Scientific Session 17 — Breast -MRI/New TechnologiesWednesday, May 3, 2017
2861. Diagnostic Utility of Contrast-Enhanced Breast MRI for the Evaluation of Nipple Discharge
Bahl M*, Gadd M, Lehman C. Massachusetts General Hospital, Boston, MA
Address correspondence to M. Bahl (email@example.com)
Objective: The imaging workup and management of nipple discharge, which can be a presenting symptom of malignancy, remain controversial. In particular, conclusions drawn about the diagnostic value of MRI have been based on small studies with mixed results. The purpose of this study, which is one of the largest series to date, was to determine the diagnostic utility of MRI in the setting of nipple discharge.
Materials and Methods: We performed a retrospective review of consecutive women who underwent breast MRI from January 2006 to December 2015 for evaluation of nipple discharge after negative or inconclusive mammography. Radiographic findings, pathology results, and clinical notes were reviewed.
Results: Over a 10-year period, 118 women (mean age, 49 years; range, 23–82 years) underwent MRI for evaluation of nipple discharge after negative or inconclusive mammography. A total of 105 (89%) had surgical excision, clinical or radiographic follow-up, or both at least 2 years after presentation and thus constitute the study population. A total of six patients (5.7%) were diagnosed with malignancy. Lesions included ductal carcinoma in situ (DCIS) in four patients, extensive DCIS with microinvasive ductal carcinoma in one patient, and invasive papillary carcinoma in one patient. Twenty-eight patients (26.7%) had positive MRI findings (coded as BI-RADS category 0, 4, or 5). Of these patients, three (10.7%) were found to have malignancies (grade 2–3 DCIS in one patient, extensive grade 2 DCIS with microinvasive ductal carcinoma in one patient, and invasive papillary carcinoma in one patient). An additional three patients were diagnosed with malignancy, all of which were grade 1 DCIS at surgical excision. One of these patients had a negative MRI, and the other two had MRI results coded as BI-RADS category 3. Of note, one of the two patients with a BI-RADS category 3 MRI was diagnosed with grade 1 DCIS during the follow-up period, nearly 1.5 years after her initial presentation of nipple discharge. For patients with negative or benign MRI findings (BI-RADS category 1 or 2), the negative predictive value of MRI was 98.5%.
Conclusion: In women who underwent breast MRI for evaluation of nipple discharge after negative or inconclusive mammography, the rate of malignancy was approximately 6%. Surveillance rather than surgical excision may be a reasonable option for patients with negative or benign MRI findings.