DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge

Marco Moschetta,Amato Antonio Stabile Ianora,Angelica Drago,Nicoletta Troiano,Vincenzo De Ruvo,Giuseppe Rubini,Michele Telegrafo,Simona Paolicelli

doi:10.1186/s41747-020-00170-5

Marco Moschetta, Amato Antonio Stabile Ianora + Show 6 more

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https://doi.org/10.1186/s41747-020-00170-5

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Abstract

BackgroundOur 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.MethodsForty-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.ResultsSensitivity 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.ConclusionDBT-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.

Highlights

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
The most common causes of pathologic nipple discharge consist in benign lesions, such as intraductal papilloma and papillomatosis occurring in 48% of cases, ductal ectasia in 15–20% or malignant lesions, such as papillary carcinoma, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma with a high variable rate ranging from 1 to 45% of patients [3,4,5]
The aim of our study was to evaluate the diagnostic value of DBT-galactography for detecting intraductal breast lesion in the clinical setting of pathological nipple discharge and to compare its performance with that of FFD-galactography, having the histological findings as a reference standard

Summary

Introduction

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. Nipple discharge represents the third most common breast complaint after pain and lump, with a reported. Most nipple discharges are benign or not associated with an underlying breast disease [1,2,3]. The most common causes of pathologic nipple discharge consist in benign lesions, such as intraductal papilloma and papillomatosis occurring in 48% of cases, ductal ectasia in 15–20% or malignant lesions, such as papillary carcinoma, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma with a high variable rate ranging from 1 to 45% of patients [3,4,5]. Ultrasonography of papillary lesions typically shows a solid, oval, intra-ductal mass, often associated with duct dilatation. A cystic component is commonly seen [1, 8, 9]

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