DUCTAL DILATATION INSIDE THE PAPILA: A NEW SIGN IN BREAST ULTRASOUND

Camargo Júnior, H. S. A. (CDE Diagnóstico por Imagem, Campinas, SP, Brasil.), Camargo, M. M. A. (CDE Diagnóstico por Imagem, Campinas, SP, Brasil.), Teixeira, S. R. C. (CDE Diagnóstico por Imagem, Campinas, SP, Brasil.), Azevedo, J. (CDE Diagnóstico por I

CDE Diagnóstico por Imagem, Campinas, SP, Brasil.We present a new finding in breast ultrasound that seems to be of clinical relevance in patients who present with pathological nipple discharge (clear or bloody and unilateral). It is the ductal dilatation inside the papilla (DDIP). We first perceived DDIP in 2014 while examining a patient with bloody discharge, without really knowing how to interpret it. After seeing the same finding again in 2016, we started to pay close attention to it. Altogether, we identified DIPP in 15 patients, all of them with pathological breast discharge. Meanwhile, we looked for DDIP in asymptomatic patients, finding it in only one out of 1255 patients. In the patients with pathological discharge, all had different findings inside the extra papillary portion of the ducts, but in two of them these findings were only seen after the detection of the DDIP. In another patient, the DDIP was related to a different ductal branch than the one related to the trigger point, therefore showing the possibility of two branches being compromised by disease. The diagnostic and therapeutic approach to patients with pathological breast discharge can be challenging. Image studies are frequently negative, but that doesn’t exclude the possibility of papilloma or even carcinoma. The specific diagnosis of the ductal branch with is producing the discharge is desirable, since it allows for less extensive surgeries or even percutaneous treatment, usually with vacuum assisted devices. Blind surgical excision of retroareolar ducts, as a matter of fact, can eventually miss peripheral lesions, burying the symptom while not treating the disease. This paper describes a sign that may allow better identification of the problematic duct. All it needs is a special attention to the papilla during the normal breast ultrasound examination, with a few maneuvers. This new sign demonstrated mainly on breast ultrasound might help to identify significant ductal disease in patients with pathological nipple discharge, improving the accuracy of breast ultrasound and permitting more specific, more efficient and less invasive treatment.breast cancer, papilla

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