The additional role of contrast-enhanced ultrasound in identifying lesions in pathological nipple discharge patients: a prospective study comparing with DCE-MRI

Objective To evaluate the auxiliary role of contrast-enhanced ultrasound (CEUS) in the etiological diagnosis of pathological nipple discharge (PND) and compare its effectiveness with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods In this prospective study conducted from March 2021 to February 2024, PND patients underwent breast ultrasound and DCE-MRI after initial history and physical examination. Lesions were categorized as mass or non-mass-like on baseline US and assessed for vascularity using color Doppler. CEUS was utilized to refine the breast imaging reporting and data system (BI-RADS) classification. Logistic regression identified risk factors, and diagnostic performance was evaluated using receiver operating characteristic curve analysis. Results A total of 116 lesions from 112 PND patients were analyzed. CEUS-assisted ultrasound showed increased specificity (ranging from 50.0% to 80.0% compared to US alone, p = 0.009) while maintaining sensitivity. Of the 81 patients who underwent DCE-MRI, CEUS demonstrated a higher positive predictive value (83.3% vs. 75.5%), with comparable negative predictive values (97.0% vs. 96.4%). CEUS was particularly effective in accurately diagnosing benign lesions that were overestimated by DCE-MRI and in identifying ductal carcinoma in situ with greater precision than US alone. Conclusion The auxiliary use of CEUS with ultrasound improves the specificity and positive predictive value in diagnosing PND-associated malignancies and serves as a valuable secondary imaging method to DCE-MRI, potentially reducing unnecessary biopsies of benign lesions. Advances in knowledge CEUS can enhance the diagnostic accuracy of PND, effectively differentiating benign from malignant lesions, and its integration into clinical practice could offer significant benefits in patient management.