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Role of breast Magnetic Resonance Imaging (MRI) in patients with unilateral nipple discharge: preliminary study

Ruolo della risonanza magnetica mammaria nello studio delle pazienti con secrezione mammaria monolaterale dal capezzolo: studio preliminare

  • Breast Radiology Senologia
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Abstract

Purpose

This study was performed to assess the role of magnetic resonance imaging (MRI) in patients with unilateral nipple discharge.

Materials and methods

Forty-four patients with bloody or serosanguineous nipple discharge and negative mammographic findings (35/44 cases) underwent MRI for evaluation of breast ducts. Ultrasonography, negative in 18 patients, identified 26 cases of ductal ectasia (12 simple, nine with solid intraductal echoes and wall thickening, five with inhomogeneous parenchyma). Galactography was negative in three patients and positive in nine. Nineteen patients were followed up by clinical examination, ultrasonography, and cytological evaluation of nipple discharge (6–12 months); three patients underwent excisional biopsy, ten core biopsy and 12 cytological biopsy (followed by excisional biopsy).

Results

MRI identified 25 enhancing lesions Breast Imaging Reporting and Data Systems (BI-RADS) 3 or 4) and confirmed the galactographic findings (ductal ectasia, intraluminal filling defects). Five papillomatoses appeared as patchy, homogeneous enhancing areas, 15 intraductal papillomas as areas with well-defined margins and type II time-intensity curves, and two atypical ductal hyperplasias as diffuse nodular enhancement. One micropapillary ductal carcinoma in situ (DCIS), one papillary carcinoma and one infiltrating ductal carcinoma (IDC) were visualised as two segmental areas of enhancement and one mass-like enhancement with poorly defined margins (BI-RADS 4). The follow-up was negative, showing no pathological enhancement (BI-RADS 1) in 12 patients and benign enhancement (BI-RADS 2) in seven.

Conclusions

Breast MRI can be considered a valuable examination in the diagnosis of suspected ductal disease and an alternative to galactography when the latter cannot be used.

Riassunto

Obiettivo

Valutare il ruolo della risonanza magnetica (RM) in pazienti con secrezione monorifiziale dal capezzolo.

Materiali e metodi

Quarantaquattro pazienti con secrezione ematica/sieroematica dal capezzolo, mammografia negativa (35/44 casi) si sottoponevano allo studio dei dotti con RM. L’ecografia negativa in 18 casi, identificava ectasia duttale in 26: semplici in 12, con proliferazione solida intraduttale ed ispessimento parietale in 9 e con disomogeneità ghiandolare in 5; la galattografia negativa in 3 e positiva in 9. Diciannove pazienti effettuavano follow-up clinico, radiologico, citologico della secrezione (6–12 mesi), 3 biopsia chirurgica, 10 core-biopsy e 12 prelievo citologico (seguite da biopsia chirurgica).

Risultati

RM identificava 25 aree di potenziamento classificate BI-RADS 3 o 4. Nelle pazienti sottoposte a galattografia, la RM riconosceva i reperti galattografici (ectasia o difetti di riempimento). Cinque papillomatosi duttali si identificavano come potenziamento lineare ed omogeneo; 15 papillomi: enhancement a margini netti e curva intensità-tempo di tipo II, 2 iperplasie duttali atipiche: potenziamento nodulare diffuso. Un carcinoma papillare, 1 CDIS con aspetto micropapillare e 1 CDI si evidenziavano come 2 aree di potenziamento segmentale e un’area di potenziamento nodulare a margini irregolari (BI-RADS4). Follow-up negativo in 12 pazienti senza potenziamento patologico (BI-RADS1) e in 7 con potenziamento benigno (BIRADS2).

Conclusioni

La RM può essere considerata valida metodica diagnostica nello studio della sospetta patologia duttale con secrezione, in alternativa alla galattografia quando questa metodica non sia utilizzabile.

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Authors and Affiliations

  1. Dipartimento di Scienze Radiologiche, Università di Roma “La Sapienza”, Policlinico Umberto I, Viale Regina Elena 324, 00166, Roma, Italy

    L. Ballesio, C. Maggi, S. Savelli, M. Angeletti, C. De Felice, M. L. Meggiorini, L. Manganaro & L. M. Porfiri

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  1. L. Ballesio
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  2. C. Maggi
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  3. S. Savelli
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  4. M. Angeletti
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  5. C. De Felice
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  6. M. L. Meggiorini
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  7. L. Manganaro
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  8. L. M. Porfiri
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Correspondence to C. Maggi.

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Ballesio, L., Maggi, C., Savelli, S. et al. Role of breast Magnetic Resonance Imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol med 113, 249–264 (2008). https://doi.org/10.1007/s11547-008-0245-x

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  • DOI: https://doi.org/10.1007/s11547-008-0245-x

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