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Romero KN, Ouellette T, Patel R, Patel T. The Use of MRI to Detect Malignancy in a Patient Presenting With Unilateral Bloody Nipple Discharge. Cureus 2023; 15:e47986. [PMID: 38034172 PMCID: PMC10686522 DOI: 10.7759/cureus.47986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Nipple discharge presents as either physiological, which is green, white, or yellow, or is considered pathological, which is typically unilateral, spontaneous, and bloody. Bloody nipple discharge (BND) can be due to underlying malignancy or premalignant lesions. Mammogram (MMG), ultrasound (US), MRI, and ductography are all used to evaluate BND, but different modalities offer greater value in the diagnostic process. Here, we present a case that demonstrates the ability of MRI to detect abnormalities not seen on MMG and US in the setting of BND due to underlying malignancy. The use of MRI earlier in the diagnostic process allows for the use of breast-conserving measures and decreases the possibility of metastasis. This would result in less of a need for more aggressive treatments.
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Affiliation(s)
- Kaitlyn N Romero
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Taylor Ouellette
- General Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Radhika Patel
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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Avdan Aslan A, Gültekin S. What is the role of breast MRI in the management of women with pathologic nipple discharge and normal conventional imaging? Ir J Med Sci 2023; 192:2331-2335. [PMID: 36409422 DOI: 10.1007/s11845-022-03230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS To investigate the diagnostic performance of breast MRI in revealing mammographically and sonographically occult lesions requiring excision in patients with pathologic nipple discharge. MATERIALS AND METHODS In this retrospective study, 57 women with pathologic nipple discharge who had normal or inconclusive mammography and ultrasonography results and underwent breast MRI were determined. Patients who had histopathological diagnosis or ≥ 1-year imaging follow-up were included. MRIs were classified as positive and negative according to final BI-RADS assessment categories. Diagnostic performance of MRI, including sensitivity, specificity, negative predictive value, and positive predictive value, was calculated for detecting both malignancy and lesions requiring surgery. RESULTS Abnormal contrast enhancement on the pathologic nipple discharge side was detected in 29 MRIs (50.8%), categorized as BI-RADS 4. Abnormal findings were solid masses in 17 cases (58.6%) and non-mass enhancement in 12 cases (41.3%). Despite normal conventional imaging results, 4 malignant lesions and 16 lesions requiring surgery were detected with MRI. The sensitivity and specificity of MRI for detecting lesions requiring surgery were 100% and 68.2%, respectively. The positive predictive value (PPV) and negative predictive value were 55.1% and 100%, respectively. CONCLUSION In conclusion, this study confirmed that MRI is a reliable tool to detect lesions requiring surgery in patients with pathologic nipple discharge. MRI should be used in routine workup in patients with normal conventional imaging and imaging follow-up can be safely applied in patients with negative MRI.
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Affiliation(s)
- Aydan Avdan Aslan
- Department of Radiology, Faculty of Medicine, Gazi University, Emniyet, Mevlana Blv. No:29, Yenimahalle, Ankara, 06560, Turkey.
| | - Serap Gültekin
- Department of Radiology, Faculty of Medicine, Gazi University, Emniyet, Mevlana Blv. No:29, Yenimahalle, Ankara, 06560, Turkey
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Xu F, Zhu C, Wang Z, Zhang L, Gao H, Ma Z, Gao Y, Guo Y, Li X, Luo Y, Li M, Shen G, Liu H, Li Y, Zhang C, Cui J, Li J, Jiang H, Liu J. Deep learning for real-time detection of breast cancer presenting pathological nipple discharge by ductoscopy. Front Oncol 2023; 13:1103145. [PMID: 37035165 PMCID: PMC10073663 DOI: 10.3389/fonc.2023.1103145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Objective As a common breast cancer-related complaint, pathological nipple discharge (PND) detected by ductoscopy is often missed diagnosed. Deep learning techniques have enabled great advances in clinical imaging but are rarely applied in breast cancer with PND. This study aimed to design and validate an Intelligent Ductoscopy for Breast Cancer Diagnostic System (IDBCS) for breast cancer diagnosis by analyzing real-time imaging data acquired by ductoscopy. Materials and methods The present multicenter, case-control trial was carried out in 6 hospitals in China. Images for consecutive patients, aged ≥18 years, with no previous ductoscopy, were obtained from the involved hospitals. All individuals with PND confirmed from breast lesions by ductoscopy were eligible. Images from Beijing Chao-Yang Hospital were randomly assigned (8:2) to the training (IDBCS development) and internal validation (performance evaluation of the IDBCS) datasets. Diagnostic performance was further assessed with internal and prospective validation datasets from Beijing Chao-Yang Hospital; further external validation was carried out with datasets from 5 primary care hospitals. Diagnostic accuracies, sensitivities, specificities, and positive and negative predictive values for IDBCS and endoscopists (expert, competent, or trainee) in the detection of malignant lesions were obtained by the Clopper-Pearson method. Results Totally 11305 ductoscopy images in 1072 patients were utilized for developing and testing the IDBCS. Area under the curves (AUCs) in breast cancer detection were 0·975 (95%CI 0·899-0·998) and 0·954 (95%CI 0·925-0·975) in the internal validation and prospective datasets, respectively, and ranged between 0·922 (95%CI 0·866-0·960) and 0·965 (95%CI 0·892-0·994) in the 5 external validation datasets. The IDBCS had superior diagnostic accuracy compared with expert (0.912 [95%CI 0.839-0.959] vs 0.726 [0.672-0.775]; p<0.001), competent (0.699 [95%CI 0.645-0.750], p<0.001), and trainee (0.703 [95%CI 0.648-0.753], p<0.001) endoscopists. Conclusions IDBCS outperforms clinical oncologists, achieving high accuracy in diagnosing breast cancer with PND. The novel system could help endoscopists improve their diagnostic efficacy in breast cancer diagnosis.
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Affiliation(s)
- Feng Xu
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Feng Xu, ; Chuang Zhu, ; Hongchuan Jiang, ; Jun Liu,
| | - Chuang Zhu
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
- *Correspondence: Feng Xu, ; Chuang Zhu, ; Hongchuan Jiang, ; Jun Liu,
| | - Zhihao Wang
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Lei Zhang
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Haifeng Gao
- Breast Disease Prevention and Treatment Center, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Zhenhai Ma
- Department of General Surgery , Beijing Huairou Hospital, Beijing, China
| | - Yue Gao
- Department of General Surgery , Beijing Huairou Hospital, Beijing, China
| | - Yang Guo
- Department of Breast Surgery, Beijing Yanqing District Maternal and Child Health Care Hospital, Beijing, China
| | - Xuewen Li
- Department of General Surgery, Beijing Pinggu Hospital, Beijing, China
| | - Yunzhao Luo
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mengxin Li
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guangqian Shen
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - He Liu
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanshuang Li
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jianxiu Cui
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jie Li
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Jiang
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Feng Xu, ; Chuang Zhu, ; Hongchuan Jiang, ; Jun Liu,
| | - Jun Liu
- Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Feng Xu, ; Chuang Zhu, ; Hongchuan Jiang, ; Jun Liu,
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Chung HL, Bevers TB, Legha RS, Speer ME, Tso HH, Sun J, Leung JW. Nipple Discharge Imaging Evaluation with Mammography, Ultrasound, Galactography, and MRI. Acad Radiol 2022; 30:783-797. [PMID: 35760711 DOI: 10.1016/j.acra.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVE To determine the diagnostic yield of various imaging tests used to evaluate nipple discharge. MATERIALS AND METHODS A single institution, IRB-approved, retrospective study was performed of 320 consecutive patients presenting with nipple discharge. Imaging and pathology were reviewed to determine the yield for malignancy, atypical high-risk lesions (HRLs), and intraductal papillomas (IDPs). RESULTS Of the 320 patients, pathology or follow up confirmed 40 breast malignancies (40/320, 12.5%),14 atypical HRLs (14/320, 4.4%), 71 IDPs (71/320, 22.2%), 48 other benign pathologies (48/320,15.0%), and 147 unknown but benign cases (147/320, 45.9%). Physiologic discharge characteristics were observed in a minority of malignant cases: nonspontaneous (4/40, 10.0%); neither bloody nor clear (4/40, 10.0%); bilateral (3/40, 7.5%). Malignancy was associated with older age (p < 0.001) and bloody discharge (odds ratio 6.5, p < 0.0001). The combination of digital mammography and ultrasound had a 93% sensitivity and a 98% NPV, while contrast enhanced MRI (CE-MRI) had a 100% sensitivity and a 100% NPV for malignancy. Only three galactography examinations were performed among the malignant cohort, with minimal contribution (1 of 3) to the diagnostic evaluation. In this case, galactography findings helped determine imaging-pathology discordance, prompting a recommendation for surgical excision and subsequently a malignant diagnosis. CONCLUSION The combination of mammography and ultrasonography detected 93% of breast malignancies associated with nipple discharge and had a 98% NPV for malignancy. The value of CE-MRI is its ability to detect the remaining malignancies, not detected on mammography or ultrasound, and its ability to obviate the need for surgical duct excision.
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