Comparison of Galactography, Ultrasonography and Contrast Enhanced Magnetic Resonance Imaging Findings with Pathology Results in Patients with Pathologic Nipple Discharge

Abstract

Objective: The purpose of this study was to evaluate the lesion detection rates of imaging methods by comparing galactography, ultrasonography (US) and contrast enhanced-magnetic resonance imaging (CE-MRI) findings with pathology results in patients with pathologic nipple discharge (PND). Materials and Methods: Fifty-two female patients (age range, 18–79 years; mean age, 49,12 years) with PND were included the study. Radiologic imaging and pathology results of patients were evaluated retrospectively. The lesion detection rates of galactography, US and CE-MRI were evaluated. Galactography findings were evaluated according to modified Galactogram Image Classification System (GICS) and compared with the pathology results. Results: Galactography was applied in 48 patients. While in 45 (93.8%) of 48 patients lesion that causes PND was found on galactography. All of the patients had breast US. In 48 (92.3%) patients, causing lesion was found on US. CE-MRI was performed in 33 of 52 patients, and lesion was found in 30 patients (90.9%). Lesion detection rates of galactography, US and CE-MRI findings were similar. Pathology results of 48 patients (92.3%) were benign, and the results of 3 patients (5.8%) were malignant. The result of 1 patient (2%), there was no lesion on pathologic examination. The sensitivity of galactography, US and CE-MRI were 93.6%, 92.2% and 90.6%, respectively. In the double and triple combinations of imaging methods regarding the lesion detection, sensitivity was found as 100%. There was no significant relationship between modified GICS scores and pathology results. Conclusion: Galactography, US and CE-MRI have high sensitivity for lesion detection in patients with PND. When galactography, US and CE-MRI findings are used in double and triple combinations, lesion detection rates could be increase.

Keywords

• Nipple discharge
• Breast Magnetic Resonance Imaging
• Galactography
• Ultrasonography

Patolojik Meme Başı Akıntısı Olan Hastalarda Galaktografi, Ultrasonografi ve Kontrastlı Manyetik Rezonans Görüntüleme Bulgularının Patoloji Sonuçları ile Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı patolojik meme başı akıntısı (PMA) olan hastalarda galaktografi, ultrasonografi (US) ve kontrastlı manyetik rezonans görüntüleme (MRG) bulgularını patoloji sonuçlarıyla karşılaştırarak görüntüleme yöntemlerinin lezyon tespit oranlarını değerlendirmektir. Gereç ve Yöntem: PMA ile başvuran 52 kadın hasta (yaş aralığı 18–79 yıl; ort. 49,12 yıl) çalışmaya dahil edildi. Hastaların radyolojik görüntüleme ve patoloji sonuçları retrospektif olarak değerlendirildi. Galaktografi, US ve MRG'nin lezyon tespit oranları değerlendirildi. Galaktografi bulguları modifiye Galaktogram Görüntü Sınıflandırma Sistemine (GICS) göre değerlendirildi ve patoloji sonuçlarıyla karşılaştırıldı. Bulgular: 48 hastaya galaktografi uygulandı. 48 hastanın 45'inde (%93,8) galaktografide PMA’na neden olan lezyon saptandı. Hastaların tamamına meme US uygulandı. Hastaların 48'inde (%92,3) US'de neden olan lezyon tespit edildi. 52 hastanın 33'üne MRG çekildi ve 30 hastada (%90,9) lezyon saptandı. Galaktografi, US ve MRG bulgularının lezyon tespit oranları benzerdi. 48 hastanın (%92,3) patoloji sonucu benign, 3 hastanın (%5,8) sonucu malign idi. 1 hastada (%2) yapılan patolojik incelemede lezyona rastlanmadı. Galaktografi, US ve MRG'nin duyarlılığı sırasıyla %93,6, %92,2 ve %90,6 idi. Lezyon tespitine ilişkin görüntüleme yöntemlerinin ikili ve üçlü kombinasyonlarında duyarlılık %100 olarak bulunmuştur. Modifiye GICS skorları ile patoloji sonuçları arasında anlamlı ilişki bulunamadı. Sonuç: PMA olan hastalarda lezyon tespitinde Galaktografi, US ve MRG'nin duyarlılıkları yüksektir. Görüntüleme yöntemleri ikili ve üçlü kombinasyonlar halinde kullanıldığında lezyon tespit oranları artabilmektedir.

Keywords

• Meme başı akıntısı
• Meme Manyetik Rezonans Görüntüleme
• Galaktografi
• Ultrasonografi

References

1. 1. Pena KS, Rosenfeld JA. Evaluation and treatment of galactorrhea. Am. Fam. Physician 2001;63:1763-70.
2. 2. Hussain AN, Policarpio C, Vincent MT. Evaluating nipple discharge. Obstet Gynecol Surv. 2006;61:278-83.
3. 3. Sakorafas GH. Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 2001;27:275-82.
4. 4. Becker S, Choti M: Breast diseases. In: The Johns Hopkins Manual of Gynecology and Obstetrics. Bankowski, BJ, Hearne, AE, Lambrou, NC, Fox, HE, Wallach, EE (Eds). Lippincott, Williams & Wilkins, PA, USA (2002).
5. 5. Simmons R, Adamovich T, Brennan M, Christos P, Schultz M, Eisen C, et al. Nonsurgical evaluation of pathologic nipple discharge. Ann. Surg. Oncol. 2003;10:113-6.
6. 6. Berna-Serna JD, Torres-Ales C, Berna-Mestre JD, Sola-Perez J, Canteras-Jordana M. Galactography: An application of the galactogram imaging classification system (GICS). Acta Radiol 2010;51(2):128-36.
7. 7. Istomin A, Masarwah A, Pitka¨nen M, Joukainen S, Sutela A, Vanninen R, et al. Galactography is not an obsolete investigation inthe evaluation of pathological nipple discharge. PLoS ONE 2018;13(10):e0204326.
8. 8. Lau S, Chenmeister IK, Stachs A, Gerber B, Krause A, Reimer T. Pathologic nipple discharge: surgery is imperative in postmenopausal women. Ann Surg Oncol 2005;12:246-51.

9. 9. Zaky M.M, Hafez A, Zaky M.M, Shoma A, Soliman N, Elmokadem A.H. MRI For Assessment Of Pathologic Nipple Discharge: İs İt Mandatory? Egypt J Radiol Nucl Med. 2019;50:92.
10. 10. Paula IB, Campos AM. Breast imaging in patients with nipple discharge. Radiol Bras 2017; 50(6):383-8
11. 11. Jung Hk, Park Ym, Baek Hj, Choo Hj, Kim Ek, Kim Dw, et al. Comparison Between Ultrasonography And Galactography İn Detecting Lesions In Patients With Pathologic Nipple Discharge. Ultrasound Q. 2019;35(1):93-8.
12. 12. Chung SY, Lee KW, Park KS, Lee Y, Bae SH. Breast tumors associated with nipple discharge: correlation of findings on galactography and sonography. Clin Imaging 1995;19:165-71.
13. 13. Hild F, Duda VF, Schulz KD. Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev 1998;7(suppl 1):S57-62.
14. 14. Hirose M, Nabusawa H, Gokan T. MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics 2007;27(suppl 1):S183-96.
15. 15. Manganaro L, D'Ambrosio I, Gigli S, Di Pastena F, Giraldi G, Tardioli S, et al. Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography. Biomed Res Int. 2015:806368.
16. 16. Yılmaz R, Bender O,Yabul F.Ç, Dursun M, Tunacı M, Acunas G. Diagnosis of Nipple Discharge: Value of Magnetic Resonance Imaging and Ultrasonography in Comparison with Ductoscopy Balkan Med J. 2017;34(2):119-26.
17. 17. Ohlinger R, Stomps A, Paepke S, Blohmer JU, Grunwald S, Hahndorf W, et al. Ductoscopic detection of intraductal lesions in cases of pathologic nipple discharge in comparison with standard diagnostics: the German multicenter study. Oncol Res Treat. 2014;37(11):628-32.
18. 18. Adepoju LJ, Chun J, El-Tamer M, Ditkoff BA, Schnabel F, Joseph KA. The value of clinical characteristics and breast-imaging studies in predicting a histopathologic diagnosis of cancer or high-risk lesion in patients with spontaneous nipple discharge. Am J Surg 2005;190:644-6.
19. 19. Vargas HI, Vargas MP, Eldrageely K, Gonzalez KD, Khalkhali I. Outcomes of clinical and surgical assessment of women with pathological nipple discharge. Am Surg 2006;72:124-8.
20. 20. Hahn M, Krainick-Strobel U, Toellner T, Gissler J, Kluge S, Krapfl E, et al. Minimally Invasive Breast Intervention Study Group (AG MiMi) of the German Society of Senology (DGS); Study Group for Breast Ultrasonography of the German Society for Ultrasound in Medicine (DEGUM) Interdisciplinary consensus recommendations for the use of vacuum-assisted breast biopsy under sonographic guidance: first update 2012. Ultraschall Med 2012;33:366-71.
21. 21. Morrog M, Morris EA, Libermann L, Borgen PI, King TA. The predictive values of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol 2007;12:3369-77.
22. 22. Grunwald S, Heyer H, Paepke S, Schwesinger G, Schimming A, Hahn M,et al. Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to Standard methods. Onkologie 2007;30:243-8.
23. 23. Albrecht C, Thele F, Grunwald S, Kohlmann T, Hegenscheid K, Utpatel K. et al. Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests. Onkologie 2013;36:12-6.
24. 24. Nakahara H, Namba K, Watanaba R, Furusawa H, Matsu T, Akiyama F, et al. A comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer 2003;10:320-9.
25. 25. Ishikawa T, Momiyama N, Hamaguchi Y, Takeuchi M, Iwasawa T, Yoshida T, et al. Evaluation of Dynamics studies of MR mammography for the diagnosis of intraductal lesions with nipple discharge. Breast Cancer 2004;11:288-94.
26. 26. Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. Ductal enhancement on MR imaging of the breast. Am J Roentgenol 2003;181:519-25.
27. 27. Blum KS, Rubbert C, Antoch G, Mohrmann S, Obenauer S. Diagnostic accuracy of abnormal galactographic and sonographic findings in the diagnosis of intraductal pathology in patients with abnormal nipple discharge. Clin Imaging. 2015;39(4):587-91.
28. 28. Dinkel HP, Trusen A, Gassel AM, Rominger M, Lourens S, Müller T, et al. Predictive value of galactographic patterns for benign and malignant neoplasms of the breast in patients with nipple discharge. Br J Radiol 2000;73:706-14.
29. 29. Hou MF, Huang TJ, Liu GC. The diagnostic value of galactography in patients with nipple discharge. Clin Imaging 2001;25:75-81.
30. 30. Kim SH, Cha ES, Kim HS, Kang BJ, Choi JJ, Jung JH. Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis. Arch Gynecol Obstet 2009;280:217-22.