Korean Journal of Radiology

  • 제23권9호
  • /
  • Pages.866-877
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  • 2022
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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The Value of Adding Ductography to Ultrasonography for the Evaluation of Pathologic Nipple Discharge in Women with Negative Mammography

  • Younjung Choi (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Sun Mi Kim (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Mijung Jang (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bo La Yun (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Eunyoung Kang (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Eun-Kyu Kim (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • So Yeon Park (Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bohyoung Kim (Division of Biomedical Engineering, Hankuk University of Foreign Studies) ;
  • Nariya Cho (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Woo Kyung Moon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • 투고 : 2020.06.03
  • 심사 : 2022.07.17
  • 발행 : 2022.09.01
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초록

Objective: The optimal imaging approach for evaluating pathological nipple discharge remains unclear. We investigated the value of adding ductography to ultrasound (US) for evaluating pathologic nipple discharge in patients with negative mammography findings. Materials and Methods: From July 2003 to December 2018, 101 women (mean age, 46.3 ± 12.2 years; range, 23-75 years) with pathologic nipple discharge were evaluated using pre-ductography (initial) US, ductography, and post-ductography US. The imaging findings were reviewed retrospectively. The standard reference was surgery (70 patients) or > 2 years of follow-up with US (31 patients). The diagnostic performances of initial US, ductography, and post-ductography US for detecting malignancy were compared using the McNemar's test or a generalized estimating equation. Results: In total, 47 papillomas, 30 other benign lesions, seven high-risk lesions, and 17 malignant lesions were identified as underlying causes of pathologic nipple discharge. Only eight of the 17 malignancies were detected on the initial US, while the remaining nine malignancies were detected by ductography. Among the nine malignancies detected by ductography, eight were detected on post-ductography US and could be localized for US-guided intervention. The sensitivities of ductography (94.1% [16/17]) and post-ductography US (94.1% [16/17]) were significantly higher than those of initial US (47.1% [8/17]; p = 0.027 and 0.013, respectively). The negative predictive value of post-ductography US (96.9% [31/32]) was significantly higher than that of the initial US (83.3% [45/54]; p = 0.006). Specificity was significantly higher for initial US than for ductography and post-ductography US (p = 0.001 for all). Conclusion: The combined use of ductography and US has a high sensitivity for detecting malignancy in patients with pathologic nipple discharge and negative mammography. Ductography findings enable lesion localization on second-look post-ductography US, thus facilitating the selection of optimal treatment plans.

키워드

과제정보

The authors would like to thank the Division of Statistics of the Medical Research Collaborating Center at Seoul National University Bundang Hospital for their statistical analyses.

참고문헌

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