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Retroareolar Intraductal Lesions Detected by Screening Ultrasound in Dense Breasts: Malignancy Rate and Predictive
Su Min Ha1,2,3, Woo Jung Choi4, Heera Yoen1
1Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Objective:
The clinical significance of intraductal lesions detected as primary findings on screening breast ultrasound (US) remains unclear. This study aimed to determine the malignancy rate of retroareolar intraductal lesions detected by supplemental screening breast US in asymptomatic women with mammographically dense breasts and to identify imaging features associated with malignancy.
Materials And Methods:
This multicenter retrospective study included asymptomatic women with dense breasts who had intraductal lesions located in the retroareolar area detected on screening breast US between January 2012 and December 2021. Sonographic and mammographic features were evaluated by three radiologists. Logistic regression analysis was conducted to identify imaging and clinicopathologic factors associated with malignancy. The diagnostic performance of imaging features for predicting malignant retroareolar intraductal lesions was assessed. A reader study was performed to evaluate interreader agreement for sonographic features.
Results:
Among 550 intraductal lesions in 544 women (mean age ± standard deviation, 49.8 ± 9.3 years), 529 (96.2%) were benign, and 21 (3.8%) were malignant. Multivariable analysis demonstrated that a beyond-the-duct appearance (adjusted odds ratio [OR], 11.4; 95% confidence interval [CI], 2.4-53.3; P = 0.002) and the presence of vascularity on color Doppler US (adjusted OR, 10.0; 95% CI, 1.3-76.7; P = 0.027) were independently associated with malignancy. The beyond-the-duct appearance on US demonstrated a sensitivity of 14.3% (3 of 21) and a high specificity of 99.1% (524 of 529). The presence of vascularity on color Doppler US demonstrated a sensitivity of 95.2% (20 of 21) and a low specificity of 41.2% (218 of 529). Interreader agreement for sonographic features ranged from marginal to excellent (lower bounds of the 95% CI for Fleiss' kappa, 0.39-0.89).
Conclusion:
Retroareolar intraductal lesions detected on screening US in women with dense breasts exhibited a low malignancy rate of 3.8%. A beyond-the-duct appearance and the presence of vascularity on color Doppler US were independently associated with malignancy in retroareolar intraductal lesions detected on screening breast US.