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Objective:To explore the diagnostic value of magnetic resonance imaging (MRI) for patients with pathologic nipple discharge.Methods:A retrospective analysis was made on patients with nipple discharge who underwent breast MRI and surgical excision between Oct 2010 to Oct 2020. Sensitivity, speci?city, positive predictive value, and negative predictive value of MRI were calculated.Results:A total of 184 patients fulfilled our selection criteria, including breast cancer in 43 cases (23.4%), intraductal papilloma in 96 cases (52.2%) and other benign diseases in 45 cases (24.5%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI for intraductal lesions of pathologic nipple discharge were respectively 76.8%, 52.2%, 82.8% and 42.9%. The sensitivity, specificity, PPV and NPV of MRI for pathologic malignant nipple discharge were respectively 97.7%, 41.1%, 33.6% and 98.3%. Among the 43 cases of breast cancer, 10 cases (23.3%) were occult malignancy with negative ultrasound and mammography and malignant lesions were detected by MRI. The sensitivity, specificity, PPV and NPV of MRI for occult malignancy were 81.8%, 53.7%, 24.4%, and 97.3%.Conclusion:MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge, especially when conventional imaging is negative .
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Objective To evaluate the long-term safety of sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue in breast cancer patients.Methods 198 breast cancer patients with clinical negative axillary lymph node received sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue.Patients were followed up and regional lymph node recurrence,disease free survival(DFS) and overall survival(OS) were analyzed.Results After a median follow-up of 70 months,2 patients had ipsilateral lymph node recurrence with a regional lymph node recurrence rate of 1％ (2/198).14 patient had recurrence or metastasis and 6 patients died of distant metastasis.The estimated 6 years DFS was 94.4％ and OS was 96.5％.The incidence of arm lymphoedema within patients who received axillary lymph node dissection was 4.5％ and it was 2.5％ in patients who received sentinel lymph node biopsy.Conclusions The sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue was safe and reliable method for further staging axillary lymph node stastus.
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Objective:To evaluate the frequency and predictive factors of nipple involvement in a large contemporary cohort of pa-tients and to improve patient selection for the preservation of the nipple-areolar complex. Methods: This retrospective study re-viewed the medical charts of 1,190 patients who underwent traditional mastectomy in Peking University People's Hospital between October 2008 and March 2014. Nipple involvement incidence was compared between the cases of clinically abnormal and clinically normal breasts. Other clinicopathological features and nipple status were analyzed to evaluate the association between these factors and occult nipple involvement. Univariate and multivariate analyses were conducted to identify predictive factors. Results:Nipple in-volvement was detected in 6.0%of the mastectomy specimens. Meanwhile, incidence was 40.7%(22 out of 54) in clinically abnormal nipple cases and 4.3%(49 out of 1,136) in clinically normal nipple cases (χ2=121.9, P2 cm), lymphovascular invasion, diameter (including carcinoma in situ;≤3.5 and>3.5 cm), T stage, N stage, and TNM stage were associated with occult nipple involvement. By logistic regression analysis, tumor location, tumor to nipple distance, T stage, and N stage were determined to be the independent predictors of nipple involvement. Conclusion:Clinical abnormalities of the nipples are reliable and potent predictors of nipple pathology. The cases with peripheral tumor, T1-T2 stage, and N0-N1 stage have lower probability of occult nipple involvement.
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Objective To evaluate the value of fine needle aspiration (FNA) and core needle biopsy (CNB) in highly suspicious breast malignant lesions in terms of diagnostic accuracy,complication rate and cost-effectiveness.Methods We retrospectively reviewed records of patients with imaging diagnosis of BI-RADS 4c or 5 categories who have undergone either FNA or CNB under ultrasound guidance in Peking University People's Hospital from 2012 to 2014.Sensitivity,specificity,diagnostic accuracy,positive predictive,negative predictive,false positive rate,false negative rate,accuracy rate and unsatisfactory rate (non-diagnostic rate) were calculated and compared between FNAC and CNB.The complication of the procedures,operation time and cost were assessed.Results Among 638 consecutive cases,273 of them underwent FNA,and 365 underwent CNB.The accuracy rate of FNA and CNB were 99％ and 97.2％.The sensitivity,specificity,diagnostic accuracy,positive predictive,false positive rate and false negative rate were similar between the two groups.The unsatisfactory rate of FNA was significantly higher than that of CNB (25.3％ vs.10.9％,x2 =22.59,P =0.000).There was not severe complication in either groups,while subcutaneous ecchymosis and hematoma were more common in FNA group than in CNB group.The operation time of FNA was shorter than that of CNB (4.8 ± 1.3 min vs.15.5-± 1.7 min,P =0.000).The waiting time for final pathological report was shorter in patients undergoing FNA (1 vs.3 days).An estimated cost for FNA was RMB 447.5 Yuan/case,whereas that was 995 Yuan/case for CNB.Conclusions FNA and CNB are both accurate and safe preoperative diagnostic procedures.FNA is a simple and cost-effective method.