MRI for assessment of pathologic nipple discharge: is it mandatory?

Mona M Zaky,Ali H Elmokadem,Asmaa Hafez,Nermin Y Soliman,Marwa M Zaky,Ashraf Shoma

doi:10.1186/s43055-019-0105-9

Mona M Zaky, Ali H Elmokadem + Show 4 more

Open Access

https://doi.org/10.1186/s43055-019-0105-9

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Abstract

BackgroundBenign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. Ninety-three patients with pathologic nipple discharge were evaluated by sonomammography and DCE-MRI. Sonomammography and MR imaging features were analyzed and correlated with the histopathology.ResultsHistopathology revealed 69 benign, three high-risk, and 21 malignant lesions. Simply dilated ducts and presence of a mass on US examination as well as non-mass enhancement and STIR signal changes on MRI were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value = 0.017 and 0.001) and (p value ≤ 0.001). Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%,negative predictive value of 86.7%, and accuracy of 58.1%. MRI gave higher sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%.ConclusionMagnetic resonance imaging is superior to sonommagraphy in diagnosis of pathologic nipple discharge and we recommend it in special situations.

Highlights

Benign breast lesions is the most common cause of nipple discharge; a rare but major cause is breast cancer
Benign conditions such as papilloma or ductal ectasia are the commonest causes of most unilateral bloody nipple discharge
A rare but major cause of spontaneous pathologic nipple discharge (SPND) is breast cancer which accounts for 7–33% of the cases [2]

Summary

Introduction

Benign breast lesions is the most common cause of nipple discharge; a rare but major cause is breast cancer. A clear or bloody discharge is of major significance due to its higher association with breast masses [1]. Benign conditions such as papilloma or ductal ectasia are the commonest causes of most unilateral bloody nipple discharge. A rare but major cause of spontaneous pathologic nipple discharge (SPND) is breast cancer which accounts for 7–33% of the cases [2]. Mammography is of limited use in cases of bloody nipple discharge, as it is often negative and fails to suggest the causative lesion. Not always microcalcifications associate the underlying process and sometimes masses are so small, so the sensitivity of mammography in these cases is inadequate [3]

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