Share this content in WeChat
Experience Exchange
Pathological nipple discharge: A comparative study of galactography and MRI
SHEN Xia  MO Rongguang  ZHOU Zhiqin  JIANG Guoyuan 

Cite this article as: SHEN X, MO R G, ZHOU Z Q, et al. Pathological nipple discharge: A comparative study of galactography and MRI[J]. Chin J Magn Reson Imaging, 2023, 14(6): 75-81. DOI:10.12015/issn.1674-8034.2023.06.012.

[Abstract] Objective To compare the diagnostic value of galactography (GL) and MRI in patients with pathological nipple discharge (PND) and differential for benign and malignant lesions.Materials and Methods Forty-eight breasts with nipple discharge in 45 cases were analyzed retrospectively. The discharge was bloody in 25 cases, yellow or yellowish in 10 cases, serous in 7 cases, watery in 4 cases, brown in 2 cases. GL and MRI were performed in all cases, and pathological findings were used as the gold standard. When breast cancer, ductal papilloma and atypical hyperplasia, Breast Imaging Reporting and Data System (BI-RADS) 4-5, BI-RADS 5 were selected as positive findings, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the two diagnostic techniques for PND were compared.Results There were 48 breast lesions in 45 cases. The pathological results showed that there were 7 cases of malignant lesions, all of which were unilateral, including 2 cases of invasive ductal carcinoma, 5 cases of ductal carcinoma in situ with microinvasion and 41 cases of benign lesions. GL for the accury diagnosis of PND (breast cancer, ductal papilloma, dysplasia), sensitivity, specificity, positive predictive value, negative predictive value was 97.05%, 28.57%, 76.74%, 80.00% and 77.08%; MRI were 91.17%, 50.00%, 81.57%, 70.00% and 79.16%. When BI-RADS category 4-5 was designated as a positive finding, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GL diagnosis were 100.00%, 12.19%, 16.27%, 100.00%, 25.00%; MRI was 100.00%, 24.39%, 18.42%, 100.00%, 35.41%. When BI-RADS category 5 was designated as a positive finding, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GL diagnosis were 42.85%, 97.56%, 75.00%, 90.90%, 89.58%; MRI was 85.71%, 95.12%, 75.00%, 97.50%, 93.75%. The χ2 test was used for the comparison of rates between populations, and the difference between the two was not statistically significant (P>0.05). However, the sensitivity of MRI for breast cancer (85.71%) was significantly higher than that of GL (42.85%), and its accuracy was 93.75% and 89.58%.Conclusions GL and MRI have high accuracy in the diagnosis of PND, and MRI is better than GL in the evaluation of breast cancer.
[Keywords] pathological nipple discharge;breast cancer;differential diagnosis;galactography;magnetic resonance imaging

SHEN Xia   MO Rongguang   ZHOU Zhiqin   JIANG Guoyuan*  

Breast Thyroid Center, the First People's Hospital of Zunyi, Guizhou Province (the Third Affiliated Hospital of Zunyi Medical University), Zunyi 563000, China

Corresponding author: Jiang GY, E-mail:

Conflicts of interest   None.

Received  2022-10-18
Accepted  2023-05-18
DOI: 10.12015/issn.1674-8034.2023.06.012
Cite this article as: SHEN X, MO R G, ZHOU Z Q, et al. Pathological nipple discharge: A comparative study of galactography and MRI[J]. Chin J Magn Reson Imaging, 2023, 14(6): 75-81. DOI:10.12015/issn.1674-8034.2023.06.012.

Breast cancer Expert Committee of National Cancer Quality Control Center, Health Management Professional Committee of Beijing Breast Disease Prevention and Treatment. Comprehensive management guideline for breast cancer follow-up and healthcare (2022 edition)[J]. Chin J Oncol, 2022, 44(1): 1-28. DOI: 10.3760/cma.j.cn112152-20211029-00798.
NEMER A AL, KUSSAIBI H. The accuracy of nipple discharge cytology in detecting breast cancer[J]. Diagnosis (Berl), 2021, 8(2): 269-273. DOI: 10.1515/dx-2020-0026.
FILIPE M D, PATULEIA S I S, DE JONG V M T, et al. Network meta-analysis for the diagnostic approach to pathologic nipple discharge[J/OL]. Clin Breast Cancer, 2020, 20(6): e723-e748 [2023-5-11]. DOI: 10.1016/j.clbc.2020.05.015.
Chinese Society of Clinical Oncology, breast cancer Diagnosis and Treatment Guidelines(2022)[J].Chin J Ration Drug Use, 2022, 19(10): 1-26. DOI: 10.3969/j.issn.2096-3327.2022.10.001
MANGANARO L, D'AMBROSIO I, GIGLI S, et al. Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography[J/OL]. Biomed Res Int, 2015, 2015: 806368 [2022-10-17]. DOI: 10.1155/2015/806368.
ISTOMIN A, MASARWAH A, PITKÄNEN M, et al. Galactography is not an obsolete investigation in the evaluation of pathological nipple discharge[J/OL]. PLoS One, 2018, 13(10): e0204326 [2022-10-17]. DOI: 10.1371/journal.pone.0204326.
BERNÁ-SERNA J D, TORRES-ALES C, BERNÁ-MESTRE J D, et al. Role of galactography in the early diagnosis of breast cancer[J]. Breast Care, 2013, 8(2): 122-126. DOI: 10.1159/000350779.
YANG Y, WANG S, TONG F Z, et al. Value of magnetic resonance imaging in diagnosis of pathological nipple discharge[J]. Chin J Gen Surg, 2021, 36(8): 575-578. DOI: 10.3760/cma.j.cn113855-20210403-00217.
YING X X, ZHU Z H, LIN Y P, et al. Evaluation of suspicious nipple discharge by magnetic resonance mammography[J]. J Surg Concepts Pract, 2010, 15(5):482-485. DOI: 10.16139/j.1007-9610.a2544.
BAYDOUN S, GONZALEZ P, WHITMAN G J, et al. Is ductography still warranted in the 21st century?[J]. Breast J, 2019, 25(4): 654-662. DOI: 10.1111/tbj.13302.
GUPTA D, MENDELSON E B, KARST I. Nipple discharge: current clinical and imaging evaluation[J]. AJR Am J Roentgenol, 2021, 216(2): 330-339. DOI: 10.2214/AJR.19.22025.
PAULA I B D, CAMPOS A M. Breast imaging in patients with nipple discharge[J]. Radiol Bras, 2017, 50(6): 383-388. DOI: 10.1590/0100-3984.2016.0103.
YILMAZ R, BENDER Ö, ÇELIK YABUL F, et al. Diagnosis of nipple discharge: value of magnetic resonance imaging and ultrasonography in comparison with ductoscopy[J]. Balkan Med J, 2017, 34(2): 119-126. DOI: 10.4274/balkanmedj.2016.0184.
BERGER N, LUPARIA A, DI LEO G, et al. Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: a systematic review and meta-analysis[J]. AJR Am J Roentgenol, 2017, 209(2): 465-471. DOI: 10.2214/AJR.16.16682.
Breast Cancer Professional Committee of Chinese Anti-Cancer Association. Guidelines and norms for the diagnosis and treatment of breast cancer by Chinese Anti-Cancer Association (2021 edition)[J].China Oncology, 2021, 32(8):770-856.
蒋国元, 李廷超, 邱毅, 等. 高场MRI对乳腺X线摄影可疑钙化良、恶性病变的鉴别诊断[J]. 重庆医学, 2015, 44(27): 3818-3822. DOI: 10.3969/j.issn.1671-8348.2015.27.024.JIANG G Y, LI T C, QIU Y, et al. 高场MRI对乳腺x线摄影可疑钙化良,恶性病变的鉴别诊断[J]. Chongqing Med, 2015, 44(27): 3818-3822. DOI: 10.3969/j.issn.1671-8348.2015.27.024.
MEYER H J, MARTIN M, DENECKE T. DWI of the Breast-Possibilities and Limitations[J]. Rofo, 2022, 194(9): 966-974. DOI: 10.1055/a-1775-8572.
LEE S A, LEE Y, RYU H S, et al. Diffusion-weighted breast MRI in prediction of upstaging in women with biopsy-proven ductal carcinoma in situ[J]. Radiology, 2022, 305(1): E60. DOI: 10.1148/radiol.229018.
ZHAO G J, FU K, GUO L L,et al. The value of dynamic contrast enhancement curve and early enhancement rate of 3.0T magnetic resonance imaging in the differential diagnosis of benign and malignant breast lesions[J].Chin J Exper Diagn, 2013, 17(1): 72-75.
WU X D, DONG S Y. Diagnosis and treatment of breast diseases[M]. 2nd ed. Beijing: People's Medical Publishing House, 2009: 167.
WU E H, FENG G S. Medical imaging[M]. 6th ed. Beijing: People's Medical Publishing House, 2008: 54.
LUO R, CHEN H S, HE H H, et al. Application of galactography in the diagnosis of breast cancer with nipple discharge[J]. Radiol Pract, 2012, 27(10): 1086-1088. DOI: 10.3969/j.issn.1000-0313.2012.10.012.
MORROGH M, MORRIS E A, LIBERMAN L, et al. The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge[J]. Ann Surg Oncol, 2007, 14(12): 3369-3377. DOI: 10.1245/s10434-007-9530-5.
JIANG G Y, ZHOU Z Q, QIU Y, et al. MRI study of intermediate calcification of breast[J]. J Pract Med, 2016, 32(2): 248-251. DOI: 10.3969/j.issn.1006-5725.2016.02.024
ZACHARIOUDAKIS K, KONTOULIS T, VELLA J X, et al. Can we see what is invisible? The role of MRI in the evaluation and management of patients with pathological nipple discharge[J]. Breast Cancer Res Treat, 2019, 178(1): 115-120. DOI: 10.1007/s10549-019-05321-w.
BAHL M, GADD M A, LEHMAN C D. JOURNAL CLUB: diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge[J]. AJR Am J Roentgenol, 2017, 209(6): 1404-1410. DOI: 10.2214/AJR.17.18139.
PANZIRONI G, PEDICONI F, SARDANELLI F. Nipple discharge: the state of the art[J/OL]. BJR Open, 2019, 1(1): 20180016 [2023-5-11]. DOI: 10.1259/bjro.20180016.
BOISSERIE-LACROIX M, DOUTRIAUX-DUMOULIN I, CHOPIER J, et al. Diagnostic accuracy of breast MRI for patients with suspicious nipple discharge and negative mammography and ultrasound: a prospective study[J]. Eur Radiol, 2021, 31(10): 7783-7791. DOI: 10.1007/s00330-021-07790-4.
SAMREEN N, MADSEN L B, CHACKO C, et al. Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings[J/OL]. Br J Radiol, 2021, 94(1120): 20201013 [2023-05-11]. DOI: 10.1259/bjr.20201013.
SCHULZ-WENDTLAND R, PREUSS C, FASCHING P A, et al. Galactography with tomosynthesis technique (galactomosynthesis) - renaissance of a method?[J]. Geburtshilfe Frauenheilkd, 2018, 78(5): 493-498. DOI: 10.1055/a-0594-2277.
MOSCHETTA M, DE RUVO V, DRAGO A, et al. DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge[J/OL]. Eur Radiol Exp, 2020, 4(1): 40 [2022-01-10]. DOI: 10.1186/s41747-020-00170-5.

PREV The Value of compressed sensing 3D MRI sagittal T2 weighted imaging-spectral attenuated in-version recovery to display the anterior talofibular ligament
NEXT Complete hydatidiform mole and coexisting fetus with pulmonary metastases: One case report

Tel & Fax: +8610-67113815    E-mail: