Sonographic ductal changes and pertinent characteristics that associate with proliferative lesions of breast

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.