and classification scheme for tree-like structures in medical images: analyzing the branching pattern of ductal trees in X-ray galactograms. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:487-93. [PMID: 19272984 PMCID: PMC3390200 DOI: 10.1109/tmi.2008.929102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We propose a multistep approach for representing and classifying tree-like structures in medical images. Tree-like structures are frequently encountered in biomedical contexts; examples are the bronchial system, the vascular topology, and the breast ductal network. We use tree encoding techniques, such as the depth-first string encoding and the PrUfer encoding, to obtain a symbolic string representation of the tree's branching topology; the problem of classifying trees is then reduced to string classification. We use the tf-idf text mining technique to assign a weight of significance to each string term (i.e., tree node label). Similarity searches and k-nearest neighbor classification of the trees is performed using the tf-idf weight vectors and the cosine similarity metric. We applied our approach to characterize the ductal tree-like parenchymal structure in X-ray galactograms, in order to distinguish among different radiological findings. Experimental results demonstrate the effectiveness of the proposed approach with classification accuracy reaching up to 86%, and also indicate that our method can potentially aid in providing insight to the relationship between branching patterns and function or pathology.
Collapse
|
11
|
Cutaneous application of local anaesthetic–a useful help in galactography. Eur Radiol 2008; 18:2085-6. [DOI: 10.1007/s00330-008-0992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/05/2008] [Accepted: 03/23/2008] [Indexed: 10/22/2022]
|
12
|
Vargas HI, Vargas MP, Eldrageely K, Gonzalez KD, Khalkhali I. Outcomes of Clinical and Surgical Assessment of Women with Pathological Nipple Discharge. Am Surg 2006. [DOI: 10.1177/000313480607200205] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is no consensus about the diagnostic approach to pathologic nipple discharge (PND). We hypothesize that lactiferous duct excision (microdochectomy) or image-guided biopsy are safe and effective means of diagnosis of PND. Eighty-two patients with PND underwent history and physical exam followed by breast sonography and mammogram. Image-guided biopsy was done if imaging studies were positive, whereas microdochectomy was done if normal. Discharge was unilateral (96%), bloody (79%), and spontaneous (62%). The sensitivity, specificity, positive and negative predictive values for the detection of neoplasia were 0.07, 1.0, 1.0, and 0.4 for mammography and 0.26, 0.97, 0.91, and 0.48 for sonography, respectively. Tissue diagnosis revealed papillary lesion (57%), mammary duct ectasia (33%), breast cancer (5%), and inflammatory/infectious (5%) causes. Hemorrhagic discharge associated with pregnancy or infections was managed successfully without surgery. After a median follow-up of 18 months, no PND recurrence was seen, but one patient developed cancer in a different location after diagnosis of atypical ductal hyperplasia. In conclusion, imaging studies provide confirmatory information and a biopsy target when positive. Negative imaging does not reliably exclude neoplasia or malignancy. Microdochectomy provides a sensible and effective approach in the workup of patients with PND.
Collapse
|
13
|
Adenomyoepithelioma of the Breast. J Med Ultrasound 2005. [DOI: 10.1016/s0929-6441(09)60104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|