Abstract:
Managing for sonographic focally thick duct lesions is not established in practice guidelines. Most cases showed scant cells on fine-needle aspiration (FNA). The study aimed to detect any variables that could predict proliferative lesions of the ducts and avoid unnecessary biopsies. A retrospective cohort design was done to analyze the association between ultrasound (US) variables and the outcome of proliferative or non-proliferative ductal lesions, determined by corresponding histopathology or cytology on consecutive follow-ups for at least three years. The data collection from 2015-2017 at King Chulalongkorn Memorial Hospital showed that 199 female patients with 210 index lesions met the eligibility criteria, 56.3% were the patients on screening (setting#1), 22.1% were examined for symptomatic lesions (setting#2), and 21.6% were treated breast cancer in follow-up (setting#3). The patients' age was categorized into <50 and ≥50 years old with a ratio of 53:47. The presence of the six associated US parameters was as follows; internal nodularity (65.7%), mixed echoic wall (41.0%), location at the periphery (69.0%), vascularity (35.2%), calcification (39.5%), and mean diameter of 4.50 (SD 1.43) mm. Of the final outcome, 71 cases had proliferative ductal lesions (18 of which were malignant). The non-proliferative disease was found in 66.2% of cases (52.4% yielded scanty cells on FNA). The regression model depicted vascularity as the single fixed predictor with an odds of 2.21 (95%CI 1.16, 4.19). The age cutoff at 50 and settings#2, #3 categories did not fit well when added to the model with OR of 1.17 (95%CI 0.62, 2.22), 1.87 (95%CI 0.90, 3.87), 0.55 (95%CI 0.23, 1.30), respectively. In conclusion, feeding vessels are a pertinent parameter to be a predictor of proliferative lesions. Focally thick ducts without associated parameters seem not worrisome, and only observation is merited.
