Acute nipple inversion can be unsettling for patients and is sometimes associated with an underlying breast malignancy. It also poses a diagnostic challenge with lack of consensus management guidelines. This study reviewed institutional experience with new nipple inversion, including malignant association, imaging utilization, and outcomes, in an effort to improve management. A multisite institutional retrospective review was conducted of all breast imaging reports from 1/2010 to 6/2022 mentioning nipple inversion as an indication or finding. Patients with new nipple inversion, defined as arising since the time of last breast imaging exam or if reported as new by the patient/provider, were included for analysis. Retroareolar imaging findings, BI-RADS assessments/recommendations, pathology obtained from percutaneous or excisional biopsies, and follow-up imaging and clinical exams were collated. Cases of chronic or stable nipple inversion were excluded. Descriptive statistics were performed. A total of 414 patients had new nipple inversion, 387/414 (93.5 %) with benign or negative results at initial imaging and 27/414 (6.5 %) with malignant lesions. Diagnostic mammography/ultrasound detected 25/27 (92.6 %) cancers (sensitivity 92.6 %, specificity 75.5 %, PPV 20.8 %, NPV 99.3 %). Of 62 breast MRI exams performed in patients with negative mammogram/ultrasound, no cancers were detected in the retroareolar space with 2 incidental malignant lesions discovered distant from the nipple. Diagnostic mammography/ultrasound is reliable in workups of acute nipple inversion, with a high sensitivity and NPV for excluding malignancy. Breast MRI and surgical referral should be reserved for patients with suspicious associated symptoms or clinical findings.

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评估急性乳头内陷、影像学表现和结果


急性乳头内陷可能会让患者感到不安，有时与潜在的乳腺恶性肿瘤有关。由于缺乏共识管理指南，这也带来了诊断挑战。本研究回顾了新乳头内陷的机构经验，包括恶性关联、影像学利用和结果，以努力改进管理。对 1/2010 至 6/2022 期间的所有乳腺影像报告进行了多中心机构回顾性审查，其中提及乳头内陷作为指征或发现。出现新乳头内陷的患者（定义为自上次乳房成像检查后出现的乳头内陷或患者/提供者报告为新发生的乳头内陷）被纳入分析。对乳晕后成像结果、BI-RADS 评估/建议、经皮或切除活检获得的病理学以及后续成像和临床检查进行了整理。慢性或稳定乳头内陷的病例被排除在外。进行了描述性统计。共有 414 名患者出现新的乳头内陷，其中 387/414 (93.5 %) 患者初次影像学结果为良性或阴性，27/414 (6.5 %) 患者为恶性病变。诊断性乳房 X 光检查/超声检测出 25/27 (92.6 %) 癌症（敏感性 92.6 %，特异性 75.5 %，PPV 20.8 %，NPV 99.3 %）。在对乳房 X 光检查 / 超声检查阴性的患者进行的 62 次乳房 MRI 检查中，在乳晕后间隙中未检测到癌症，并在远离乳头的地方发现了 2 个偶然的恶性病变。诊断性乳房X线摄影/超声检查在急性乳头内陷的检查中是可靠的，具有高灵敏度和NPV以排除恶性肿瘤。乳腺 MRI 和手术转诊应保留给有可疑相关症状或临床发现的患者。