Clinical and sonographic features of nipple lesions

Medicine (Baltimore). 2020 Apr;99(15):e19728. doi: 10.1097/MD.0000000000019728.

Abstract

Background: The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis.

Methods: A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features.

Results: There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05).

Conclusions: The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.

Publication types

  • Comparative Study

MeSH terms

  • Adenoma / pathology
  • Adult
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Calcinosis / pathology
  • Diagnosis, Differential
  • Female
  • Fibrocystic Breast Disease / pathology
  • Humans
  • Leiomyoma / pathology
  • Male
  • Mastitis
  • Middle Aged
  • Nipples / blood supply*
  • Nipples / diagnostic imaging*
  • Nipples / pathology
  • Paget's Disease, Mammary / pathology
  • Pain / diagnosis
  • Plasma Cells / pathology
  • Predictive Value of Tests
  • Retrospective Studies
  • Ultrasonography / methods*
  • Ultrasonography / trends
  • Warts