Diagnostic performance of abbreviated breast MRI in differentiating intraductal papilloma from ductal secretion

To evaluate the diagnostic efficacy of abbreviated breast magnetic resonance imaging (AB-MRI) in aiding the differentiation of intraductal papilloma (IDP) from ductal secretion, as compared to full diagnostic breast magnetic resonance imaging (FDB-MRI).

This retrospective study included patients who underwent breast MRI between June 2016 and January 2024 due to inconclusive ultrasonographic findings suggestive of IDP or ductal secretions, A total of 62 patients were analyzed with histopathological results used as the reference standard. Two radiologists independently reviewed the AB-MRI protocols in a blinded manner. These protocols included fat-suppressed precontrast T1, first postcontrast T1, and subtracted images derived from the FDB-MRI. After a one-week interval, the same radiologists evaluated the FDB-MRI examinations in a separate session, blinded to the AB-MRI results. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Interobserver agreement for AB-MRI, as well as agreement between AB-MRI and FDB-MRI interpretations, were analyzed using Cohen's kappa test.

The mean age of the 62 patients was 46.05 ± 11.59 years, Histopathological results identified 48 IDPs, 6 cases of adenosis and fibrosis, and 8 cases of ductal secretions. The FDB-MRI demonstrated high sensitivity (87.5 %) and PPV (85.7 %) for IDP detection but limited specificity (50 %) and NPV (53.85 %). The comparison between FDB-MRI and pathology did not reveal a statistically significant difference (p > 0.05). The diagnostic performance of AB-MRI was observer-dependent; for Observer 1, sensitivity and specificity were 75.0 % and 57.1 %, respectively, with no significant difference compared to pathology (p = 0.0525) or FDB-MRI (p = 0.124). For Observer 2, sensitivity and specificity were 66.67 % and 57.14 %, also not significantly different from pathology (p = 0.1945) or FDB-MRI (p = 0.347). Interobserver agreement was high (Cohen's Kappa = 0.79) CONCLUSION: The AB-MRI protocol demonstrated moderate-to-high diagnostic performance and high interobserver agreement as a time-efficient alternative. While the FDB-MRI remains superior in sensitivity and diagnostic accuracy, AB-MRI offers a reasonable alternative in clinical scenarios where shorter imaging time is prioritized, such as in the differentiation of IDPs from ductal secretions.