Breast MR for the Evaluation of Occult Nipple Discharge

Pathologic nipple discharge often presents a diagnostic and therapeutic dilemma for clinicians. We present two patients with pathologic nipple discharge in whom breast MR facilitated preoperative identification of and management of otherwise occult index lesions. Breast MR should be considered in the toolbox for evaluation of occult nipple discharge when other available strategies have failed to demonstrate an underlying etiology for the pathologic discharge. The use of breast MR in this setting may permit directed evaluation and management of potentially malignant lesions.

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MRI for assessment of pathologic nipple discharge: is it mandatory?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0105-9 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Mona M. Zaky ◽

Asmaa Hafez ◽

Marwa M. Zaky ◽

Ashraf Shoma ◽

Nermin Y. Soliman ◽

...

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Nipple Discharge ◽

Imaging Features ◽

Pathologic Nipple Discharge ◽

Significant Probability ◽

Malignant Lesions ◽

Higher Sensitivity

Abstract Background Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. Ninety-three patients with pathologic nipple discharge were evaluated by sonomammography and DCE-MRI. Sonomammography and MR imaging features were analyzed and correlated with the histopathology. Results Histopathology revealed 69 benign, three high-risk, and 21 malignant lesions. Simply dilated ducts and presence of a mass on US examination as well as non-mass enhancement and STIR signal changes on MRI were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value = 0.017 and 0.001) and (p value ≤ 0.001). Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%,negative predictive value of 86.7%, and accuracy of 58.1%. MRI gave higher sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%. Conclusion Magnetic resonance imaging is superior to sonommagraphy in diagnosis of pathologic nipple discharge and we recommend it in special situations.

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Galactographic Differentiation between Malignant and Benign Disease in Patients with Pathologic Nipple Discharge

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2003.48.6.511 ◽

2003 ◽

Vol 48 (6) ◽

pp. 511 ◽

Cited By ~ 3

Author(s):

Nariya Cho ◽

Ki Keun Oh ◽

Hyun Yee Cho

Keyword(s):

Nipple Discharge ◽

Benign Disease ◽

Pathologic Nipple Discharge

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PREVALENCE OF ORAL SQUAMOUS CELL CARCINOMA AND ORAL POTENTIALLY MALIGNANT LESIONS DIAGNOSED IN SANTA CATARINA STATE

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology ◽

10.1016/j.oooo.2019.06.759 ◽

2020 ◽

Vol 129 (1) ◽

pp. e179

Author(s):

ACIR JOSÉ DIRSCHNABEL ◽

JANAINA PITT ◽

FRANCIELLE KAFER ◽

CAMILA PEZZINI ◽

LEA MARIA FRANCESCHI DALLANORA ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Santa Catarina ◽

Potentially Malignant ◽

Malignant Lesions ◽

Santa Catarina State

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Duct Excision is Still Necessary to Rule out Breast Cancer in Patients Presenting with Spontaneous Bloodstained Nipple Discharge

International Journal of Breast Cancer ◽

10.4061/2011/495315 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

R. E. Foulkes ◽

G. Heard ◽

T. Boyce ◽

R. Skyrme ◽

P. A. Holland ◽

...

Keyword(s):

Breast Cancer ◽

Malignant Disease ◽

Nonoperative Management ◽

Nipple Discharge ◽

Breast Clinic ◽

Exact Test ◽

Malignant Lesions ◽

Duct Excision ◽

Symptomatic Breast ◽

Rule Out

Introduction. Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic. Benign and malignant causes of spontaneous nipple discharge continue to be difficult to distinguish. We analyse our experience of duct excisions for spontaneous nipple discharge to try to identify features that raise suspicion of breast cancer and to identify features indicative of benign disease that would be suitable for nonoperative management.Methods. Details of one hundred and ninety-four patients who underwent duct excision for spontaneous nipple discharge between 1995 and 2005 were analysed.Results. Malignant disease was identified in 11 (5.7%) patients, 4 invasive and 7 insitu, which was 10.2% of those presenting with bloodstained discharge. All patients with malignant disease had bloodstained discharge. Discharge due to malignant disease was more likely to be bloodstained than that due to benign causes (Fisher's exact test, 2-tailedPvalue = 0.00134).Conclusion. Our findings do not support a policy of conservative management of spontaneous bloodstained nipple discharge. Cases of demonstrable spontaneous bloodstained nipple discharge should undergo duct excision to prevent malignant lesions being missed.

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Strengths and weaknesses of screening programmes for oral malignancies and potentially malignant lesions

European Journal of Cancer Prevention ◽

10.1097/00008469-199604000-00002 ◽

1996 ◽

Vol 5 (2) ◽

pp. 93-98 ◽

Cited By ~ 22

Author(s):

K A A S Warnakulasuriya ◽

N W Johnson

Keyword(s):

Potentially Malignant ◽

Malignant Lesions ◽

Oral Malignancies

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Evaluation and Quantification of Cytomorphometry in Conjunction with Visual Examination and Exfoliative Cytology in Early Diagnosis of Oral Premalignant and Malignant Lesions

Acta Cytologica ◽

10.1159/000518582 ◽

2021 ◽

pp. 1-7

Author(s):

Vasudha Singh ◽

Mudita Bhargava ◽

Kachnar Varma ◽

Vatsala Misra ◽

Richa Singh

Keyword(s):

Tertiary Hospital ◽

Accurate Diagnosis ◽

Exfoliative Cytology ◽

Visual Examination ◽

Normal Cytology ◽

Subjective Analysis ◽

Oral Epithelial Dysplasia ◽

Significant Difference ◽

Potentially Malignant ◽

Malignant Lesions

Introduction: Incidence of oral epithelial dysplasia and oral squamous cell carcinoma (SCC) is very high in south Asian countries as compared to western population owing to a greater use of tobacco in these regions. While visual examination and exfoliative cytology are the most common screening and diagnostic modalities at present, it is a subjective analysis. Quantitative analyses such as nuclear size, cell size, and nuclear-to-cytoplasmic ratio may provide an accurate diagnosis and improve reproducibility. The aim of the study was to evaluate the role of morphometry as a diagnostic adjunct to exfoliative cytology and to derive a significant cutoff to identify the population at risk for development of SCC among chronic tobacco users. Material and Methods: This was an outpatient-based prospective study done in a tertiary hospital over a period of 2 years. Hundred and fifty cases with a history of chronic tobacco use for a minimum period of 5 years were evaluated. Visual inspection using acetic acid was done. Oral scrapes were taken for cytological and morphometric analysis followed by incision biopsy for histopathological evaluation, wherever possible. Results: On morphometrical analysis, mean nuclear area and nuclear:cytoplasmic (N:C) ratio increased, while the cytoplasmic area decreased from smears with normal cytology to oral dysplasia to SCC. Analysis of variance and post hoc Tukey’s honest significant difference test showed a statistically significant difference among the 3 groups (p value <0.05). A cutoff value for a significant N:C ratio was calculated as ≥0.08 using Youden’s index with a sensitivity and a specificity of 88% and 94%, respectively. Conclusion: In high-risk cases, morphometry can be a useful adjunct to exfoliative cytology and visual examination for an early and accurate diagnosis and timely intervention in oral potentially malignant and malignant lesions, thereby improving the prognosis.

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