Department of Radiology, Faculty of Medicine, Gazi University, Emniyet, Mevlana Blv. No:29, Yenimahalle, Ankara, 06560, Turkey.
Ir J Med Sci. 2023 Oct;192(5):2331-2335. doi: 10.1007/s11845-022-03230-4. Epub 2022 Nov 21.
BACKGROUND/AIMS: To investigate the diagnostic performance of breast MRI in revealing mammographically and sonographically occult lesions requiring excision in patients with pathologic nipple discharge.
In this retrospective study, 57 women with pathologic nipple discharge who had normal or inconclusive mammography and ultrasonography results and underwent breast MRI were determined. Patients who had histopathological diagnosis or ≥ 1-year imaging follow-up were included. MRIs were classified as positive and negative according to final BI-RADS assessment categories. Diagnostic performance of MRI, including sensitivity, specificity, negative predictive value, and positive predictive value, was calculated for detecting both malignancy and lesions requiring surgery.
Abnormal contrast enhancement on the pathologic nipple discharge side was detected in 29 MRIs (50.8%), categorized as BI-RADS 4. Abnormal findings were solid masses in 17 cases (58.6%) and non-mass enhancement in 12 cases (41.3%). Despite normal conventional imaging results, 4 malignant lesions and 16 lesions requiring surgery were detected with MRI. The sensitivity and specificity of MRI for detecting lesions requiring surgery were 100% and 68.2%, respectively. The positive predictive value (PPV) and negative predictive value were 55.1% and 100%, respectively.
In conclusion, this study confirmed that MRI is a reliable tool to detect lesions requiring surgery in patients with pathologic nipple discharge. MRI should be used in routine workup in patients with normal conventional imaging and imaging follow-up can be safely applied in patients with negative MRI.
背景/目的：旨在探讨乳腺 MRI 在显示病理性乳头溢液患者中需要切除的乳腺 X 线摄影和超声检查隐匿性病变的诊断性能。
在这项回顾性研究中，我们确定了 57 例有病理乳头溢液且乳腺 X 线摄影和超声检查结果正常或不确定，并接受了乳腺 MRI 检查的患者。纳入有组织病理学诊断或≥1 年影像学随访的患者。根据最终 BI-RADS 评估类别，将 MRI 分为阳性和阴性。计算 MRI 检测恶性肿瘤和需要手术的病变的诊断性能，包括敏感性、特异性、阴性预测值和阳性预测值。
在 29 例 MRI（50.8%）中发现病理性乳头溢液侧有异常对比增强，分类为 BI-RADS 4。异常发现包括 17 例（58.6%）实性肿块和 12 例（41.3%）非肿块强化。尽管常规影像学结果正常，但 MRI 检测到 4 例恶性病变和 16 例需要手术的病变。MRI 检测需要手术的病变的敏感性和特异性分别为 100%和 68.2%。阳性预测值（PPV）和阴性预测值分别为 55.1%和 100%。
总之，本研究证实 MRI 是一种可靠的工具，可以检测病理性乳头溢液患者中需要手术的病变。在常规成像和影像学随访正常的患者中，应常规使用 MRI；在 MRI 阴性的患者中，可以安全地进行影像学随访。
