Differential diagnosis of breast intraductal papilloma from other benign lesion with dynamic contrast-enhanced MRI

doi:10.16139/j.1007-9610.2019.04.013

Abstract

Abstract: Objective To assess the value of magnetic resonance imaging (MRI) in differential diagnosis of breast intraductal papilloma (IDP) from other benign lesions. Methods A retrospective analysis of breast MRI was performed in 96 patients with IDP and 200 patients with other benign lesions of breast. The lesions were detected as MRI BI-RADS category 4 or higher. Time-signal intensity curve and apparent diffusion coefficient (ADC) were achieved from the 1.5T Siemens Aera workstation and were used in differential diagnosis of breast lesions. Results The mean age was (49.9±12.0) years in IDP group and (41.2±11.8) years in other benign lesions group. The enhanced mass lesions with smooth margin were predominated in both groups. Spiculated margin was found in IDP group only. More lesions in IDP group had diameter less than 1 cm and the diameter of other benign lesions was 1-5 cm (P<0.001). The lesions in IDP group presented homogeneous enhancement and located in retroareolar region more than those in other benign group. There were 146 enhanced mass lesions in other benign group and 70 (47.7%) lesions presented dark internal septations which included 64 (60.4%) of 106 fibroadenoma, 3 (60.0%) of 5 benign phyllode tumors and 1 lipoma, 2 adenoma disease. In non mass enhancement lesions, lesions in IDP group tended to appear segmental distribution 57.1% and lesions in other benign group appeared focal distribution 44.4%. Wash-out curve was 44.7% in IDP group and persistent curve was 56.5% in other benign group. Ductal dilation was seen more in IDP group than in other benign group. Mean ADC was [(1.15±0.19) ×10^-3 mm²/s vs (1.30±0.29)×10^-3 mm²/s] in IDP group and other benign group respectively. The best discriminative value of ADC was (1.30×10^-3 mm²/s) and area under the curve 0.710 with the sensitivity 56.5%, specificity 79.2% and accuracy 63.9%. Conclusions There are size, location and enhancement pattern of the mass, the distribution of non mass enhancement, ductal dilation, time-signal intensity curve and ADC values which have value in differential diagnosis of breast IDP from other benign lesions.

Key words: Dynamic contrast-enhanced magnetic resonance imaging, Diffusion weighted imaging, Intraductal papilloma, Benign breast lesion

CLC Number:

R737.9

LI Xinyue, LI Ya, CHAI Weimin. Differential diagnosis of breast intraductal papilloma from other benign lesion with dynamic contrast-enhanced MRI[J]. Journal of Surgery Concepts & Practice, 2019, 24(04): 337-343.

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