engleski

Diagnostic performance of digital breast tomosynthesis in patients with nipple discharge

Nipple discharge (ND) is one of the most commonly reported complaints related to the breast for which women seek advice from physicians. The vast majority of these reported cases are of benign origin. Clinically, ND can be classified either as physiologic or pathologic (pND). pND is often described as being unilateral, bloody or serous, persistent, spontaneous, associated with a mass and arising from a single duct. Unlike physiologic ND, clinical diagnosis of pND should always lead to additional diagnostic evaluation due to the associated increased risk of malignancy with an incidence of up to 21.3%. Furthermore, pND is most commonly caused by papilloma or benign duct ectasia, but can also suggest malignancy. Initial diagnostic approach in the evaluation of pND includes mammography (MMG) and ultrasound (US). Although magnetic resonance imaging (MRI) is not a part of the initial evaluation, it is recommended in the assessment of pND if MMG and US results are negative. To the best of our knowledge, there were no reports published on the diagnostic performance of digital breast tomosynthesis (DBT) in the evaluation of pND. Therefore, the goal of this study is to determine the diagnostic performance of DBT in the assessment of patients with ND and to compare it with MMG, US and MRI. This study included 53 patients with ND. All patients underwent DBT and results were compared to MMG, breast US and MRI. MMG, DBT, US, and MRI findings were classified according to BI-RADS classification, where categories 3-5 were considered positive and 1-2 negative. The final diagnosis was established based on histopathological results if a tissue specimen was obtained ; otherwise, a clinical follow-up was required for at least two years to confirm the benign radiological findings. The diagnostic accuracy of DBT, MMG, US, and MRI for the detection of malignant disease were calculated. The mean age of the patients was 54 years (range, 31-84 years). Final histopathological analysis revealed five malignant breast lesions, all of which were observed in patients with pathologic ND accounting for 12.5% of all patients with pathologic ND. DBT and MRI showed high sensitivity (100%) and high NPV (100%) for the detection of breast carcinoma in patients with ND. DBT showed greater specificity in comparison to MRI (82.9% vs. 61.9%). MMG in the diagnosis of breast carcinoma was determined to have a sensitivity of 83.3% and a specificity of 76.6%. The sensitivity and specificity of US were determined as 66.7% and 57.5%, respectively. DBT showed greater specificity than MRI at the same level of sensitivity and NPV. Thus, it should be considered as an alternative to MRI in the evaluation of patients with ND.

Breast, Oncology, Mammography, MR, Ultrasound, Biopsy, Comparative studies, Diagnostic procedure, Calcifications / Calculi, Cancer, Retrospective, Diagnostic or prognostic study, Performed at one institution

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