Network Meta-analysis for the Diagnostic Approach to Pathologic Nipple Discharge

Area of Science:

• Oncology
• Radiology
• Diagnostic Medicine

Background:

• Pathologic nipple discharge (PND) is a frequent breast complaint, often prompting investigation due to its association with breast cancer.
• Accurate diagnostic methods are crucial for assessing malignancy risk in patients presenting with PND.

Purpose of the Study:

• To conduct a network meta-analysis (NMA) comparing the diagnostic efficacy of ultrasound, mammography, cytology, MRI, and ductoscopy for PND.
• To identify the optimal diagnostic strategy for evaluating malignancy in PND.

Main Methods:

• A systematic literature search was performed across Cochrane Library, PubMed, and Embase up to January 27, 2020.
• Included 36 studies with 3764 patients, utilizing NMA to compare diagnostic values (sensitivity, specificity, accuracy) of various methods.
• A subgroup meta-analysis compared ductoscopy and MRI when conventional imaging was negative.

Main Results:

• MRI demonstrated the highest sensitivity (83%) for malignancy detection, followed by ductoscopy (58%).
• Mammography showed the highest specificity (93%), with ductoscopy close behind (92%).
• Ductoscopy achieved the highest overall diagnostic accuracy (88%), surpassing MRI and cytology, especially when conventional imaging was inconclusive.

Conclusions:

• While ultrasound and mammography serve as cost-effective initial screening tools for PND, ductoscopy exhibits superior diagnostic performance.
• Ductoscopy outperforms MRI and cytology in accuracy for detecting malignancy in PND, offering a valuable diagnostic option.