Comparison Study between MRI with Contrast and Doppler Ultrasound in Diagnosis Pathological Nipple Discharge

Abstract

Abstract Background Pathologic nipple discharge (PND) is characterized by spontaneous secretions that stem from unilateral single or several ducts. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal (ID) papilloma and papillomatosis. A rare but major cause of PND is breast cancer, which comprises 5%-21% of such cases. Aim of the Work In this study we aimed to compare the accuracy of Contrast-Enhanced Magnetic Resonance Imaging (CEMRI) and Doppler ultrasonography in patients with pathological nipple discharge using pathological examination as a golden standard. Patients and Methods This cross sectional study was conducted in Mit - Ghamer Oncology Center and Ain Shams university Hospitals. We enrolled 50 female patients their mean age (SD) was 44.44 years & ranged between (17-73) years. Results There was statistically significant difference between malignant and benign lesions regarding Doppler findings as benign lesions more liable to appear as avascular (84.62%) and hypovascular (61.11%) than malignant lesions; on the other hand malignant lesions appeared mainly as intermediate (91.67%) or hypervascular (85.71%). There was statistically significant difference between benign and malignant lesions regarding vascular flow Pattern; as avascular pattern appeared mainly in benign lesions (84.62%), However, penetrating (57.14%) as well as peripheral and penetrating (83.33%) pattern appeared mainly in malignant lesions. Doppler US showing accuracy 80%, sensitivity 84.6% and specificity 75%. Regarding MRI findings, homogenous enhancement was statistically significant as main finding of all benign lesions (100%). Also, heterogeneous enhancement was significantly significant among malignant (92.86%) lesions. Regarding curve type, there was statistically significant difference between benign and malignant lesions as type I curve was represented mainly benign lesions (93.33%), type III curve was represented malignant lesions (100%) and type II curve was represented in 10 benign cases (71.43%) and in 4 malignant cases (28.57%). Regarding MRI it had a higher accuracy (88%), sensitivity (88.5%) and specificity (87.5%) than Doppler. Conclusion Contrast enhanced MRI is superior to Doppler US in the diagnosis of PND. Contrast enhanced MRI has higher sensitivity, specificity and accuracy (88.5%, 87.5% and 88%) respectively than Doppler US (84.6%, 75% and 80%) respectively.