Abstract
BackgroundThe purpose of this study was to assess the accuracy of contrast-enhanced spectral mammography (CESM) as compared to dynamic contrast-enhanced MRI (DCE-MRI) in the evaluation of intraductal breast papilloma with histopathological correlation. This study is a retrospective study done on 45 consecutive patients. Their ages ranged between 36 and 70 years with a mean age of 51.1 ± 8.7. All of them were suspected to have intraductal papilloma on full-field digital mammography (FFDM), 3D automated breast ultrasound (3D-ABUS), and 2D handheld ultrasound (2DHHUS). CESM and DCE-MRI were done for all patients. The data were collected, tabulated, statistically analyzed using an IBM personal computer with Statistical Package of Social Science (SPSS).ResultsThere were 37 histopathology proven papillomas either by US-guided core needle biopsy, surgical biopsy following wire localization or fine-needle aspiration cytology (FNAC). Lesions are divided into three subgroups according to size. When the size of lesion > 10 mm MRI sensitivity and specificity is 100% and 66.7%, that of CESM is 90.1% and 0% respectively. In lesions sized 5–10 mm Sensitivity and specificity of MRI is 100% and 58% respectively and those of CESM are 63.6% and 50% respectively. Lesions less than 5mm MRI sensitivity and specificity is 100% and 0%, that of CESM was 0% and 100% respectively.ConclusionDCE-MRI has a significantly higher sensitivity than CESM for the diagnosis of intraductal papilloma whatever the size of the lesion, especially when the size is less than 5 mm.
Highlights
The purpose of this study was to assess the accuracy of contrast-enhanced spectral mammography (CESM) as compared to dynamic contrast-enhanced MRI (DCE-MRI) in the evaluation of intraductal breast papilloma with histopathological correlation
Associated atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), ductal carcinoma in-situ (DCIS), or malignancy occurs in about 80.4% of multiple papillomas [3]
When we sub-grouped the cases according to the size of the lesion, we found that DCE-MRI sensitivity is high in all groups (100%), while its specificity became less when the size of the lesion was smaller and was 0% when the size of the lesion was less than 5 mm
Summary
The purpose of this study was to assess the accuracy of contrast-enhanced spectral mammography (CESM) as compared to dynamic contrast-enhanced MRI (DCE-MRI) in the evaluation of intraductal breast papilloma with histopathological correlation. This study is a retrospective study done on 45 consecutive patients. Intraductal papilloma is a benign tumor which occurs as a result of epithelial and myoepithelial cell proliferation over fibrovascular stalk forming an arborescent structure inside the duct lumen [1]. Regarding its location, it is either a central papilloma which arises in the retroareolar region in a large duct or a peripheral papilloma which arises in terminal ducts. Multiple papillomas arise from the terminal ductal lobular unit, so they usually present as palpable mass and not nipple discharge. Associated atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), ductal carcinoma in-situ (DCIS), or malignancy occurs in about 80.4% of multiple papillomas [3]
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