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Wang B, Yang D, Zhang X, Gong X, Xu T, Han J, Ren Y, Zou S, Li L, Wang Y. The diagnostic value of contrast-enhanced ultrasonography in breast ductal abnormalities. Cancer Imaging 2023; 23:25. [PMID: 36899406 PMCID: PMC10007791 DOI: 10.1186/s40644-023-00539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 02/25/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Ductal lesions are an important, often overlooked, and poorly understood issue in breast imaging, which have a risk of underlying malignancy ranging from 5 to 23%. Ultrasonography (US), which has largely replaced galactography or ductography, has become an important imaging method to assess patients with ductal lesions. However, it is difficult to distinguish benign from malignant ductal abnormalities only by ultrasonography, most of which are recommended to be at least in subcategory 4A; these require biopsy according to the ACR BI-RADS®atlas 5th Edition-breast ultrasound. Contrast-enhanced ultrasound (CEUS) has been shown to be valuable for differentiating benign from malignant tumors, but its value is unclear in breast ductal lesions. Therefore, the purposes of this study were to explore the characteristics of malignant ductal abnormalities on US and CEUS imaging and the diagnostic value of CEUS in breast ductal abnormalities. METHODS Overall, 82 patients with 82 suspicious ductal lesions were recruited for this prospective study. They were divided into benign and malignant groups according to the pathological results. Morphologic features and quantitative parameters of US and CEUS were analyzed by comparison and multivariate logistic regression to determine the independent risk factors. The diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS Shape, margin, inner echo, size, microcalcification and blood flow classification on US, wash-in time, enhancement intensity, enhancement mode, enhancement scope, blood perfusion defects, peripheral high enhancement and boundary on CEUS were identified as features correlated with malignant ductal lesions. However, multivariate logistic regression showed that only microcalcification (OR = 8.96, P = 0.047) and enhancement scope (enlarged, OR = 27.42, P = 0.018) were independent risk factors for predicting malignant ductal lesions. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the ROC curve of microcalcifications combined with an enlarged enhancement scope were 0.895, 0.886, 0.872, 0.907, 0.890, and 0.92, respectively. CONCLUSIONS Microcalcification and enlarged enhancement scope are independent factors for predicting malignant ductal lesions. The combined diagnosis can greatly improve the diagnostic performance, indicating that CEUS can be useful in the differentiation of benign and malignant lesions to formulate more appropriate management for ductal lesions.
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Affiliation(s)
- Bo Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Di Yang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuan Zhang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - XuanTong Gong
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tong Xu
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Han
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - YinPeng Ren
- Department of Breast Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - ShuangMei Zou
- Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yong Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Sanford MF, Slanetz PJ, Lewin AA, Baskies AM, Bozzuto L, Branton SA, Hayward JH, Le-Petross HT, Newell MS, Scheel JR, Sharpe RE, Ulaner GA, Weinstein SP, Moy L. ACR Appropriateness Criteria® Evaluation of Nipple Discharge: 2022 Update. J Am Coll Radiol 2022; 19:S304-S318. [PMID: 36436958 DOI: 10.1016/j.jacr.2022.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
The type of nipple discharge dictates the appropriate imaging study. Physiologic nipple discharge is common and does not require diagnostic imaging. Pathologic nipple discharge in women, men, and transgender patients necessitates breast imaging. Evidence-based guidelines were used to evaluate breast imaging modalities for appropriateness based on patient age and gender. For an adult female or male 40 years of age or greater, mammography or digital breast tomosynthesis (DBT) is performed initially. Breast ultrasound is usually performed at the same time with rare exception. For males or females 30 to 39 years of age, mammography/DBT or breast ultrasound is performed based on institutional preference and individual patient considerations. For young women less than 30 years of age, ultrasound is performed first with mammography/DBT added if there are suspicious findings or if the patient is at elevated lifetime risk for developing breast cancer. There is a high incidence of breast cancer in males with pathologic discharge. Men 25 years and older should be evaluated using mammography/DBT and ultrasound added when indicted. In transfeminine (male-to-female) patients, mammography/DBT and ultrasound are useful due to the increased incidence of breast cancer. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Matthew F Sanford
- Lead Interpreting Physician, Sanford Health of Northern Minnesota, Bemidji, Minnesota.
| | - Priscilla J Slanetz
- Panel Chair, Boston University School of Medicine, Boston, Massachusetts; Vice Chair, Academic Affairs, Department of Radiology, Associate Program Director, BMC Diagnostic Radiology Residency and Program Director, Academic Writing Program Boston Medical Center, Boston, Massachusetts
| | - Alana A Lewin
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Arnold M Baskies
- Virtua Willingboro Hospital, Willingboro, New Jersey; American College of Surgeons; Clinical Professor, Surgery, Rowan School of Medicine, Stratford, New Jersey
| | - Laura Bozzuto
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; American College of Obstetricians and Gynecologists
| | - Susan A Branton
- Medical Directo, Breast Health Center and Medical Staff President, UPMC North Central, Pittsburgh, Pennsylvania; American College of Surgeons
| | | | - Huong T Le-Petross
- Breast MRI Director, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - John R Scheel
- Vice-Chair, Global Health, University of Washington, Seattle, Washington
| | | | - Gary A Ulaner
- James & Pamela Muzzy Endowed Chair, Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, California
| | - Susan P Weinstein
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Associate Chair for Radiology Network Strategic Projects
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York
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Moschetta M, De Ruvo V, Drago A, Troiano N, Paolicelli S, Rubini G, Stabile Ianora AA, Telegrafo M. DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge. Eur Radiol Exp 2020; 4:40. [PMID: 32748294 PMCID: PMC7399007 DOI: 10.1186/s41747-020-00170-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our aim was to compare the diagnostic performance of digital breast tomosynthesis (DBT)-galactography with that of full-field digital (FFD)-galactography for detecting intraductal breast lesions using an intra-individual design. METHODS Forty-nine consecutive patients with spontaneous, unilateral, single-pore nipple discharge and inconclusive FFD mammography and ultrasonography underwent galactography with a "COMBO" technique combining FFD- and DBT-galactography acquisitions. Examinations were independently analysed by two breast radiologists with 10-year experience. Sensitivity, specificity, and accuracy for both FFD- and DBT-galactography were calculated having histological examinations of surgical specimens as a reference standard. Data were presented as percentages with their 95% confidence intervals (CI). McNemar test was used. Interobserver agreement was assessed by using Cohen κ test for both techniques. RESULTS Sensitivity was 41/43 (95%, 95% CI 84.2-99.4) for DBT-galactography and 33/43 (77%, 95% CI 61.4-88.2) for FFD-galactography (p = 0.008), specificity 6/6 (100%, 95% CI 54.1-100.0) for both imaging tools, accuracy 47/49 (96%, 95% CI 86.0-99.5) and 39/49 (80%, 95% CI 65.7-89.8) (p = 0.038), respectively. The inter-observer agreement was 0.86 for DBT-galactography and 0.78 for FFD-galactography. The AGD resulted to 1.94 ± 0.64 for the combined technique. CONCLUSION DBT-galactography showed a significantly higher sensitivity and accuracy than FFD-galactography for the identification of the intraductal findings, improving the possibility of a reliable diagnosis in patients with pathologic nipple-discharge.
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Affiliation(s)
- Marco Moschetta
- DETO-Department of Emergency and Organ Transplantation-Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Vincenzo De Ruvo
- DETO-Department of Emergency and Organ Transplantation-Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Angelica Drago
- DIM-Interdisciplinary Department of Medicine-Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicoletta Troiano
- DIM-Interdisciplinary Department of Medicine-Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Simona Paolicelli
- DIM-Interdisciplinary Department of Medicine-Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giuseppe Rubini
- DIM-Interdisciplinary Department of Medicine-Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Amato Antonio Stabile Ianora
- DIM-Interdisciplinary Department of Medicine-Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele Telegrafo
- DETO-Department of Emergency and Organ Transplantation-Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Evaluation and management of pathological nipple discharges without using intraductal imaging methods. Ir J Med Sci 2019; 189:451-460. [PMID: 31631245 DOI: 10.1007/s11845-019-02107-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The most common cause of pathological nipple discharge (PND) is single papilloma, which is a benign intraductal lesion (BIL). However, underlying malign (MIL) or high-risk intraductal lesions (HIL) should be considered during examination. AIM To reveal the value of conventional imaging methods (CIM), discharge characteristics, and cytology in lack of intraductal imaging methods to detect intraductal lesions (IL) and MIL that cause PND. METHODS We compared the pathological findings with the characteristics of discharge, CIM, and cytology findings of the patients who admitted to our clinic with nipple discharge and underwent duct excision (n = 111). RESULTS IL were detected in 69 (62.2%) patients as BIL (n = 31), HIL (n = 23), and MIL (n = 15). Most of the IL was observed with bloody, serosanguineous, and serous discharges (83.3%, 76.2%, and 69.2%, respectively). The sensitivities of ultrasonography, MRI, and cytology in detecting IL were found to be 50.7%, 42.6%, and 74.1%, while their specificities were found to be 73.8%, 88.2%, and 48.6%, respectively. None of the CIM was sufficient to detect MIL in 5 (33.3%) patients. The appearance of red blood cells detailed in cytology was significantly related to IL (p < 0.01), whereas the presence of inflammatory cells was related to ductal ectasia and periductal mastitis (p < 0.001). CONCLUSIONS Although patients' physical examinations, CIM, and cytology findings were normal, duct excision procedures should be applied to exclude MIL or HIL, which can be a cause of discharge in case of suspicious color. The details in cytology reports have a role in increasing the value of cytology.
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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.
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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.
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Comparison Between Ultrasonography and Galactography in Detecting Lesions in Patients With Pathologic Nipple Discharge. Ultrasound Q 2019; 35:93-98. [DOI: 10.1097/ruq.0000000000000365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Istomin A, Masarwah A, Pitkänen M, Joukainen S, Sutela A, Vanninen R, Sudah M. Galactography is not an obsolete investigation in the evaluation of pathological nipple discharge. PLoS One 2018; 13:e0204326. [PMID: 30296280 PMCID: PMC6175274 DOI: 10.1371/journal.pone.0204326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/06/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the malignancy rate and diagnostic performance of galactography in patients with pathological nipple discharge (PND) after negative clinical breast examination, mammography and ultrasound. Materials and methods We retrospectively evaluated all galactograms obtained between January 2006 and December 2014 in women with PND. Galactographic findings were classified into 6 groups according to a modified Galactogram Image Classification system (GICS) to comply with the breast imaging reporting and data system classification. Observers were blinded to the final histology and clinical outcome at the time of analysis. MRI was performed as a problem solving ancillary examination. Imaging findings, pathological diagnosis and follow-up data were evaluated. The diagnostic performance of MRI and technically successful galactography in the detection of neoplastic or risk lesions were separately calculated. Results A total of 146 patients with PND (mean age, 51.5 years; range, 17–93) were examined. Malignant lesions were detected in only 4 patients (2.7%) and risk-lesions in 5 patients (3.4%). Only one low-grade ductal carcinoma in situ was missed by galactography (GICS 1) and MRI. MRI examinations were performed in 21 (14.4%) patients; one of these patients (4.8%) had a malignant finding (GICS 0), two (9.5%) had risk-lesions (GICS 2 and 5). In the detection of neoplastic or risk lesions the sensitivity and specificity of galactography were 77.4% and 75.7% and of MRI 85.7% and 71.4%, consecutively. Conclusion The malignancy rate is negligible if clinical, mammography, ultrasound and galactography examinations are negative. Galactography remains a practical, valuable and cost-effective examination procedure. If galactography is technically unsuccessful, MRI should be considered as an additional ancillary tool to evaluate the possible etiology of symptoms, but the routine use of MRI in all patients cannot be justified.
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Affiliation(s)
- Aleksandr Istomin
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
- Department of Plastic Surgery, Surgical Division, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
| | - Amro Masarwah
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Marja Pitkänen
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Sarianna Joukainen
- Department of Plastic Surgery, Surgical Division, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Clinical Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mazen Sudah
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
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Lee SJ, Trikha S, Moy L, Baron P, diFlorio RM, Green ED, Heller SL, Holbrook AI, Lewin AA, Lourenco AP, Niell BL, Slanetz PJ, Stuckey AR, Vincoff NS, Weinstein SP, Yepes MM, Newell MS. ACR Appropriateness Criteria ® Evaluation of Nipple Discharge. J Am Coll Radiol 2018; 14:S138-S153. [PMID: 28473070 DOI: 10.1016/j.jacr.2017.01.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
Abstract
Appropriate imaging evaluation of nipple discharge depends the nature of the discharge. Imaging is not indicated for women with physiologic nipple discharge. For evaluation of pathologic nipple discharge, multiple breast imaging modalities are rated for evidence-based appropriateness under various scenarios. For women age 40 or older, mammography or digital breast tomosynthesis (DBT) should be the initial examination. Ultrasound is usually added as a complementary examination, with some exceptions. For women age 30 to 39, either mammogram or ultrasound may be used as the initial examination on the basis of institutional preference. For women age 30 or younger, ultrasound should be the initial examination, with mammography/DBT added when ultrasound shows suspicious findings or if the patient is predisposed to developing breast cancer. For men age 25 or older, mammography/DBT should be performed initially, with ultrasound added as indicated, given the high incidence of breast cancer in men with pathologic nipple discharge. Although MRI and ductography are not usually appropriate as initial examinations, each may be useful when the initial standard imaging evaluation is negative. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Su-Ju Lee
- Principal Author, University of Cincinnati Medical Center, Cincinnati, Ohio.
| | | | - Linda Moy
- Panel Vice-Chair, NYU Clinical Cancer Center, New York, New York
| | - Paul Baron
- Roper St. Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons
| | | | - Edward D Green
- The University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Alana A Lewin
- New York University School of Medicine, New York, New York
| | | | | | | | - Ashley R Stuckey
- Women and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists
| | - Nina S Vincoff
- Hofstra Northwell School of Medicine, Manhasset, New York
| | - Susan P Weinstein
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Mary S Newell
- Panel Chair, Emory University Hospital, Atlanta, Georgia
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Chatterjee A, Bhagat S, Saini ML, Verma S, Saini KS. Galactogram for Investigation of Pathological Nipple Discharge: A Forgotten Arrow in the Radiologists’ Quiver? Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_33_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractConventional X-ray galactogram (CG) is an underutilized procedure in modern breast imaging despite offering the highest spatial resolution among all modalities available for imaging of the breast ducts. The superior diagnostic performance of CG as compared to that of both conventional mammogram and high-resolution ultrasonography makes it a valuable imaging modality for the evaluation of pathological nipple discharge (PND). In addition, CG should always be considered in women with bloody nipple discharge but normal ultrasound and mammogram. CG also has an important role in the preoperative localization of intraductal lesions. CG may be especially useful in resource-restricted settings where breast magnetic resonance imaging is not readily available as it can be easily performed at any mammography facility without the need for additional equipment. In this article, we describe two cases of PND, one of benign and the other of malignant etiology, to demonstrate the value of CG in these cases. We also review the current literature and compare CG with other modalities used for imaging of ductal system of the breast.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Swapnil Bhagat
- Department of Radiodiagnosis, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Monika Lamba Saini
- Department of Anatomic Pathology, Cliniques Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sanjeev Verma
- Department of Medical Oncology, Quantum Health Analytics, SPRL, Liège, Belgium
| | - Kamal S Saini
- Department of Medical Oncology, Quantum Health Analytics, SPRL, Liège, Belgium
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10
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Zhang K, Wang YW, Ma R. Bioinformatics analysis of dysregulated microRNAs in the nipple discharge of patients with breast cancer. Oncol Lett 2017; 13:3100-3108. [PMID: 28521415 PMCID: PMC5431374 DOI: 10.3892/ol.2017.5801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/13/2017] [Indexed: 01/18/2023] Open
Abstract
MicroRNAs (miRNAs/miRs) have been reported to be associated with the tumorigenesis and progression of various types of human cancer; however, the underlying mechanisms of this association remain unclear. The aim of the present study was to explore the potential functions of miRNAs in the development of breast cancer using bioinformatics analysis, based on the miRNA expression profile in nipple discharge. A previous study demonstrated the upregulation of miR-3646 and miR-4484, and the downregulation of miR-4732-5p in the nipple discharge of patients with breast cancer, compared with patients with benign breast lesions. In the present study, the target genes of miR-3646, −4484 and −4732-5p were predicted using TargetScan and the MicroRNA Target Prediction and Functional Study Database. The predicted target genes were further analyzed by Gene Ontology term enrichment analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis and protein-protein interaction analysis. Numerous carcinoma-associated genes, including ADIPOQ, CPEB1, DNAJB4, EIF4E, APP and BCLAF1, were revealed to be putative targets of miR-3646, −4484 and −4732-5p. Bioinformatics analysis associated miR-3646 with the Rap1 and TGF-β signaling pathways, miR-4484 with the ErbB, estrogen and focal adhesion signaling pathways, and miR-4732-5p with the proteoglycan signaling pathway. Notably, protein-protein interaction analysis identified that numerous predicted targets of these miRNAs were associated with one other. In addition, the target genes of the miRNAs were identified to be under the regulation of a number of transcription factors (TFs). The predicted target genes of miR-3646, −4484 and −4732-5p were identified to serve a role in cancer-associated signaling pathways and TF-mRNA networks, indicating that they serve a role in breast carcinogenesis and progression. These results provide a comprehensive view of the functions and molecular mechanisms of miR-3646, −4484 and −4732-5p, and will aid in future studies.
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Affiliation(s)
- Kai Zhang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ya-Wen Wang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Rong Ma
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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CA153 in Breast Secretions as a Potential Molecular Marker for Diagnosing Breast Cancer: A Meta Analysis. PLoS One 2016; 11:e0163030. [PMID: 27636552 PMCID: PMC5026335 DOI: 10.1371/journal.pone.0163030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/01/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Many studies have reported that carbohydrate antigen 153 (CA153) in breast secretions (BS) can discriminate breast cancer (BC) patients from healthy individuals, indicating CA153 in BS as a potential index for BC. This meta-analysis aimed to evaluate the actual diagnostic value of CA153 in BS. METHODS Related papers were obtained from Pubmed, Embase, Scopus, Ovid, Sciverse, the Cochrane library, Chinese Biomedical literature Database (CBM), Technology of Chongqing (VIP), Wan Fang Data, and Chinese National Knowledge Infrastructure (CNKI). Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of CA153 in BS for BC diagnosis were analyzed with the random effect model. SROC and the area under the curve (AUC) were applied to assess overall diagnostic efficiency. RESULTS This meta-analysis included five studies with a total of 329 BC patients and 381 healthy subjects. For CA153 in BS, the summary sensitivity, specificity, and DOR to diagnose BC were 0.63 (95% confidence interval (CI): 0.57∼0.68), 0.82 (95% CI: 0.78∼0.86), and 9.18 (95% CI: 4.22∼19.95), respectively. Furthermore, the AUC of BS CA153 in the diagnosis of BC was 0.8614. CONCLUSIONS CA153 in BS is a valuable molecular marker in diagnosing BC and should be applied in standard clinical practices of BC screening upon confirmation of our findings in a larger prospective study.
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Wong Chung JERE, Jeuriens-van de Ven SAH, van Helmond N, Wauters CAP, Duijm LEM, Strobbe LJA. Does Nipple Discharge Color Predict (pre-) Malignant Breast Pathology? Breast J 2016; 22:202-8. [PMID: 26799061 DOI: 10.1111/tbj.12544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Unilateral single-duct nipple discharge is associated with an increased risk for underlying breast malignancy. There is no consensus whether color of nipple discharge independently indicates the risk of malignancy. We sought to assess the relationship between the color of discharge and the risk of malignancy. Patients with unilateral single-duct nipple discharge without abnormalities on clinical and radiologic examination were included. Prior to diagnostic microdochectomy nipple discharge characteristics were registered. Multiple logistic regressions were performed to assess the relationship between color of nipple discharge and malignancy, corrected for age. During a mean follow-up period of 7.1 years we determined complication rate and false-negative rate of microdochectomy. A total of 184 patients were included (median age 53 years, range 19-84). Histologic examination revealed (in situ or invasive) breast carcinoma in 10.9% (20) of patients and high-risk lesions in 11.4% (21). Malignancy or high-risk lesions were found in 25% (OR: 1.37; 95% CI: 0.62-3.00) of patients with bloody discharge. Risk of underlying malignancy increased in patients >60 years (OR: 2.35; 95% CI: 1.14-4.83). Complication rate of microdochectomy was 2.7%. Single-duct, unilateral nipple discharge is a sign of underlying malignancy in a substantial proportion of cases. The majority of patients with unilateral single-duct nipple discharge, diagnosed with breast cancer, present with bloody discharge. However, the association between bloody nipple discharge and malignancy is not strong enough to distinguish high-risk patients. Therefore, invasive diagnostic procedures like microdochectomy should be offered to all patients with unilateral uniductal nipple discharge to search for underlying malignancy.
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Affiliation(s)
| | | | - Noud van Helmond
- Faculty of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Carla A P Wauters
- Department of Clinical Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Ouldamer L, Kellal I, Legendre G, Ngô C, Chopier J, Body G. [Management of breast nipple discharge: Recommendations]. ACTA ACUST UNITED AC 2015; 44:927-37. [PMID: 26545854 DOI: 10.1016/j.jgyn.2015.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases. RESULTS Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C).
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Affiliation(s)
- L Ouldamer
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
| | - I Kellal
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Legendre
- CESP Inserm U1018, service de gynécologie obstétrique, CHU d'Angers, 49000 Angers, France
| | - C Ngô
- Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP, 15, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, Paris, France
| | - J Chopier
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
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Lippa N, Hurtevent-Labrot G, Ferron S, Boisserie-Lacroix M. Nipple discharge: The role of imaging. Diagn Interv Imaging 2015; 96:1017-32. [DOI: 10.1016/j.diii.2015.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022]
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Zhang K, Zhao S, Wang Q, Yang HS, Zhu J, Ma R. Identification of microRNAs in Nipple Discharge as Potential Diagnostic Biomarkers for Breast Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S536-44. [PMID: 25976861 DOI: 10.1245/s10434-015-4586-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intraductal breast cancer is generally difficult to diagnose because of a lack of an efficient method for detection. The purpose of this study was to reveal and validate the differential expression of microRNAs (miRNAs) in nipple discharge from intraductal papilloma patients and identify miRNAs as novel potential biomarkers for primary breast cancer. METHODS Nipple discharge samples were collected from three intraductal carcinoma breast cancer patients and three intraductal papilloma patients. The initial screening of miRNA expression was performed with an Axon GenePix 4000B microarray scanner using a novel approach to label miRNAs. The expression levels of the miRNAs selected from the initial screening were further examined by quantitative real-time polymerase chain reaction (qRT-PCR) in 21 validation samples (8 carcinomas and 13 benign tumors). An independent t test was used to detect significant correlations between the miRNA expression levels and breast cancer. RESULTS Microarray profiling demonstrated that three miRNAs were markedly up-regulated and three miRNAs were down-regulated in the intraductal carcinoma breast cancer patients compared to the papilloma group. The qRT-PCR analysis further verified that four miRNAs (miR-4484, miR-K12-5-5p, miR-3646, and miR-4732-5p) might serve as potential tumor biomarkers for breast cancer detection. CONCLUSION The novel approach of using a microarray scanner is applicable for studying biomarkers in nipple discharge containing small amounts of miRNA. miRNAs could serve as potential tumor biomarkers that can assist in breast cancer screening. Up-regulation of miR-4484, miR-K12-5-5p, and miR-3646 in nipple discharge may be a predictor of malignant breast cancer.
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Affiliation(s)
- Kai Zhang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Song Zhao
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qing Wang
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, USA
| | - Hsin-Sheng Yang
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, USA
| | - Jiang Zhu
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Rong Ma
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Patel BK, Falcon S, Drukteinis J. Management of nipple discharge and the associated imaging findings. Am J Med 2015; 128:353-60. [PMID: 25447625 DOI: 10.1016/j.amjmed.2014.09.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022]
Abstract
Nipple discharge is commonly encountered by health care providers, accounting for 2%-5% of medical visits by women. Because nipple discharge is the presenting symptom in 5% to 12% of breast cancers, it causes considerable anxiety for both patient and providers. Furthermore, the work-up and management of nipple discharge can be confusing. Fortunately, the cause of nipple discharge is usually benign, so the primary goal of evaluation and management is separation of patients with pathologic causes of discharge from those with benign or physiologic causes. The evaluation of nipple discharge requires a thorough history, careful physical examination, and an informed approach that selects the most suitable diagnostic modality. Primary care providers, working with their radiologists and surgeons, are well positioned to design appropriate diagnostic and management protocols to assess and treat nipple discharge. A thoughtful and prudent approach to nipple discharge should alleviate patient anxiety by efficiently and effectively defining the underlying etiology.
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Affiliation(s)
- Bhavika K Patel
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla; Department of Oncological Sciences, University of South Florida, Tampa.
| | - Shannon Falcon
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla; Department of Oncological Sciences, University of South Florida, Tampa
| | - Jennifer Drukteinis
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla; Department of Oncological Sciences, University of South Florida, Tampa
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Blum KS, Rubbert C, Antoch G, Mohrmann S, Obenauer S. Diagnostic accuracy of abnormal galactographic and sonographic findings in the diagnosis of intraductal pathology in patients with abnormal nipple discharge. Clin Imaging 2015; 39:587-91. [PMID: 25778387 DOI: 10.1016/j.clinimag.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/26/2015] [Accepted: 03/01/2015] [Indexed: 11/25/2022]
Abstract
The purpose of the study was to compare the diagnostic accuracy of the combination of galactography and ultrasound in patients with pathologic nipple discharge. Fifty-six patients with pathologic nipple discharge were included in the study. Sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for each method and the combination of both were calculated. Both methods together had a sensitivity, specificity, PPV, and NPV of 91%, 17%, 61%, and 57%. The combined sensitivity of galactography and ultrasound for intraductal pathologies is higher than either modality alone, with a low specificity. No specific signs exist to predict benign or malignant lesions.
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Affiliation(s)
- Katrin S Blum
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany.
| | - Christian Rubbert
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
| | - Gerald Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
| | - Svjetlana Mohrmann
- University Dusseldorf, Medical Faculty, Department of Gynecology, Dusseldorf, Germany
| | - Silvia Obenauer
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
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Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography. BIOMED RESEARCH INTERNATIONAL 2015; 2015:806368. [PMID: 25685810 PMCID: PMC4317598 DOI: 10.1155/2015/806368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Abstract
Purpose. Assessing the role of breast MRI compared to galactography in patients with unilateral bloody or serous-bloody nipple discharge. Materials and Methods. Retrospective study including 53 unilateral discharge patients who performed galactography and MRI. We evaluated the capability of both techniques in identifying pathology and distinguishing between nonmalignant and malignant lesions. Lesions BIRADS 1/2 underwent follow-up, while the histological examination after surgery has been the gold standard to assess pathology in lesions BIRADS 3/4/5. The ROC analysis was used to test diagnostic MRI and galactography ability. Results. After surgery and follow-up, 8 patients had no disease (15%), 23 papilloma (43%), 11 papillomatosis (21%), 5 ductal cancer in situ (10%), and 6 papillary carcinoma (11%) diagnoses. Both techniques presented 100% specificity; MRI sensitivity was 98% versus 49% of galactography. Considering MRI, we found a statistical association between mass enhancement and papilloma (P < 0.001; AUC 0.957; CI 0.888–1.025), ductal enhancement and papillomatosis (P < 0.001; AUC 0.790; CI 0.623–0.958), segmental enhancement and ductal cancer in situ (P = 0.007; AUC 0.750; CI 0.429–1.071), and linear enhancement and papillary cancer (P = 0.011). Conclusions. MRI is a valid tool to detect ductal pathologies in patients with suspicious bloody or serous-bloody discharge showing higher sensitivity and specificity compared to galactography.
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Boin DP, Baez JJ, Guajardo MP, Benavides DO, Ortega MEN, Valdés DR, Apphun MC. Breast papillary lesions: an analysis of 70 cases. Ecancermedicalscience 2014; 8:461. [PMID: 25228917 PMCID: PMC4162680 DOI: 10.3332/ecancer.2014.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Papillary breast lesions are rare and constitute less than 10% of benign breast lesions and less than 1% of breast carcinomas. Objective To analyse the clinical presentation, preoperative evaluation, and surgical and anatomopathological characteristics of the patients operated on for papillary breast lesions. Material and Methods Retrospective descriptive and analytical study. We analysed the database of patients with definitive histopathological diagnosis of papillary breast lesions operated on at our institution from January 2004 to May 2013. Results During the period described, 70 patients with histopathological diagnosis of papillary breast lesions were operated upon. The median age was 50 years (19–86 years). Thirty-seven patients (52.8%) were symptomatic at diagnosis. Preoperative ultrasound was reported to be altered in all patients. A mammography showed pathologic findings in only 50% of cases. All patients underwent partial mastectomy, after needle localisation under ultrasound, if the lesion was not palpable on physical examination. The final pathological diagnosis was: benign papillary lesion in 55 patients (78.6%) and malignant in 15 patients (21.4%). Adjuvant treatment was performed in all malignant cases. Median follow-up was 46 months (3–115 months). Conclusions Patients with papillary breast lesions presented with symptoms in half of all cases. There was a high frequency of malignancy (21.4%), therefore surgical resection was recommended for papillary breast lesions.
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Affiliation(s)
- Dahiana Pulgar Boin
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Jaime Jans Baez
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Militza Petric Guajardo
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - David Oddo Benavides
- Department of Pathologic Anatomy, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Maria Elena Navarro Ortega
- Department of Radiology, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Dravna Razmilic Valdés
- Department of Radiology, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Mauricio Camus Apphun
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
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20
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Jeong BY, Kim DB, Kwak BS. Microdochectomy assisted by ultrasound-guided indigo carmine staining of intraductal lesions: a case report. J Breast Cancer 2014; 17:184-7. [PMID: 25013442 PMCID: PMC4090323 DOI: 10.4048/jbc.2014.17.2.184] [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: 09/27/2013] [Accepted: 03/27/2014] [Indexed: 11/30/2022] Open
Abstract
Spontaneous bloody nipple discharge from a single duct is a significant clinical problem. When performing preoperative marking of the discharging duct, it is sometimes difficult to identify the duct owing to intermittent discharge. Precise preoperative marking of the discharging duct and intraductal lesions is very important to avoid unnecessary wide excision of breast tissue or failure to remove the cause of nipple discharge. We herein present a case of preoperative ultrasound-guided indigo carmine staining in a patient with no discharge on the day of surgery. When a dilated duct is visualized on ultrasound, the targeted duct can be localized using indigo carmine staining, and it is possible to perform a precise minimal volume microdochectomy.
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Affiliation(s)
- Bo Young Jeong
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Dae Bong Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Beom Seok Kwak
- Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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21
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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.
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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
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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.
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Affiliation(s)
| | | | | | - Joaquín Sola-Pérez
- Department of Patology, Virgen de la Arrixaca University Hospital, El Palmar (Murcia), Spain
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Bakic PR, Zhang C, Maidment ADA. Development and characterization of an anthropomorphic breast software phantom based upon region-growing algorithm. Med Phys 2011; 38:3165-76. [PMID: 21815391 DOI: 10.1118/1.3590357] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE We present a novel algorithm for computer simulation of breast anatomy for generation of anthropomorphic software breast phantoms. A realistic breast simulation is necessary for preclinical validation of volumetric imaging modalities. METHODS The anthropomorphic software breast phantom simulates the skin, regions of adipose and fibroglandular tissue, and the matrix of Cooper's ligaments and adipose compartments. The adipose compartments are simulated using a seeded region-growing algorithm; compartments are grown from a set of seed points with specific orientation and growing speed. The resulting adipose compartments vary in shape and size similar to real breasts; the adipose region has a compact coverage by adipose compartments of various sizes, while the fibroglandular region has fewer, more widely separated adipose compartments. Simulation parameters can be selected to cover the breadth of variations in breast anatomy observed clinically. RESULTS When simulating breasts of the same glandularity with different numbers of adipose compartments, the average compartment volume was proportional to the phantom size and inversely proportional to the number of simulated compartments. The use of the software phantom in clinical image simulation is illustrated by synthetic digital breast tomosynthesis images of the phantom. The proposed phantom design was capable of simulating breasts of different size, glandularity, and adipose compartment distribution. The region-growing approach allowed us to simulate adipose compartments with various size and shape. Qualitatively, simulated x-ray projections of the phantoms, generated using the proposed algorithm, have a more realistic appearance compared to previous versions of the phantom. CONCLUSIONS A new algorithm for computer simulation of breast anatomy has been proposed that improved the realism of the anthropomorphic software breast phantom.
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Affiliation(s)
- Predrag R Bakic
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Mátrai Z, Tóth L, Bidlek M, Szabó É, Farkas E, Sávolt Á, Góbor L, Bartal A, Kásler M. [The role of ductoscopy in the modern diagnostics and therapy of breast diseases]. Orv Hetil 2011; 152:1284-93. [PMID: 21803726 DOI: 10.1556/oh.2011.29163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mammary ductoscopy is a modern, minimally invasive procedure that enables direct, in vivo observation of the mammary ductal system, primarily by nipple discharge. The rapidly developing device is suitable for aimed biopsy for further cytological or molecular examinations. High-tech equipments facilitate polypectomy or laser vaporization of certain intraluminal lesions, and play an important role in the direct surgical excision of the duct or the so-called terminal duct-lobular unit. The above listed facilitate the early diagnosis of malignancies even before imaging could detect them, and the control of high risk patients. Ductoscopy can foster surgical removal of ductal in situ tumors as anatomical units, thus enabling the optimization of radicality of breast conserving surgeries. Authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in the Hungarian language. Orv. Hetil., 2011, 152, 1284-1293.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Általános és Mellkassebészeti Osztály, Budapest, Ráth Gy. u. 7-9. 1122.
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Does direct MR galactography have the potential to become an alternative diagnostic tool in patients with pathological nipple discharge? Clin Imaging 2011; 35:85-93. [PMID: 21377045 DOI: 10.1016/j.clinimag.2010.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 02/01/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare direct magnetic resonance galactography (dMRG) and conventional galactography (CGal). MATERIALS AND METHODS Thirty women underwent CGal and dMRG. Duct localization and the depth of the assumed underlying pathology in CGal and dMRG were analyzed. RESULTS Comparing CGal and dMRG, there was no significant difference regarding sector localization, but for depth of pathology (P=.023). CONCLUSION Duct localization with dMRG was possible with the same reliability as with CGal. Thus, dMRG may have the potential to become an alternative method to CGal.
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Leung JWT. MR imaging in the evaluation of equivocal clinical and imaging findings of the breast. Magn Reson Imaging Clin N Am 2010; 18:295-308, ix-x. [PMID: 20494313 DOI: 10.1016/j.mric.2010.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of its high negative predictive value in excluding breast cancer, magnetic resonance (MR) imaging plays a role in the evaluation of selected clinical and imaging findings of the breast, especially when biopsy is not technically feasible. Case selection is very important in ensuring the efficacy of this use of MR imaging because of potential false-positive and (albeit less likely) false-negative results. This article examines the clinical scenarios and imaging findings in which MR imaging is contributory to patient management after conventional workup with equivocal results.
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Affiliation(s)
- Jessica W T Leung
- Breast Health Center, California Pacific Medical Center, 3698 California Street, 2nd Floor, San Francisco, CA 94118, USA.
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Morrogh M, Park A, Elkin EB, King TA. Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg 2010; 200:73-80. [DOI: 10.1016/j.amjsurg.2009.06.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 10/19/2022]
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Ginat DT, Sahler LG, Siddall KA. External herniation of a subareolar intraductal papilloma: a rare, yet beneficial, complication of conventional ductography. Clin Radiol 2009; 64:1238-40. [PMID: 19913136 DOI: 10.1016/j.crad.2009.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 07/07/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Affiliation(s)
- D T Ginat
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642-8648, USA.
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Hsu HH, Yu JC, Hsu GC, Chang WC, Yu CP, Tung HJ, Tzao C, Huang GS. Ultrasonographic alterations associated with the dilatation of mammary ducts: feature analysis and BI-RADS assessment. Eur Radiol 2009; 20:293-302. [DOI: 10.1007/s00330-009-1546-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/15/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
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Reiner CS, Helbich TH, Rudas M, Ponhold L, Riedl CC, Kropf N, Fuchsjäger MH. Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy? Eur Radiol 2009; 19:2878-85. [PMID: 19565246 DOI: 10.1007/s00330-009-1502-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 05/17/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine the value of galactography-guided, stereotactic, vacuum-assisted breast biopsy (VABB) for the assessment of intraductal breast lesions and its potential as a therapeutic tool that could eliminate the need for surgical excision. Eighteen patients (median age 64 years, range 37-80) with nipple discharge and galactography-verified intraductal lesions underwent galactography-guided, stereotactic, 11-gauge VABB followed by surgery. Histopathology findings from VABB and subsequent surgery were compared. Underestimation and false-negative rates were assessed. After VABB, histopathology revealed invasive ductal carcinoma (IDC) in three (17%), ductal carcinoma in situ (DCIS) in six (33%), high-risk lesions in six (33%) and benign lesions in three (17%) cases. After surgical biopsy, histopathology confirmed the previously established diagnosis in 11 lesions (61%). The underestimation rate for high-risk lesions and DCIS was 50% (6/12). The false-negative rate was 7% (1/14). Histopathology examination after surgery showed that not a single lesion had been completely removed at VABB. Galactography-guided VABB is a feasible diagnostic tool. However, its value as a therapeutic procedure is limited because of the high number of underestimated and missed lesions and because of the histopathological detection of lesions' remnants in every case. Surgical excision should be the therapeutic gold standard in cases of pathological nipple discharge and galactography abnormalities.
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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.
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Yücesoy C, Oztürk E, Ozer Y, Edgüer T, Hekimoglu B. Conventional galactography and MR contrast galactography for diagnosing nipple discharge: preliminary results. Korean J Radiol 2009; 9:426-31. [PMID: 18838852 PMCID: PMC2627215 DOI: 10.3348/kjr.2008.9.5.426] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to compare the clinical usefulness of conventional galactography and MR contrast galactography for diagnosing patients with nipple discharge. Materials and Methods Both conventional galactography and MR contrast galactography were performed prospectively in 16 patients. Gadopentate dimeglumine (0.1 ml) was mixed with non-ionic contrast medium (0.9 ml) to obtain a resultant volume of 1 ml and this was used for both examinations. Following conventional galactography, MR contrast galactography was performed after direct injection of contrast media into the duct. Results Conventional galactography and MR contrast galactography were concordant in 13 (81%) of 16 patients; the results were normal in five, ductal dilatation was noted in four and intraductal filling defects were noted in four. The remaining three (19%) patients demonstrated discordant findings on the two examinations. While conventional galactography revealed filling defects, the MR contrast galactography results were normal in two patients. The third patient had kinks-stricture on conventional galactography and MR contrast galactography showed ductal dilatation. This suggested there were false positive results for the three patients' conventional galactography, and all the three patients with discordant results underwent surgery and the histopathologic evaluation showed fibrocystic changes. Conclusion MR contrast galactography may be used as an alternative imaging modality for making the diagnosis of pathologic nipple discharge. However, statistically supported studies with large pools of subjects for comparing the galactography and MR contrast galactography results are needed to confirm our findings.
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Affiliation(s)
- Cüneyt Yücesoy
- Department of Radiology, S.B. Ankara Diskapi Training and Research Hospital, Ankara, Turkey.
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Kim SH, Cha ES, Kim HS, Kang BJ, Choi JJ, Jung JH. Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis. Arch Gynecol Obstet 2008; 280:217-22. [PMID: 19115063 DOI: 10.1007/s00404-008-0897-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 12/09/2008] [Indexed: 11/24/2022]
Affiliation(s)
- Sung Hun Kim
- Department of Radiology, Kang-Nam St Mary's Hospital, Catholic University of Medical College, Seoul, South Korea
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Kapenhas-Valdes E, Feldman SM, Boolbol SK. The Role of Mammary Ductoscopy in Breast Cancer: a Review of the Literature. Ann Surg Oncol 2008; 15:3350-60. [DOI: 10.1245/s10434-008-9911-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 02/15/2008] [Accepted: 02/17/2008] [Indexed: 11/18/2022]
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Schwab SA, Uder M, Schulz-Wendtland R, Bautz WA, Janka R, Wenkel E. Direct MR Galactography: Feasibility Study. Radiology 2008; 249:54-61. [DOI: 10.1148/radiol.2483071515] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ballesio L, Maggi C, Savelli S, Angeletti M, De Felice C, Meggiorini ML, Manganaro L, Porfiri LM. Role of breast Magnetic Resonance Imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol Med 2008; 113:249-64. [DOI: 10.1007/s11547-008-0245-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 04/11/2007] [Indexed: 11/29/2022]
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Hirose M, Nobusawa H, Gokan T. MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics 2008; 27 Suppl 1:S183-96. [PMID: 18180226 DOI: 10.1148/rg.27si075501] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nipple discharge is a common symptom that mostly results from benign conditions. The most significant cause is carcinoma, which accounts for 1%-45% of cases. Therefore, identification of intraductal lesions is important. Conventional ductography, the recommended method of identifying lesions, is invasive and has inherent limitations. Magnetic resonance (MR) ductography is performed with heavily T2-weighted sequences; it is noninvasive and requires neither radiation nor contrast media. Like conventional ductography, MR ductography shows the dilated ducts as tubular structures with high signal intensity. Intraductal lesions appear as a signal defect, duct wall irregularity, or ductal obstruction. No specific conventional ductographic or MR ductographic finding allows differentiation between benign and malignant disease, and neither technique can demonstrate the extent of disease. MR mammography with intravenous injection of contrast material reveals the extent of disease, and a dynamic study may help distinguish between malignant and benign lesions. Fusion imaging with MR ductography and MR mammography demonstrates not only the presence of an intraductal abnormality but also the extent of the lesion on one image, thus clearly showing the relationship between the dilated duct and the intraductal lesion.
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Affiliation(s)
- Masanori Hirose
- Department of Radiology, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666 Tokyo, Japan.
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Gray RJ, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg 2007; 194:850-4; discussion 854-5. [DOI: 10.1016/j.amjsurg.2007.08.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 11/25/2022]
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Abstract
Magnetic resonance (MR) imaging is emerging as the most sensitive modality that is currently available for the detection of primary or recurrent breast cancer. Although this technique has been shown to be an extremely powerful diagnostic tool, it is still relatively rarely used in clinical practice, as compared with other applications of MR imaging such as for musculoskeletal or brain and spine imaging. This is the second of a two-part series on the current status of breast MR. Part two provides an overview of the use of breast MR imaging in clinical patient care, the body of evidence that supports its use. A discussion is provided on the many controversies that exist regarding breast MR imaging for preoperative staging and for screening.
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Affiliation(s)
- Christiane K Kuhl
- Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany.
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41
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Rissanen T, Reinikainen H, Apaja-Sarkkinen M. Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1031-9. [PMID: 17646365 DOI: 10.7863/jum.2007.26.8.1031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate breast sonography in localizing abnormalities in the discharging duct in patients with spontaneous nipple discharge. METHODS Fifty-two patients with unilateral bloody or serous nipple discharge and normal findings on palpation and mammography underwent breast sonography before surgical duct excision. The results of sonography were compared with the findings of galactography and histologic examination of the surgical specimen. RESULTS The final diagnosis was benign in 47 cases (90%) and malignant in 5 cases (10%). Sonography visualized an echogenic intraductal tumor in 36 (69%) of 52 cases, dilated duct(s) without an intraductal tumor in 6 cases (12%), and no abnormality in 10 cases (19%). Eighty percent of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive. The abnormal duct was surgically removed after methylene blue staining in 38 cases, after sonographically guided wire localization in 11 cases, after both wire localization and methylene blue staining in 1 case, and with review of the diagnostic galactographic images in 2 cases. CONCLUSIONS Sonography was found to be a valuable method for localizing intraductal abnormalities, especially papillomatous lesions, in patients with nipple discharge with no other clinical or radiologic findings. Preoperative sonographically guided wire localization can be used successfully instead of conventional methylene blue staining in cases with problems in cannulation of the discharging duct. Galactography remains the primary diagnostic method, especially in depicting malignant causes of nipple discharge, which may be seen only as duct dilatation on sonography.
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Affiliation(s)
- Tarja Rissanen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Murphy IG, Dillon MF, Doherty AO, McDermott EW, Kelly G, O'Higgins N, Hill AD. Analysis of patients with false negative mammography and symptomatic breast carcinoma. J Surg Oncol 2007; 96:457-63. [DOI: 10.1002/jso.20801] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dillon MF, Mohd Nazri SR, Nasir S, McDermott EW, Evoy D, Crotty TB, O'Higgins N, Hill ADK. The role of major duct excision and microdochectomy in the detection of breast carcinoma. BMC Cancer 2006; 6:164. [PMID: 16796740 PMCID: PMC1539014 DOI: 10.1186/1471-2407-6-164] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2006] [Accepted: 06/23/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association of nipple discharge with breast carcinoma has resulted in numerous women undergoing exploratory surgery to exclude malignancy. The aim of this study was to determine whether pre-operative factors can identify those patients that are most at risk of carcinoma. METHODS All patients over a 14-year period (1991-2005) who had a microdochectomy or subareolar exploration for the evaluation of nipple discharge were assessed. Patient characteristics, pre-operative imaging and pathological findings were analysed. RESULTS Of the 211 patients included in this study, 116 patients had pathological (unilateral, uniductal serous or bloody) discharge. On excision, 6% (n = 7) of patients with pathological discharge and 2.4% (n = 2) of patients with non-pathological discharge were diagnosed with carcinoma. Overall, major duct excision resulted in the diagnosis of carcinoma in 4.3% (n = 9), ADH/LCIS in 4% (n = 8), papilloma in 39% (n = 83), and duct ectasia or non-specific benign disease in 53% (n = 111) of patients. In the patients determined to have malignancy, 44% (n = 4) were premenopausal. No patient with a non-bloody discharge in the total population analysed (28%; n = 59/211), or in the population with a pathological discharge (21%; n = 24/116) was found to have carcinoma upon excision. CONCLUSION Microdochectomy or major duct excision performed for nipple discharge resulted in a low rate of malignancy on excision. Conservative management of non-bloody nipple discharge can be considered in patients with no other clinical or radiological signs of malignancy.
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Affiliation(s)
- Mary F Dillon
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- Department of Surgery, University College Dublin, Dublin 4, Ireland
| | - Shah R Mohd Nazri
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Shaaira Nasir
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Enda W McDermott
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- Department of Surgery, University College Dublin, Dublin 4, Ireland
| | - Denis Evoy
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Thomas B Crotty
- Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Niall O'Higgins
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- Department of Surgery, University College Dublin, Dublin 4, Ireland
| | - Arnold DK Hill
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- Department of Surgery, University College Dublin, Dublin 4, Ireland
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Hirose M, Otsuki N, Hayano D, Shinjo H, Gokan T, Kashiwase T, Suzuki K, Sawada T. Multi-volume Fusion Imaging of MR Ductography and MR Mammography for Patients with Nipple Discharge. Magn Reson Med Sci 2006; 5:105-12. [PMID: 17008767 DOI: 10.2463/mrms.5.105] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Because nipple discharge is caused by carcinoma as well as benign disease, identification of intraductal abnormalities with ductography is important. Ductography is an invasive mammographic examination in which contrast material is injected directly into the duct. Failure to cannulate or extravasation may occur. Ductography shows evidence of lesions, such as filling defects, duct obstruction, or wall irregularity, but it does not reveal the lesion itself. Furthermore, ductography produces a two-dimensional image, so it does not show the shape of the dilated duct or the precise location of the intraductal lesion in the breast. We applied three-dimensional (3D) heavily T2-weighted imaging with fat suppression of the breast to produce MR ductography. The dilated ducts are seen in 3D as tubular structures with high signal, and intraductal abnormalities are seen as signal defects. Furthermore, MR ductography can show an obstructed duct that cannot be seen on ductography. We also performed 3D breast MRI with the intravenous infusion of contrast material to show the lesion itself. Finally, we fused these 2 volume images into a single 3D fused image that not only shows the existence of intraductal abnormality, but reveals the shape, size, and extent of lesion, allowing us to understand easily the relationship between the ducts with dilation and any intraductal lesions in the breast. We herein introduce and describe this noninvasive method and discuss various factors related to its diagnostic use.
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Affiliation(s)
- Masanori Hirose
- Department of Radiology, School of Medicine, Showa University, Japan.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, AZ 85259, USA.
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Adepoju LJ, Chun J, El-Tamer M, Ditkoff BA, Schnabel F, Joseph KA. The value of clinical characteristics and breast-imaging studies in predicting a histopathologic diagnosis of cancer or high-risk lesion in patients with spontaneous nipple discharge. Am J Surg 2005; 190:644-6. [PMID: 16164940 DOI: 10.1016/j.amjsurg.2005.06.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 06/16/2005] [Accepted: 06/16/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to determine the utility of breast-imaging studies in identifying cancer and high-risk lesions among patients with spontaneous, single-duct, nipple discharge (SSND). METHODS The medical records of 168 cases with SSND treated with duct excision between June 1998 and May 2004 were reviewed. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mammogram, ultrasound, and ductogram in predicting high-risk lesions and cancer were calculated. RESULTS The sensitivity of mammography was 10%, the specificity 94%, the NPV 88%, and the PPV 18%. Ultrasonography had a sensitivity of 36%, specificity of 68%, PPV of 14%, and NPV of 89%. Ductography had a sensitivity of 75%, specificity of 49%, and NPV and PPV of 93% and 18%, respectively. CONCLUSIONS Conventional imaging studies do not accurately identify cancer or high-risk lesions in patients with SSND. All patients with SSND should be offered duct excision.
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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
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Abstract
This article reviews abnormal mammographic findings that do not meet the BIRADS description of masses or clusters of microcalcifications: abnormalities visible on a single view, asymmetrical densities and unusual patterns (transparent appearances, ductal patterns and diffuse abnormalities). It is important for radiologists to become familiar with unusual mammographic manifestations of malignant lesions to avoid misdiagnosis. Correlation with clinical abnormalities, optimal mammographic technique and comparison with previous films are useful and important for accurate interpretation of these difficult and/or unusual cases. Ultrasound, MRI and percutaneous biopsy are also useful in selected cases.
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Affiliation(s)
- J Stines
- Service de Radiodiagnostic, Centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy Cedex
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49
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Le cancer du sein : les images orphelines. IMAGERIE DE LA FEMME 2004. [DOI: 10.1016/s1776-9817(04)94789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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50
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Nakahara H, Namba K, Watanabe R, Furusawa H, Matsu T, Akiyama F, Sakamoto G, Tamura S. A comparison of mr imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer 2003; 10:320-9. [PMID: 14634510 DOI: 10.1007/bf02967652] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study is to assess the usefulness of three-dimensional contrast-enhanced magnetic resonance (MR) imaging, compared with galactography and ultrasonography(US). METHODS Fifty-five patients with bloody nipple discharge were investigated retrospectively. All patients were examined by galactography, ultrasonography and MR imaging. These three sets of findings were compared with the histopathological results from 16 intraductal biopsies, 3 excisional biopsies, 24 microdochectomies and 12 mastectomies. RESULTS Contrast enhanced MR imaging demonstrated all malignant lesions including ductal carcinoma in situ (DCIS). Four cases of DCIS were not visualized by ultrasonography and three malignant lesions were missed by galactography. In the MR study, segmental clumped enhancement (positive predictive value =100 %), and focal mass with smooth border (negative predictive value =87.5 %) were the statistically significant predictive factors. CONCLUSIONS Among the three modalities, contrast-enhanced three-dimensional MR imaging demonstrated the location and distribution of the lesions most clearly, especially in cases of ductal carcinoma in situ. It has the potential to be a useful diagnostic tool for patients with nipple discharge.
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Affiliation(s)
- Hiroshi Nakahara
- Department of Radiology, Miyazaki Medical College, 5200 Ohaza Kihara, Kiyotake, Miyazaki 889-1692, Japan
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