DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge
Marco Moschetta1, Vincenzo De Ruvo2, Angelica Drago3
1DETO-Department of Emergency and Organ Transplantation-Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy. marco.moschetta@gmail.com.
Insights
Digital breast tomosynthesis (DBT)-galactography offers superior diagnostic performance for detecting intraductal breast lesions compared to full-field digital (FFD)-galactography. This advancement improves diagnostic accuracy for patients experiencing pathological nipple discharge.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Nipple discharge is a common concern, often necessitating further investigation to rule out malignancy.
- Conventional full-field digital (FFD)-galactography has limitations in detecting subtle intraductal breast lesions.
- Digital breast tomosynthesis (DBT) offers improved visualization of breast tissue, potentially enhancing galactography's diagnostic capabilities.
Purpose of the Study:
- To compare the diagnostic performance of DBT-galactography versus FFD-galactography in identifying intraductal breast lesions.
- To evaluate the sensitivity, specificity, and accuracy of both imaging techniques in patients with spontaneous nipple discharge.
Main Methods:
- An intra-individual study design was employed, comparing DBT- and FFD-galactography within the same patient cohort.
- Forty-nine patients with inconclusive mammography and ultrasound underwent a combined FFD- and DBT-galactography procedure.
- Two experienced breast radiologists independently analyzed the galactography images, with histological examination serving as the reference standard.
Main Results:
- DBT-galactography demonstrated significantly higher sensitivity (95%) and accuracy (96%) compared to FFD-galactography (77% and 80%, respectively).
- Both techniques showed 100% specificity in detecting intraductal lesions.
- Inter-observer agreement was higher for DBT-galactography (0.86) than for FFD-galactography (0.78).
Conclusions:
- DBT-galactography significantly improves the detection of intraductal breast findings compared to FFD-galactography.
- This enhanced diagnostic capability of DBT-galactography leads to more reliable diagnoses in patients with pathological nipple discharge.
Background:
Our aim was to compare the diagnostic performance of digital breast tomosynthesis (DBT)-galactography with that of full-field digital (FFD)-galactography for detecting intraductal breast lesions using an intra-individual design.
Methods:
Forty-nine consecutive patients with spontaneous, unilateral, single-pore nipple discharge and inconclusive FFD mammography and ultrasonography underwent galactography with a "COMBO" technique combining FFD- and DBT-galactography acquisitions. Examinations were independently analysed by two breast radiologists with 10-year experience. Sensitivity, specificity, and accuracy for both FFD- and DBT-galactography were calculated having histological examinations of surgical specimens as a reference standard. Data were presented as percentages with their 95% confidence intervals (CI). McNemar test was used. Interobserver agreement was assessed by using Cohen κ test for both techniques.
Results:
Sensitivity was 41/43 (95%, 95% CI 84.2-99.4) for DBT-galactography and 33/43 (77%, 95% CI 61.4-88.2) for FFD-galactography (p = 0.008), specificity 6/6 (100%, 95% CI 54.1-100.0) for both imaging tools, accuracy 47/49 (96%, 95% CI 86.0-99.5) and 39/49 (80%, 95% CI 65.7-89.8) (p = 0.038), respectively. The inter-observer agreement was 0.86 for DBT-galactography and 0.78 for FFD-galactography. The AGD resulted to 1.94 ± 0.64 for the combined technique.
Conclusion:
DBT-galactography showed a significantly higher sensitivity and accuracy than FFD-galactography for the identification of the intraductal findings, improving the possibility of a reliable diagnosis in patients with pathologic nipple-discharge.
