Mariam Ghali Eskander MD, Presenter: Nothing to Disclose

Karina Bukhanov MD, Abstract Co-Author: Nothing to Disclose

David R. McCready MD, Abstract Co-Author: Nothing to Disclose

Ravi Menezes PhD, Abstract Co-Author: Nothing to Disclose

Pavel Crystal MD, Abstract Co-Author: Nothing to Disclose

The optimal imaging algorithm for the evaluation of patients presenting with pathologic nipple discharge (ND) remains to be determined. The aim of this study was to assess results of mammography (MG), ductography (DG), ultrasound (US), and magnetic resonance imaging (MRI) in the evaluation of ND.

A retrospective chart review of 63 patients (age range 29-78 years, mean age 52 years) who presented with nipple discharge from 2007 to 2011 and underwent MRI was performed. Other inclusion criteria included histological diagnosis by means of percutaneous or excisional biopsy and minimum of two years clinical and mammographic follow-up for benign lesions. We evaluated the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and the overall accuracy of each imaging test and their combinations.

Final diagnoses included benign pathology which was diagnosed in 50 patients (27 benign papillomas, 16 other benign entities, and high-risk pathology in 7 cases), ductal carcinoma in situ (DCIS) in 6 cases, and invasive carcinomas in 7 cases.  Sensitivities of mammography, ductography, ultrasound, and MRI were 8%, 67%, 55%, and 92% respectively. Specificities of these tests were 96%, 28%, 33%, and 48% respectively. PPV’s of MG, DG, US, and MRI were 33%, 17%, 17%, and 31% respectively. NPV’s of these tests were 80%, 85%, 75%, and 96% respectively. Overall accuracies were 70%, 27%, 33%, and 57% respectively. Adding ductography to MRI has improved sensitivity from 92% to 100%. MRI had the best NPV (96%) which was not improved by adding additional tests.   

Although MG maintains the highest specificity and accuracy among imaging tests for detecting malignancy in the setting of nipple discharge, its sensitivity is unacceptable. MRI demonstrated the best sensitivity for the diagnosis of breast carcinoma and the highest NPV for excluding malignancy. MRI should be included in the imaging algorithm for the evaluation of nipple discharge.

MRI is the best standalone imaging test for the evaluation of ND. Our results do not justify avoidance of surgical exploration in cases of suspicious ND. MRI may be useful for surgical planning.

Ghali Eskander, M, Bukhanov, K, McCready, D, Menezes, R, Crystal, P, The Role of Magnetic Resonance Imaging in the Detection of Malignancy in Patients Presenting with Nipple Discharge.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12021822.html