Diagnostic accuracy of breast MRI for patients with suspicious nipple discharge and negative mammography and ultrasound: a prospective study

OBJECTIVES

To evaluate the diagnostic accuracy of breast MRI in identifying lesions requiring excision for patients with suspicious nipple discharge but normal mammograms and ultrasounds.

METHODS

Between September 2013 and May 2019, 106 female participants (mean age 57.9 years) were consecutively included in this prospective multicenter study; 102 were retained for analysis. MRI was considered negative in the absence of suspicious enhancement and positive in cases of ipsilateral abnormal enhancement (BI-RADS 3 to 5). Final diagnoses were based on histological findings of surgical or percutaneous biopsies or at 1-year follow-up. We considered all lesions requiring excision found on pathology (papilloma, atypia, nipple adenomatosis, or cancer) as positive results. We considered spontaneous resolution of the discharge at 1 year as a negative result.

RESULTS

MRI showed ipsilateral abnormal enhancement in 54 patients (53%) revealing 46 lesions requiring excision (31 benign papillomas, 5 papillomas with atypia, 2 nipple adenomatosis, and 8 cancers) and 8 benign lesions not requiring excision. No suspicious enhancement was found in the remaining 48 participants (47%). Forty-two were followed up at 1 year with spontaneous resolution of the discharge and six underwent surgery (revealing 2 benign papillomas). MRI diagnostic accuracy for the detection of a lesion requiring excision was as follows: sensitivity 96%, specificity 85%, positive predictive value 85%, and negative predictive value 96%.

CONCLUSION

In patients with suspicious nipple discharge and normal mammogram and ultrasound, MRI demonstrates excellent performance to identify lesions for which excision is required. Normal MRI indicates it is safe to propose follow-up only management, thus avoiding unnecessary duct excision.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02819362 KEY POINTS: • Breast MRI can be useful for the management of patients with suspicious nipple discharge and negative mammogram and ultrasound. • MRI detected a lesion requiring excision in 46 participants (45%) with unexplained discharge. • If breast MRI is negative, follow-up is a safe alternative for these patients.

Peer review practices by medical imaging journals

OBJECTIVE

To investigate peer review practices by medical imaging journals.

METHODS

Journals in the category "radiology, nuclear medicine and medical imaging" of the 2018 Journal Citation Reports were included.

RESULTS

Of 119 included journals, 62 (52.1%) used single-blinded peer review, 49 (41.2%) used double-blinded peer review, two (1.7%) used open peer review and one (0.8%) used both single-blinded and double-blinded peer reviews, while the peer review model of five journals (4.2%) remained unclear. The use of single-blinded peer review was significantly associated with a journal's impact factor (correlation coefficient of 0.218, P = 0.022). On subgroup analysis, only subspecialty medical imaging journals had a significant association between the use of single-blinded peer review and a journal's impact factor (correlation coefficient of 0.354, P = 0.025). Forty-eight journals (40.3%) had a reviewer preference option, 48 journals (40.3%) did not have a reviewer recommendation option, and 23 journals (19.3%) obliged authors to indicate reviewers on their manuscript submission systems. Sixty-four journals (53.8%) did not provide an explicit option on their manuscript submission Web site to indicate nonpreferred reviewers, whereas 55 (46.2%) did. There were no significant associations between the option or obligation to indicate preferred or nonpreferred reviewers and a journal's impact factor.

CONCLUSION

Single-blinded peer review and the option or obligation to indicate preferred or nonpreferred reviewers are frequently employed by medical imaging journals. Single-blinded review is (weakly) associated with a higher impact factor, also for subspecialty journals. The option or obligation to indicate preferred or nonpreferred reviewers is evenly distributed among journals, regardless of impact factor.