Magnetic resonance imaging in patients with nipple discharge: should we recommend it?
OBJECTIVE
Comparing the sensitivity of Contrast-Enhanced Magnetic Resonance Imaging (CEMRI), mammography and ultrasonography in patients with nipple discharge (ND).


METHODS
We retrospectively evaluated 38 women with ND who underwent mammography, ultrasound and 1.5 T CEMRI between March 2007 and July 2009. Imaging findings, pathological diagnosis and follow-up data (mean follow-up: 20 months) were compared. Sensitivity and specificity values were reckoned. Statistical differences in sensitivity were assessed.


RESULTS
5/38 malignancies (13.2%; 3 invasive, 2 intraductal; 4 ipsilateral, 1 contralateral to ND), and 14/38 High-Risk Lesion (HRL--36.8%; 11 intraductal papillomas, 1 papilloma with LCIS, 1 sclerosing papilloma and 1 atypical intraductal hyperplasia, all ipsilateral) were found. CEMRI identified 5/5 cancers and 13/14 HRL (Overall Sensitivity-OSS = 94.7%; Overall Specificity-OSP = 78.9%). 3/5 cancers (1 invasive, 1 in-situ; 1 invasive contralateral) and 2/14 HRL were detected by CEMRI only. Mammography found 2/5 cancer and 3/14 HRL (OSS = 26.3%; OSP = 94.7%). Ultrasound identified 1/5 cancer and 11/14 HRL (OSS = 63.2%; OSP = 84.2). 1/14 HRL was detected by ultrasound only. Compared with mammography and ultrasound, CEMRI showed statistically significantly higher OSS values (p < 0.0001, p = 0.042 respectively).


CONCLUSIONS
In women with ND, CEMRI should be recommended when conventional imaging is negative. Unexplained ND could be considered an indication for CEMRI.
Institute of Radiology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le Santa Maria della Misericordia n 15, 33100 Udine, Italy. michele.lorenzon@gmail.com
Michele
M
Lorenzon
Chiara
C
Zuiani
Anna
A
Linda
Viviana
V
Londero
Rossano
R
Girometti
Massimo
M
Bazzocchi
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
D003287:Contrast Media