Performance of Breast MRI with MR Ductography in Evaluation of Pathologic Nipple Discharge
Chayakulkheeree J, MD¹, Likitkumchorn N, MD¹
Affiliation : ¹ Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Objective: To determine diagnostic value of contrast-enhanced breast magnetic resonance imaging (CE-breast MRI) with magnetic
resonance (MR) ductography in evaluation of patients with pathologic nipple discharge focusing on sensitivities, specificities,
positive predictive value (PPV), and negative predictive value (NPV) for malignant detection.
Materials and Methods: The present study retrospectively reviewed 66 Asian patients with pathologic nipple discharge who underwent CE-breast MRI with MR ductography between 2011 and 2017. Comparison between imaging findings and gold standards, pathological diagnosis, and clinically or radiographic 2-year follow-up data were performed. Sensitivities, specificities, PPV, and NPV were evaluated. The AUC was achieved to assess the performance of each modality.
Results: Over seven years, 66 patients underwent CE-breast MRI with MR ductography for evaluation of pathologic nipple discharge. All 13 malignancies were detected by MRI. Two patients (15%) showing occult malignant lesions on mammogram and ultrasound were diagnosed by MRI. MRI showed 100% sensitivity and 100% NPV, suggesting the ability to rule out malignant lesion. The specificity and PPV were 38% and 28%, respectively.
Conclusion: CE-breast MRI with MR ductography is a useful and less-invasive tool for the evaluation of patients with pathologic nipple discharge because of its high performance in detection of malignancy by means of high sensitivity (100%), high NPV (100%), and fair specificity (38%). It is especially useful in cases of pathologic nipple discharge with negative conventional imaging. However, overestimation was found in papillomas or inflammation, benign lesions that mimic malignancy due to vivid enhancement.
Received 25 Jun 2019 | Revised 4 Oct 2019 | Accepted 17 Oct 2019
Keywords : Breast MRI, MR ductography, Nipple discharge, Ductography
