Breast Discharge: Ultrasound and Doppler Evaluation - NCI

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Soha T. Hamed, et al.
(A)
(B)
Fig. (9): Forty years old female with uniorificial discharge. A- Galactography revealed two small intraductal filling
defects (arrow). B- US revealed multiple echogenic rounded lesions separable from the wall, no flow inside.
DISCUSSION
Nipple discharge disorders is a field in which
there has been both increasing awareness on
the part of patients and advances in management
[4].
In this study in five cases the only finding
seen in galactography was intraductal filling
defects. In dedicated study done by cho and his
colleagues ,they stated that in order to thoroughly
and accurately evaluate patients exhibiting
pathologic nipple discharges, it is important to
perform ductography and not to miss the subtle
but suspicious ductographic findings associated
with breast cancer. Diffusely spreading intraductal
cancers, with or without focal invasions,
are often found to be negative by mammography
(especially in absence of microcalcifications)
and sonography. In such cases, ductography
constitutes the best imaging method, as it has
proven effective in the determination of the
nature and extent of such lesions and can facilitate
appropriate surgical management [5].
We agree with other radiologists who maintain
that ductography is prohibitively timeconsuming
and that it can be replaced, at least
in part, by sonography. Intraductal papillary
lesions are sometimes visualized as isoechoic
or hyperechoic masses in dilated ducts on sonography
and can often be biopsied under sonographic-guidance
[6-8].
The quality of breast US is closely related
to the performance of the equipment used for
the examination and the skill of the examiner.
Linear-array, broad-bandwidth transducers with
maximum frequencies of 10-13MHz and a center
frequency of at least 7 or 7.5MHz are required
to depict Ductal carcinoma in situ
(DCIS). The adjustment of focal zones, system
gain and time gain compensation setting is also
important. US should be performed in radial
and anti-radial planes as well as longitudinal
and transverse planes. In patients with DCIS,
radial US is particularly useful for depicting
intraductal masses and evaluating the ductal
extent of disease, whereas anti-radial US is
more helpful for evaluating the surface characteristics
of the mass [9]. We add to perfect US
technique for assessment of retroareolar area,
excessive gel and gentle pressure to see mass
inside the duct.
Cancer risk from nipple discharge is reported
to be anywhere from 1.3% to 47% [10]. The
incidence of malignancy in this study was 5.6%
in addition to 2.8% precancerous condition
likely hyperplasia and atypia.
In this study, masses of intraductal carcinoma
are relatively hypoechoic compared to benign
cases, this coincides with those who reported
that ultrasound appearance of non-screening
detected intraductal carcinoma is relatively
isoechoic in comparison with invasive carcinoma
[10], regarding shape; oval shaped masses
proved in this study to be papillomas but assessment
of margins, was not a point of differentiation,
as in two cases of atypia which showed
macro-lobulated outline and in two cases of