J Breast Cancer.  2010 Mar;13(1):19-26. 10.4048/jbc.2010.13.1.19.

Sonographic Findings of Mammary Duct Ectasia: Can Malignancy be Differentiated from Benign Disease

• Kim KW
• Cho KR
• Seo BK
• Whang KW
• Woo OH
• Oh YW
• Kim YH
• Bae JW
• Park YS
• Hwang CM
• Lee MS
• Kim KI

• KMID: 2286555
• DOI: http://doi.org/10.4048/jbc.2010.13.1.19

Abstract

PURPOSE
This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia.
METHODS
From January 2003 to June 2005, 54 surgically proven mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features.
RESULTS
Of the 54 lesions, 46 lesions were benign and eight lesions were malignant. Benign lesions included an inflammatory change (n=7), ductal epithelial hyperplasia (n=7), fibrocystic change (n=18), intraductal papilloma (n=11), atypical ductal hyperplasia (n=2) and sclerosing adenosis (n=1). Malignant lesions included ductal carcinoma in situ (DCIS) (n=6), infiltrating ductal carcinoma (n=1) and mucinous carcinoma (n=1). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia.
CONCLUSION
For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.

Keyword

Breast; Breast neoplasms; Diagnosis; Mammary ultrasonography

MeSH Terms

Adenocarcinoma, Mucinous
Biopsy
Breast
Breast Neoplasms
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Dilatation, Pathologic
Hyperplasia
Papilloma, Intraductal
Ultrasonography, Mammary

Figure

• 

  Figure 1 A 44-yr-old-woman without symptom and moderate to florid ductal epithelial hyperplasia. (A) Transverse (left) and longitudinal (right) scans of US reveal a well defined duct ectasia with intraductal homogeneous echogenecity (arrows) in the subareolar area of the left breast. An echogenic intraductal nodule (arrowhead) is shown with no evidence of intraductal calcification. (B) A photomicrograph demonstrates protruding ductal epithelial hyperplasia (arrow) and the hyperplastic epithelial gland, with moderate to florid ductal epithelial hyperplasia (arrowhead) (H&E stain, ×200).

• 

  Figure 2 A 49-yr-old woman with left bloody nipple discharge and intraductal papilloma and ductal epithelial hyperplasia. (A) Radial (left) and antiradial scans (right) of the left central duct demonstrate an isoechoic intraductal nodule (arrows) within well defined duct ectasia. The intraductal echogenicity is homogeneous with no abnormal ductal wall thickening. (B) A papillary projected papilloma (arrow) is well depicted on a histological examination (H&E stain, ×200).

• 

  Figure 3 A 34-yr-old woman with a palpable lump in the right breast and comedo type DCIS. (A) Radial (left) and antiradial scans (right) of US show ill defined duct ectasia filled with intraductal heterogeneous echogenecities and intraductal nodules in the peripheral portion (5 cm apart from the nipple) of the right breast. There is an associated ductal wall thickening (arrows). (B) A photomicrograph demonstrates tumor cells that invade the epithelium and basement membrane (arrows) as well as central necrosis (H&E stain, ×200).

• 

  Figure 4 A 41-yr-old-woman with bloody nipple discharge from the left breast and cribriform DCIS. (A) Radial (left) and transverse (right) scans of US depict ill defined central duct ectasia with intraductal heterogeneous echogenicities. Associated intraductal nodules and calcifications (arrows) are well seen and irregular ductal wall thickening is prominent (arrowheads). (B) On a histological examination, tumor cells invade the ductal epithelium and basement membrane (arrows) (H&E stain, ×200).

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  Figure 5 A 52-yr-old-woman with a palpable lump in the right breast and a mucinous carcinoma with infiltrating ductal components. (A) On US, several aggregated cysts with ill-defined duct ectasia are noted in the peripheral ducts (5 cm apart from the nipple) of the right breast. Intraductal heterogeneous hypoechogenicities with ductal wall thickenings (arrows) and a surrounding hypoechoic parenchymal change (arrowheads) are also demonstrated. (B) A photomicrograph demonstrates floating tumor cells (arrow) within the mucin pool (arrowheads) and associated infiltrating tumor cells (double arrows) (H&E stain, ×100).

Reference

1. Bassett LW. Imaging of breast masses. Radiol Clin North Am. 2000. 38:669–691.

2. Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 1995. 196:123–134.

3. Mendelson EB, Berg WA, Merritt CR. Toward a standardized breast ultrasound lexicon, BI-RADS: ultrasound. Semin Roentgenol. 2001. 36:217–225.

4. Hou MF, Huang TJ, Liu GC. The diagnostic value of galactography in patients with nipple discharge. Clin Imaging. 2001. 25:75–81.

5. Cardenosa G, Eklund GW. Benign papillary neoplasms of the breast: mammographic findings. Radiology. 1991. 181:751–755.

6. Kopans DB. Kopans DB, editor. Histologic, pathologic, and image correlation. Breast Imaging. 2007. 3rd ed. Philadelphia: Lippincott Williams & Wilkins;783–888.

7. Leis HP Jr. Management of nipple discharge. World J Surg. 1989. 13:736–742.

8. Oh KK, Park YH, Ji H, Park CY. Values of contrast galactography in nonlactating nipple discharge in Korean women. J Korean Radiol Soc. 1988. 24:782–794.

9. Tabár L, Dean PB, Péntek Z. Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 1983. 149:31–38.

10. Cho N, Oh KK, Cho HY. Galactographic differentiation between malignant and benign disease in patients with pathologic nipple discharge. J Korean Radiol Soc. 2003. 48:511–516.

11. Cho KR, Seo BK, Kim CH, Whang KW, Kim YH, Kim BH, et al. Non-calcified ductal carcinoma in situ: ultrasound and mammographic findings correlated with histological findings. Yonsei Med J. 2008. 49:103–110.

12. Diner WC. Galactography: mammary duct contrast examination. Am J Roentgenol. 1981. 137:853–856.

13. Moon WK, Myung JS, Lee YJ, Park IA, Noh DY, Im JG. US of ductal carcinoma in situ. Radiographics. 2002. 22:269–280.

14. Stavros AT. Silverstein M, editor. Ultrasound of ductal carcinoma in situ. Ductal Carcinoma In Situ of the Breast. 1997. Baltimore: Williams & Wilkins;135–158.

15. Gufler H, Buitrago-Téllez CH, Madjar H, Allmann KH, Uhl M, Rohr-Reyes A. Ultrasound demonstration of mammographically detected microcalcifications. Acta Radiol. 2000. 41:217–221.

16. Cheung YC, Wan YL, Chen SC, Lui KW, Ng SH, Yeow KM, et al. Sonographic evaluation of mammographically detected microcalcifications without a mass prior to stereotactic core needle biopsy. J Clin Ultrasound. 2002. 30:323–331.

17. Soo MS, Baker JA, Rosen EL. Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR Am J Roentgenol. 2003. 180:941–948.

18. Warner JK, Kumar D, Berg WA. Apocrine metaplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 1998. 170:1375–1379.

19. Berg WA. Can clusters of microcysts appropriately be followed? 2002. Radiological Society of North America;abstract #E14-E510.