Abstract

The nipple-areola complex is a region of the breast that has unique characteristics. Due to its special structural features, the lesion of nipple is major part of breast disease and disease treatment. Most patients with nipple pathologies present with the associated symptoms upon clinical examination like nipple discharge, nipple retraction, nipple inversion and changes in nipple skin, shape, volume, and symmetry. There are many different benign, malignant and congenital lesions in the nipple. Malignant lesion includes Paget’s disease, invasive ductal carcinoma and benign lesion includes adenoma, Leiomyoma, papilloma, abscess, warts, inflammation etc. Objectives: The aim of this study was to study the USG & mammographic findings in patients presenting with nipple pathologies and to elicit the sensitivity, specificity and diagnostic efficacy of mammography and ultrasonography in the presence or absence of nipple lesion in patients with nipple pathologies like pathological nipple discharge, nipple retraction, nipple inversion, skin changes. Methods: 100 patients who presented with nipple pathologies & associated clinical symptoms like nipple discharge were included in the study. Patients had undergone mammography and ultrasound and their imaging features were analysed as per ACR BI-RADS lexicon 5th edition. The lesions were classified as benign or malignant based on histopathology. Results: In our study38% of the total patients were found malignant; who were having nipple pathologies like nipple discharge, nipple retraction ; and 62% of the total patients were found benign. Involvement of nipple areola complex among malignant lesions was seen in 20% cases on mammogram and 29% cases on USG. USG is more sensitive than mammography for detection of involvement of NAC. Breast masses having spiculated margins, angular margins and micro lobulations indicated a malignant pathology on both mammogram and USG. The negative predictive value of USG in detecting malignancy amongst patients with nipple discharge, nipple retraction and nipple inversion was slightly higher than mammography (100% vs. 88.24%) and associated with higher sensitivity of USG (100% vs. 94.74%) but less specific as compared with mammography (66.18%vs. 54.55%).

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