Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Korean J Radiol. 2022 Sep;23(9):866-877. doi: 10.3348/kjr.2021.0850.
The optimal imaging approach for evaluating pathological nipple discharge remains unclear. We investigated the value of adding ductography to ultrasound (US) for evaluating pathologic nipple discharge in patients with negative mammography findings.
From July 2003 to December 2018, 101 women (mean age, 46.3 ± 12.2 years; range, 23-75 years) with pathologic nipple discharge were evaluated using pre-ductography (initial) US, ductography, and post-ductography US. The imaging findings were reviewed retrospectively. The standard reference was surgery (70 patients) or > 2 years of follow-up with US (31 patients). The diagnostic performances of initial US, ductography, and post-ductography US for detecting malignancy were compared using the McNemar's test or a generalized estimating equation.
In total, 47 papillomas, 30 other benign lesions, seven high-risk lesions, and 17 malignant lesions were identified as underlying causes of pathologic nipple discharge. Only eight of the 17 malignancies were detected on the initial US, while the remaining nine malignancies were detected by ductography. Among the nine malignancies detected by ductography, eight were detected on post-ductography US and could be localized for US-guided intervention. The sensitivities of ductography (94.1% [16/17]) and post-ductography US (94.1% [16/17]) were significantly higher than those of initial US (47.1% [8/17]; = 0.027 and 0.013, respectively). The negative predictive value of post-ductography US (96.9% [31/32]) was significantly higher than that of the initial US (83.3% [45/54]; = 0.006). Specificity was significantly higher for initial US than for ductography and post-ductography US ( = 0.001 for all).
The combined use of ductography and US has a high sensitivity for detecting malignancy in patients with pathologic nipple discharge and negative mammography. Ductography findings enable lesion localization on second-look post-ductography US, thus facilitating the selection of optimal treatment plans.
评估病理性乳头溢液的最佳影像学方法仍不清楚。我们研究了在乳腺 X 线摄影阴性的患者中，将乳管造影术与超声（US）联合用于评估病理性乳头溢液的价值。
自 2003 年 7 月至 2018 年 12 月，101 例（平均年龄 46.3±12.2 岁；范围 23-75 岁）有病理乳头溢液的患者接受了乳管造影术前（初始）US、乳管造影术和乳管造影术后 US 检查。回顾性分析影像学结果。以手术（70 例）或＞2 年的 US 随访（31 例）作为标准参考。采用 McNemar 检验或广义估计方程比较初始 US、乳管造影术和乳管造影术后 US 检测恶性肿瘤的诊断性能。
总共确定 47 例乳头瘤、30 例其他良性病变、7 例高危病变和 17 例恶性病变为病理性乳头溢液的潜在原因。在初始 US 上仅发现 17 例恶性肿瘤中的 8 例，而其余 9 例恶性肿瘤则通过乳管造影术发现。在乳管造影术发现的 9 例恶性肿瘤中，8 例在乳管造影术后 US 上发现，可进行定位以便进行 US 引导下的干预。乳管造影术（94.1%[16/17]）和乳管造影术后 US（94.1%[16/17]）的敏感性明显高于初始 US（47.1%[8/17]；=0.027 和 0.013）。乳管造影术后 US（96.9%[31/32]）的阴性预测值明显高于初始 US（83.3%[45/54]；=0.006）。与乳管造影术和乳管造影术后 US 相比，初始 US 的特异性明显更高（所有比较均为=0.001）。
对于乳腺 X 线摄影阴性的病理性乳头溢液患者，联合使用乳管造影术和 US 具有较高的恶性肿瘤检出率。乳管造影术结果可在乳管造影术后的二次检查中定位病变，从而有助于选择最佳治疗方案。
