Sonographic Findings of Mammary Duct Ectasia: Can Malignancy be Differentiated from Benign Disease?
Journal of Breast Cancer
INTRODUCTION Breast ultrasonography (US) is appropriate for the initial evaluation of women younger than 30 yr with a palpable lump and as an adjunctive method for the evaluation of mammographically detected masses, persistent focal asymmetric densities and palpable abnormalities not seen on mammography.(1) Recently, US has been widely used for screening in women with a dense breast parenchyma. The analysis of US features of solid masses continues to improve, though observer variability remains
... variability remains to be problematic to avoid a biopsy.(2) The American College of Radiology illustrated Breast Imaging Reporting and Data System (BI-RADS) US lexicon is helpful to improve observer performance.(3) BI-RADS defines ductal changes as an abnormal caliber and/or arborization and describes as a change of the surrounding tissue associated with a solid breast mass.(3) However, ductal changes, especially duct ectasia itself, is a frequently encountered finding during a US examination. Although several reports have described the galactographic findings of malignant duct ectasia,(4,5) US findings of duct ectasia have not yet been investigated and there is no morphological criteria suggesting malignant duct ectasia using the BI-RADS US lexicon. Thus, confusion remains in the description and management for this abnormality and radiologists often interpret 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.