Breast Discharge: Ultrasound and Doppler Evaluation - NCI

Breast Discharge: Ultrasound & Doppler Evaluation
papilloma irregular outline was encountered.
Other authors reported that An oval or lobulated
shape was found more frequently in intraductal
carcinoma than in invasive carcinomas [11].
In malignant cases diagnosed in this study,
no microcalcification could be seen in mammography
even in the case of invasive duct
carcinoma. The microcalcifications were obscured
by dilated duct proximal to mass. Mammographic
detection of DCIS lesions without
microcalcifications may be quite difficult, especially
in dense breasts. At US, most DCIS
lesions without calcifications manifest as single
or multiple hypoechoic masses without a
pseudocapsule. Ductal extension is sometimes
seen. It is easier to visualize noncalcified DCIS
lesions than calcified DCIS lesions at US because
of their hypoechogenicity, but they can
also be misinterpreted as benign nodules due
to their roundness and well-circumscribed margins.
Posterior acoustic enhancement may be
seen in large masses. DCIS lesions without
calcifications may manifest as a solid or cystic
mass with solid component [12]. Diagnosis of
non-calcified DCIS by mammography is not an
easy task due to the lack of typical malignant
calcifications or masses. High resolution ultrasound
can be useful for detecting non-calcified
DCIS [13].
In the study of Yang and TSI in 2004, Color
power Doppler sonography revealed a positive
signal in 22 (69%) of 32 patients in whom it
was performed, so they concluded that it is not
discriminating feature [14]. In the contrary, in
our study all cases with intraductal masses
showed different pattern of vascularity. So it
was highly sensitive and specific (100%) in
discriminating between solid masses and inspissated
secretions. Vessel arrangement helped in
differentiating benign from malignant masses.
In this study, ultrasound guided ductoscopy
in three cases facilitated lesion delineation. The
size of the mass and its distance from the nipple
was comparable. Mammary endoscopy (ductoscopy)
is a recently introduced technique, which
may allow more precise identification and delineation
of intraductal disease but is not currently
a standard practice among most surgeons.
Ductoscopy has been reported to result in improved
localization of intraductal lesions [15].
269
We concluded that ultrasound examination
is highly sensitive(100%) but less specific
(82.4%) in diagnosis of intraductal pathology.
Colour & power Doppler are sensitive (94%)
in detecting flow in intraductal echogenic masses
to differentiate them from insipissated secretions.
Colour & power Doppler raises specificity
and diagnostic accuracy to 100%. Ultrasonography
is a mandatory complement to mammography
in these cases. US guided fine needle
biopsy is minimally invasive technique in confirming
the diagnosis of suspicious mass. Ultrasound
may also be a guide to fibro-optic ductoscope.
Ductography is an underused procedure
that is sensitive (100%) but less specific (60%)
in characterization of intraductal filling defects.
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