Breast Discharge: Ultrasound and Doppler Evaluation - NCI

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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. REFERENCES 1- Azavedo E. Breast, Nipple Discharge Evaluation. e Medicine specialties. Radiology. Breast 10 June. 2005. 2- Baker KS, Davey DD, Stelling CB. Ductal abnormalities detected with galactography: Frequency of adequate excisional biopsy. AJR Am J Roentgenol. 1994, Apr 162 (4): 821-4. 3- Shalmali Pal. Ultrasound continues to make inroads in breast imaging, Aunt Minnie.com. Ultrasound digital community. 2/6/2007. 4- Okazaki A, Hirata K, Okazaki M, Svane G, Azavedo E. Nipple discharge disorders: Current diagnostic management and the role of fiber-ductoscopy. European Radiology. 1999, 9 (4): 583-590. 5- Cho N, Moon WK, Chung SY, Cha JH, Cho KS, Kim EK, et al. Ductographic Findings of Breast Cancer. Korean Journal of Radiology. 2005, March 6 (1): 31- 36. 6- Stavros AT. Non targeted indications: Breast secretions, nipple discharge, and intraductal papillary lesions of the breast. In: Stavros AT, ed. Breast ultrasound, 1 st ed. Philadelphia, Pa: Lippincott Williams & Wilkins. 2004, 157-198. 7- Moon WK, Myung JS, Lee YJ, Park IA, Noh DY, Im JG. US of ductal carcinoma in situ. RadioGraphics. 2002, 22: 269-280. 8- Chung SY, Lee KW, Park KS, Lee Y, Bae SH. Breast tumors associated with nipple discharge. Correlation of findings on galactography and sonography. Clin Imaging. 1995, 19: 165-171. 9- Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: Use of sonography to distinguish between benign and malignant lesions. Radiology. 1995, 196: 123-134. 10- Nelson S, Hoehn JL: Twenty-Year Outcome Following Central Duct Resection for Bloody Nipple Discharge. Ann Surg. 2006, April 243 (4): 522-524.
270 Soha T. Hamed, et al. 11- Chen S-C, Cheung Y-C, Lo Y-F, Chen M-F, Hwang T-L, Su C-H, et al. Sonographic differentiation of invasive and intraductal carcinomas of the breast. British Journal of Radiology. 2003, 76: 600-604. 12- Moon WK, Myung JS, Lee YJ, Park IN, Noh DY, Im YG. US of Ductal Carcinoma In Situ. Radiographics. 2002, 22: 269-281. 13- Cho KR, Seo BK, Kim CH, Whang KW, Kim YH, Kim BH, et al. Non-Calcified Ductal Carcinoma in Situ: Ultrasound and Mammographic Findings Correlated with Histological Findings. Yonsei Med J. 2008, 49 (1): 103-110. 14- Yang WT, Tse GM. K. Sonographic, Mammographic and Histopathologic Correlation of Symptomatic Ductal Carcinoma In Situ AJR. 2004, 182: 101-110. 15- Moncrief RM, Nayar R, Diaz LK, Staradub VL, Morrow M, Khan SA. A Comparison of Ductoscopy- Guided and Conventional Surgical Excision in Women With Spontaneous Nipple Discharge. Ann Surg. 2005, April 241 (4): 575-581.
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