J Breast Cancer.  2016 Sep;19(3):308-315. 10.4048/jbc.2016.19.3.308.

Reliability of Breast Ultrasound BI-RADS Final Assessment in Mammographically Negative Patients with Nipple Discharge and Radiologic Predictors of Malignancy

• Park CJ
• Kim EK
• Moon HJ
• Yoon JH
• Kim MJ

• KMID: 2413956
• DOI: http://doi.org/10.4048/jbc.2016.19.3.308

Abstract

PURPOSE
The purpose of this study was to retrospectively investigate the reliability of breast ultrasound (US) Breast Imaging Reporting and Data System (BI-RADS) final assessment in mammographically negative patients with pathologic nipple discharge, and to determine the clinical and ultrasonographic variables associated with malignancy in this group of patients.
METHODS
A total of 65 patients with 67 mammographically negative breast lesions that were pathologically confirmed through US-guided biopsy were included.
RESULTS
Of the 53 BI-RADS category 4 and 5 lesions, eight (15.1%) were malignant (six ductal carcinomas in situ, one invasive ductal carcinoma, and one solid papillary carcinoma). There was no malignancy among the remaining 14 category 3 lesions. Malignant lesions more frequently displayed a round or irregular shape (75.0%, 6/8; p=0.030) and nonparallel orientation (33.3%, 4/12; p=0.029) compared to the benign lesions. The increase in the BI-RADS category corresponded with a rise in the malignancy rate (p=0.004).
CONCLUSION
The BI-RADS lexicon and final assessment of breast US reliably detect and characterize malignancy in mammographically negative patients with pathologic nipple discharge.

Keyword

Breast neoplasms; Galactorrhea; Mammography; Ultrasonography

MeSH Terms

Biopsy
Breast Neoplasms
Breast*
Carcinoma, Ductal
Female
Galactorrhea
Humans
Information Systems
Mammography
Nipples*
Pregnancy
Retrospective Studies
Ultrasonography*

Figure

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  Figure 1 Flow chart of the study investigating the reliability of breast ultrasound Breast Imaging Reporting and Data System (BI-RADS) final assessment in mammographically negative patients with nipple discharge and radiologic predictors of malignancy. US=ultrasound.

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  Figure 2 Radiologic findings of a 38-year-old woman with a several-week history of spontaneous serous discharge from the right nipple. (A) Mediolateral mammography of the both breast shows dense breasts with no abnormalities to explain right nipple discharge (Breast Imaging Reporting and Data System [BI-RADS] category 1). (B) Longitudinal ultrasound images show a 2.0 cm sized isoechoic, oval shaped, microlobulated mass with parallel orientation which was located at 1 o'clock 2 cm from nipple (BI-RADS category 3). Ultrasound-guided vacuum-assisted biopsy was performed and the pathologic result was consistent with fibrocystic disease with stromal fibrosis. After the procedure, the patient had no persistent nipple discharge, and no malignancy was detected during a 2-year follow-up period.

• 

  Figure 3 Radiologic findings of a 73-year-old woman with a 1-week history of spontaneous bloody discharge from the right nipple. (A) Mediolateral mammography of right breast shows no definite abnormality to explain right bloody nipple discharge. Transverse (B) and longitudinal (C) ultrasound images of the right breast show a 1.0 cm sized isoechoic, irregularly shaped, spiculated mass with nonparallel orientation (Breast Imaging Reporting and Data System category 5) which was located at 8 o'clock 1 cm from nipple. Ultrasound-guided biopsy was performed, and the pathologic result was consistent with ductal carcinoma in situ. Subsequent surgery was performed.

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