Diagnostic Utility of MRI in the evaluation of potential malignancy in patients presented with nipple discharge

Author(s) Yang N.P.C.; Nijjar P.S.; Phyu S.; Barkeji M.; Butt M.A.J.
Institution(s) (Yang, Nijjar, Phyu, Barkeji) West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust
(Butt) Royal Blackburn Hospital
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: Nipple discharge is a presentation commonly seen at breast clinics. It is conventionally evaluated with physical examination and sonography( or mammography). The aim of this study is to investigate the diagnostic value of magnetic resonance imaging (MRI) as an additional imaging tool in the evaluation of potential malignancy in patients presented with nipple discharge. Method(s): A retrospective evaluation of 85 patients with nipple discharge who underwent breast ultrasound (USS) and MRI between 04/ 06/2008 and 25/10/2019 was conducted. Clinical notes, radiographic reports and biopsy results were reviewed. Sensitivity, specificity, positive predictive value and negative predictive value of USS and MRI were calculated. Result(s): Out of the 85 patients (all female; mean age 45.33 +/- 12.93 years old) with nipple discharge, 11 were found to have biopsy-proven malignancy (invasive ductal carcinoma/ ductal carcinoma in situ; 12.94% risk). USS failed to identify seven malignancies (27.27% sensitivity) while MRI missed three malignancies (72.72% sensitivity). USS falsely identified four malignancies from 74 patients with no malignancy (94.59% specificity) while MRI only falsely identified one case (98.65% specificity). For patients with negative USS results (U1/U2/U3) or negative MRI results (BI-RADS category 1,2 or 3), the negative predictive values of USS is 89.74% while that of MRI is 96.05%. The positive predictive values of USS and MRI are 42.86% and 88.88% respectively. Conclusion(s): Compared to USS, MRI has a higher sensitivity, specificity, positive predictive value and predictive value. It will be a valuable addition to the standard nipple discharge evaluation workup to help rule out malignancy.

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