| Backgrounds:Nipple discharge is a common complain encountered by health care providers,accounting for 3%-10%of medical visits by women.it is the second clinical symptoms among surgery.Nipple discharge is usually physiologic or due to a benign etiology and relatively uncommon presenting symptom in breast cancer(5%to 20%).While nearly 90%of women with nipple discharge have benign disease.There is no clear guideline on what differentiates a benign etiology from a malignancy based on clinical or radiographic assessment.There are several common clinical choice workup and finding associated with nipple discharge such as mammography,galactography,ductoscopy,cytology.Mammography is typically recommended for any patient presenting with abnormal nipple discharge.But it always no positive symptoms show in the diagnosis of benign duct pathology while low sensitivity of 57%for malignant duct pathology.And the sensitivity is descended for Chinese women with dense breast.Ductoscopy has limitations for detecting peripheral duct,and it needs local anesthetic.Perforation of the duct is a potential complication.Cytology is not routinely recommended or performed due to a reported low sensitivity for detection of cancer.Ultrasound is used primarily to detect masses and determine whether a palpable or mammographically identified mass is cystic solid,or within a duct.But it can't identify whether the hypoechoic mass is the cause of nipple discharge.Galactography diagnosis intraductal lesions and localizes it when obtaining high contrast mammographic images after the injection of iodine-containing contrast medium into the duct.Breast ultrasound is noninvasive,free of ionizing radiation,and is extremely useful in the evaluation of patients with nipple discharge.There is no solitary accurate-modality to reach our definitive purpose while have neither a palpable mass nor a mammography abnormality.So it is difficult to diagnose and locate and choose treat plan.This clinical study urge to explore a way which combine the advantages of ultrasound and galactography.Objective:The purpose of our study was to evaluate the feasibility and qualitative diagnosis and preoperative localization value of ultrasound galactography apply to patient with suspicious nipple discharge by SonoVue.We want to provide more suitable and comfortable choice to nipple discharge patients.Methods:Twenty patients were recruited from Qilu Hospital of Shandong University from Aug.20th2016 to Fed.30th,2017.Patients underwent conventional galactography and ultrasound galactography after informed consent.Contrast-enhanced ultrasound ductography use SonoVue as the contrast while conventional galactography use Ultravist-300.The basic clinical information were collected,analyzed and arranged by Microsoft office software.Conventional galactography images were analyzed by GICS standard.The gold standard was pathology by surgery.The sensitivity and accuracy and localization effect of two methods were evaluated.SPSS 19.0 statistical software was used for data analysis.Significance was set at P<0.05.Results:1.20 patients had successful ultrasound galactography by using SonoVue as contrast,it shows negative duct and ductal ectasia and filling defect and filing stop and lake form.2.Ultrasound reveling 15 Hypoechoic mass,it shows 8 mass related to nipple discharge by ultrasound galactography.3.Ultrasound galactography detect 7 positive image symptoms which missed diagnosis on conventional ultrasound.These include 6 intraductal papilloma by pathology.4.Preoperative localization of 20 patients were accurately down by ultrasound galactography.5.25 breast lesions were obtained in this study.Two cancer were diagnosed in two women.And other benign lesions were found in 6 cases.Thirteen papilloma and four fibroadenoma were detected.Histology for the remaining six lesions were benign,including ductal ectasia,hyperplasia,adiponecrosis.6.the sensitivity and specificity,positive predictive value and negative predictive value of conventional mammography,ultrasound,conventional galactography,ultrasound galactography were 15%,100%,100%,22.7%;65%,60%,86.7%,30%;80%,40%,84%,33%,60%,90.9%,100%;100%,respectively.7.A pain score on VAS(mean±SD)of ultrasound galactography and conventional galactography were 2.35 ±0.96,2.80±1.07,respectively.The results of the comparison are shown significant difference between two ways.(p<0.05)Conclusions:1.This is entirely feasible to diagnose intra-duct space occupying lesions with pathological nipple discharge with ultrasound galactography using SonoVue2.Ultrasound galactography with SonoVue can be used to delineate the relationship of the hypoechoic mass or solid-cystic mass and abnormal breast duct and increase the detection rate of intra-duct space occupying lesions among the women with pathological nipple discharge.3.Lesions and abnormal duct system can be localized before operation,it is valuable to design surgical incision and mark the pathological tissue.4.Ultrasound galactography with SonoVue should be considered clinically valuable as a practical,non-invasive,free of ionizing radiation,comf-ortable investigatory tool for nipple discharge. |
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