Steven Edward Harms MD, Presenter: Consultant, Aurora Imaging Technology, Inc

Danna F. Grear MD, Abstract Co-Author: Nothing to Disclose

Kevin L. Pope MD, Abstract Co-Author: Stock options, Aurora Imaging Technology, Inc Speaker, Myriad Genetics, Inc

Stacy Anne Smith-Foley MD, Abstract Co-Author: Stock Option, Aurora Imaging Technology, Inc

Kelly Anne Johnson MD, Abstract Co-Author: Nothing to Disclose

Unilateral spontaneous bloody or serous nipple discharge is recognized as a symptom of malignancy. Although malignancy is sometimes seen, papilloma is the most common etiology with representation of 40-78% (bloody) and 41-59% (serous). Galactography is recognized for imaging of intraductal lesions. High resolution, high contrast breast MR is a potential alternative for the accurate demonstration of intraductal lesions.

95 patients presenting with unilateral spontaneous bloody or serous nipple discharge were examined with breast MR after a negative or inconclusive diagnostic mammographic and sonographic work-up. Isotropic 700 micron resolution acquisitions were performed using pre-contrast non-spoiled T1 and T2 weighted images that are subtracted from post-contrast spoiled T1 weighted images. The resulting subtractions depict papillomas as bright enhancing masses amid a background of dark fluid even if the fluid is bloody or proteinaceous. High resolution isotropic acquisitions allow image reformation in oblique or curved planes for optimal ductal display.

A distinctive appearance for 23 intraductal papillomas was identified in 22 cases (23.2%) with breast MR. Intraductal papillomas were diagnosed with second look ultrasound (17) or MR-directed (6) vacuum assisted biopsy. 21 other BI-RADS 3 and higher lesions were seen with MR with histologies representing: DCIS (4), fibrosis (3), fibrocystic change (2), fibroadenoma (2), apocrine metaplasia (2), adenoma (1), myofibroblastoma (1), atypical ductal hyperplasia (1) and other (5). 48 negative MR cases were negative at 1 year or longer follow up. One negative MR case was a missed papilloma where a dilated duct but no mass was seen. Negative histology was confirmed in 3 other MR negative cases.

Conventional breast MR is known for its high NPV for malignancy, but may miss small intraductal papillomas, the most pathology associated with nipple discharge. This study confirms the potential for high resolution, high contrast MR acquisitions to display intraductal papillomas with accuracy. MR may provide an alternative to galactography for women presenting with unilateral spontaneous bloody or serous nipple discharge.

High contrast, high resolution breast MR with oblique image reformation may be an alternative to galactography for women presenting with unilateral spontaneous bloody or serous nipple discharge.

Harms, S, Grear, D, Pope, K, Smith-Foley, S, Johnson, K, High Contrast, High Resolution MR of Intraductal Papillomas: Can MR Replace Galactography?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12024360.html