The role of magnetic resonance imaging in detection and surgical treatment of breast intraductal papillomas

Na Hao, Xiaoyan Yuan, Quansheng Wang, Junyong Zhu, Yiqiong Zheng, Yanjun Zhang, Mei Liu, Liuquan Cheng, Xiru Li


Background: Intraductal papillomas are discrete benign tumors of the breast duct epithelium. Due to the risk of subsequent carcinoma, a surgical excision is generally recommended as a precaution. However, it is difficult to initially diagnose and accurately locate the lesions both in pre-surgery and surgery periods.
Methods: Retrospectively analyzed 245 patients, with a pathologically proven breast intraductal papillomas. All the patients underwent magnetic resonance imaging (MRI) scans and ultrasound examination(s) pre-surgery and/or in surgery. All the patients who underwent surgery were divided into four groups according to the following operation method type(s): ultrasound & clinical examination excision, methylene blue notation excision, methylene blue notation & MRI guide excision, and MRI guide excision. Then, the differences between the last two MRI guide excisions and the first two conventional methods were analyzed. Afterwards, 238 patients were followed up for recurrence checks. SPSS 19.0 statistical software was used and the results of P<0.05 being considered statistically significant.
Results: A total of 161 (65.7%) and 48 (19.6%) patients were pathological diagnosed of solitary and multiple papilloma separately, and 36 (14.7%) patients had papillomatosis; 168 and 243 cases with positive signs, which were detected in all 245 patients who had underwent ultrasound and MRI examination(s), with the detection rate being 68.6% and 99.0% respectively. MRI imaging could clearly present mass-like lesions (solitary and multiple mass) and non-mass like lesions (ductal and regional). Whereas, ultrasound imaging could barely show mass-like (solitary and multiple mass) lesions. In surgery, when compared with traditional methods, MRI imaging could also more accurately locate the lesions and guide the excision. MRI guidance is both applicable to patients with and without nipple discharge, in addition to those who show no abnormal signs in ultrasound imaging. The recurrence-free survival time with traditional surgery methods was significantly lower than those in the MRI guide groups.
Conclusions: MRI is accurate at the detection, localization and resection range of intraductal papilloma lesions; all capabilities which are critical to successful breast surgery.