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- Title
Is Ductography Still Warranted in the 21st century?
- Authors
Baydoun, Serine; Gonzalez, Pedro; Whitman, Gary J.; Dryden, Mark; Xi, Yin; Dogan, Basak
- Abstract
Objective: To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple‐modality evaluation. Materials and Methods: We retrospectively reviewed the medical records of patients who had presented with pathologic nipple discharge and had undergone mammography and/or ultrasound and ductography between January 1, 2005, and October 31, 2010. We tested the diagnostic sensitivity, specificity and accuracy of combined triple‐modality evaluation as well as of MRI performed in addition to these imaging techniques. We used the gold standard of image‐guided biopsies, surgical excision, or long‐term clinical and imaging follow‐up. Results: Among 94 study patients, benign papillomas were identified in 42 (44.7%), abscess in one (1%), duct ectasia in four (4.3%), and malignancy (invasive ductal carcinoma or ductal carcinoma in situ) or high‐risk lesion (atypical ductal hyperplasia) in 10 (10.6%). Forty‐six patients (49%) underwent surgical excision; 89.1% of which had presurgical planning with ductography. In 35 (37.2%) with negative imaging, resolution of nipple discharge was confirmed on median clinical and imaging follow‐up of 36 months. Two patients with negative imaging were lost to follow‐up. Sensitivity, specificity, PPV, and NPV for accurately demonstrating the etiology of pathologic nipple discharge were 13%, 97%, 89%, and 37% respectively for mammography; 73%, 97%, 98%, and 64% respectively for ultrasound; 76%, 72%, 84%, and 61% respectively for ductography; 86%, 70%, 85%, and 72% respectively for combined ultrasound and ductography; and 75%, 100%, 100% and 67% respectively for DCE‐MRI. Conclusion: The combination of mammography, ultrasound and ductography is highly accurate for identifying the etiology of pathologic nipple discharge. DCE‐MRI can be used as an alternate to ductography if necessary.
- Subjects
BREAST cancer diagnosis; BREAST disease diagnosis; ABSCESSES; HYPERPLASIA; BIOPSY; BREAST diseases; MAMMOGRAMS; LONGITUDINAL method; MAGNETIC resonance imaging; MEDICAL records; PAPILLOMA; PREOPERATIVE care; RESEARCH evaluation; RETROSPECTIVE studies; DUCTAL carcinoma; COMPUTER-assisted surgery; DESCRIPTIVE statistics; ACQUISITION of data methodology; NIPPLE discharge
- Publication
Breast Journal, 2019, Vol 25, Issue 4, p654
- ISSN
1075-122X
- Publication type
Article
- DOI
10.1111/tbj.13302