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.
[1] 倪韵碧, 谢文杰. 乳腺乳头状病变[J]. 中华病理学杂志,2013,42(11):721-726.
[2] 杨文涛. 乳腺乳头状病变的诊断与鉴别诊断[J]. 诊断病理学杂志,2008,15(4):257-260.
[3] Boufelli G, Giannotti MA, Ruiz CA, et al.Papillomas of the breast: factors associated with underestimation[J]. Eur J Cancer Prev,2018,27(4):310-314.
[4] Kuhl C.The current status of breast MR imaging. PartⅠ. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice[J]. Radiology,2007,244(2):356-378.
[5] Skandarajah A, Field L, Yuen L, et al.Benign papilloma on core biopsy requires surgical excision[J]. Ann Surg Oncol,2008,15(227):2-7.
[6] Jaffer S, Nagi C, Bleiweiss IJ.Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy[J]. Cancer,2009,115(28);37-43.
[7] Cyr AE, Novack D, Trinkaus K, et al.Are we overtrea-ting papillomas diagnosed on core needle biopsy?[J]. Ann Surg Oncol,2011,18(9):46-51.
[8] Maxwell AJ, Mataka G, Pearson JM, et al.Benign papilloma diagnosed on image-guided 14 G core biopsy of the breast: Effect of lesion type on likelihood of malignancy at excision[J]. Clin Radiol,2013,68(4):383-387.
[9] Sohn V, Keylock J, Arthurs Z, et al.Breast papillomas in the era of percutaneous needle biopsy[J]. Ann Surg Oncol,2007,14(29):79-84.
[10] Sydnor MK, Wilson JD, Massey HD, et al.Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy[J]. Radio-logy,2007,242(1):58-62.
[11] Gatta G, Iaselli F, Parlato V, et al.Differential diagnosis between fibroadenoma, giant fibroadenoma and phyllodes tumour: sonographic features and core needle biopsy[J]. Radiol Med,2011,116(6):905-918.
[12] Frederick CK.分叶性肿瘤[M]//薛德彬. 乳腺病理诊断难点.北京:人民卫生出版社, 2011:318.
[13] Sarica O, Uluc F, Tasmali D, et al.Magnetic resonance imaging features of papillary breast lesions[J]. Eur J Radiol,2014,83(3):524-530.
[14] 展颖, 柴维敏, 谭令, 等. 1.5T乳腺专用磁共振诊断乳腺导管内乳头状瘤的应用价值[J]. 外科理论与实践,2012,17(4):366-369.
[15] 阮玫, 赵亚娥, 汪登斌, 等. 乳腺导管内乳头状瘤的乳腺专用磁共振成像表现及其诊断价值[J]. 放射学实践,2013,28(3):341-345.
[16] Zhu Y, Zhang SP, Liu PF, et al.Solitary intraductal papillomas of the breast: MRI features and differentiation from small invasive ductal carcinomas[J]. AJR,2012,199(4):936-942.
[17] Kathinka DK, Sumit R, Andreas S, et al.MRI features of intraductal papiloma of the breast: sheep in wolf's clo-thing[J]. Acta Radiol,2011,52(3):264-272.
[18] Bhatarai N, Kanemaki Y, Kurihara Y, et al.Intraductal papiloma: features on MR ductography using a microscopic coil[J]. AJR Am J Roentgenol,2006,186(1):44-47.
[19] Yildiz S, Toprak H, Ersoy YE, et al.Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of papillary breast lesions[J]. Breast J,2018,24(2):176-179.
[20] Lale D, Naciye S, Pinar B, et al.Differentiation between phyllodes tumors and fibroadenomas based on mammographic sonographic and MRI features[J]. Breast Care,2016,11(2):123-127.
[21] Sana D, Nadia V, Habib R, et al.Diffusion weighted imaging reflects variable cellularity and stromal density present in breast fibroadenomas[J]. Clin Imaging,2016, 40(5):1047-1054.
[22] Wada A, Hayashi N, Endo F, et al.Repeat recurrence and malignant transition of phyllodes tumors of the breast[J]. Breast Cancer,2018(25):736-741.
[23] Kuhl CK.MRI of breast tumors[J]. Eur Radiol,2000,10(1):46-58.
[24] Hochman MG, Oreal SG, Powell CM, et al.Fibroadenomas: MR imaging appearances with radiologic histopatho-logic correlation[J]. Radiology,1997,204(1):123-129.
[25] Kamitani T, Matsuo Y, Yabuuchi H, et al.Differentiation between benign phyllodes tumors and fibroadenomas of the breast on MR imaging[J]. Eur J Radiol,2014,83(8):1344-1349.
[26] 王丽君, 汪登斌, 李志, 等. MRI非肿块样强化对乳腺导管原位癌与导管内乳头状瘤的鉴别诊断[J]. 实用放射学杂志,2013,29(2):215-219.
[27] Tozaki M, Igarashi T, Fukuda K.Breast MRI using the VIBE sequence: clustered ring enhancement in the differential diagnosis of lesions showing non-masslike enhancement[J]. AJR Am J Roentgenol,2006,187(2):313-321.
[28] Kul S, Cansu A, Alhan E, et al.Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors[J]. AJR Am J Roentgenol,2011,196(1):210-217.
