Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography

Abstract

Purpose: Assessing the role of breast MRI compared to galactography in patients with unilateral bloody or serous-bloody nipple discharge.

Materials and methods: Retrospective study including 53 unilateral discharge patients who performed galactography and MRI. We evaluated the capability of both techniques in identifying pathology and distinguishing between nonmalignant and malignant lesions. Lesions BIRADS 1/2 underwent follow-up, while the histological examination after surgery has been the gold standard to assess pathology in lesions BIRADS 3/4/5. The ROC analysis was used to test diagnostic MRI and galactography ability.

Results: After surgery and follow-up, 8 patients had no disease (15%), 23 papilloma (43%), 11 papillomatosis (21%), 5 ductal cancer in situ (10%), and 6 papillary carcinoma (11%) diagnoses. Both techniques presented 100% specificity; MRI sensitivity was 98% versus 49% of galactography. Considering MRI, we found a statistical association between mass enhancement and papilloma (P < 0.001; AUC 0.957; CI 0.888-1.025), ductal enhancement and papillomatosis (P < 0.001; AUC 0.790; CI 0.623-0.958), segmental enhancement and ductal cancer in situ (P = 0.007; AUC 0.750; CI 0.429-1.071), and linear enhancement and papillary cancer (P = 0.011).

Conclusions: MRI is a valid tool to detect ductal pathologies in patients with suspicious bloody or serous-bloody discharge showing higher sensitivity and specificity compared to galactography.

Figure 1

Image findings of (a) ductal ectasia, (b) filling stop, (c) filling defect, and (d) ductal distortion.

Figure 2

The ROC curves show an association between (a) papillary cancer and G6 on galactography (AUC 0.894; CI 0.715–1.074) and (b) between DCIS and G5 (AUC 0.790; CI 0.534−1.046).

Figure 3

ROC analysis confirms the association between (a) mass enhancement and papilloma (AUC 0.957; CI 0.888−1.025) and (b) segmental enhancement and DCIS (AUC 0.750; CI 0.429−1.071).

Figure 4

53-year-old patient presenting serous-bloody nipple discharge. Craniocaudal (a) and mediolateral oblique (b) mammographic images show the filling stop few millimeters distant from the nipple of the cannulated duct, imaging finding suggestive of papilloma. MRI image (T1-weighted 3D flash acquired in the axial plane) shows a mass intraductal enhancement in the retroareolar area (c) with round and sharp margins, indicative of a benign proliferation of the ductal epithelium (papilloma). Histology later confirmed the papilloma diagnosis.

Figure 5

41-year-old patient with persistent bloody discharge of the right breast: craniocaudal (a) and mediolateral oblique (b) galactographic projections show a ductal ectasia condition with wall duct focal irregularities. MRI images (T1-weighted 3D flash), acquired on the axial plane, show a ductal enhancement. Histology revealed a papillomatosis condition.

Figure 6

54-year-old patient, presenting with bloody nipple discharge from the left breast: craniocaudal galactographic image (a) shows ductal ectasia and filling defect, as observed in papillomatosis. (b) MRI images (T1-weighted 3D flash), acquired on the axial plane, show a branched inhomogeneous ductal enhancement, suspicious of ductal malignant pathology. Histology revealed DCIS. This case represents a galactography FN case; MRI correctly identified the malignant disease.