背阔肌肌皮瓣联合假体在乳腺癌术后二期乳房再造中的应用

目的探讨背阔肌肌皮瓣联合假体植入在乳腺癌术后二期乳房再造术中的临床应用。方法 2009年至2013年,共8例乳腺癌术后年轻患者接受二期乳房再造手术。术前以排水法测定健侧乳房体积,根据患者健侧乳房形状、大小及背部组织情况,设计胸背部供区皮瓣,术中测量移植皮瓣的容积,然后根据健侧乳房和移植皮瓣的容积差,选择大小合适的乳房假体,将假体埋植于背阔肌-胸大肌后间隙,利用背阔肌肌皮瓣移植联合乳房硅胶假体进行二期乳房再造。结果本组患者术后随访6个月至4年,再造乳房外形较佳,效果满意,供区无明显并发症。结论对于年轻有生育要求的乳腺癌术后乳房缺失患者,健侧乳房较大,利用背阔肌肌皮瓣联合假体进行乳房再造,可取得良好的手术效果。     

早期乳腺癌患者术后应用整形技术的临床观察

目的:观察并总结采用整形美容技术对早期乳腺癌患者进行手术治疗的临床经验。方法:回顾性分析2007年3月～2011年2月期间我院收治的86例术前分期为I～II期的乳腺癌患者,分别应用腹直肌肌皮瓣(TRAM)、腹壁下动脉穿支皮瓣(DIEP)、TRAM与DIEP联合皮瓣、背阔肌肌皮瓣(LDF)加或不加假体、硅凝胶乳房假体、保留乳头乳晕复合体的方法对其中74例施行乳腺癌改良根治术的患者进行乳房整形手术,总结该74例患者的临床病例资料,对术后美容效果及远期预后进行评估。结果:患者均为女性,年龄分布35～68岁,平均(48.2±6.5)岁,中位年龄46岁。12例患者仅采用改良根治术治疗,74例应用乳房整形技术的患者中,采用腹直肌肌皮瓣(TRAM)进行乳房再造26例,腹壁下动脉穿支皮瓣(DIEP)乳房再造术6例,TRAM与DIEP联合皮瓣行乳房再造术8例,背阔肌肌皮瓣(LDF)加或不加假体进行乳房再造20例,硅凝胶乳房假体进行乳房再造8例,保留乳头乳晕复合体进行乳房再造6例。不同整形技术对乳腺癌术后的恢复及并发症的发生率有影响,差异存在统计学意义,采用整形技术及单纯根治术治疗,乳腺癌术后恢复及并发症发生率的差异未发现统计学意义。术后随访10～16个月,未发现局部和区域肿瘤复发,无伤口、皮肤坏死和感染,未发现死亡病例,继续随访观察。结论:I、II期乳腺癌患者在行改良根治术后,应用乳房整形技术治疗是安全、有效的,腹直肌肌皮瓣乳房再造术进行乳房美容的效果最好,乳房整形术术后并发症较传统单纯乳腺癌改良根治术发生率无明显变化,具有广阔的应用前景。     

即刻及延期乳房再造方法的选择

目的回顾总结乳腺癌根治术后应用单纯假体植入、Becker可扩张假体植入和单蒂腹部横形腹直肌肌皮瓣（TRAM）移植、扩大背阔肌肌皮瓣（ELDF）移植乳房再造术的经验,探讨手术的适应证、方法和效果。方法自2002年7月至2005年10月,共67例患者进行了乳腺癌根治术后乳房再造术。即刻乳房再造56例：单纯假体植入38例、Becker可扩张假体植入16例、单蒂TRAM移植2例。延期乳房再造11例：单蒂TRAM移植6例、ELDF移植4例、Becker可扩张假体植入1例。结果手术效果满意,优良率超过90％。5例患者出现轻微并发症：皮瓣局灶性坏死2例,保留的乳头乳晕部分坏死1例,血清肿2例。结论单纯假体植入用于即刻乳房再造,适用于乳房较小、行保留皮肤的乳腺癌根治术后的患者,不宜用于延期乳房再造;可扩张假体植入即刻乳房再造适用于乳房较大或改良乳腺癌根治术的患者,同时可扩张假体植入延期乳房再造可用于皮肤、肌肉保留较好的乳腺癌根治患者;TRAM和ELDF皮瓣移植乳房再造是自体组织移植,其安全性高,可用于即刻和延期乳房再造。     

乳腺癌切除术后乳房再造

目的 探讨乳腺癌切除术后乳房再造的方法及时间.方法 总结30例不符合保乳条件的乳腺癌病例,乳房切除术后假体置人乳房再造16例,下腹部横行腹直肌肌皮瓣(TRAM瓣)乳房再造10例,背阔肌肌皮瓣乳房再造4例.其中即刻乳房再造27例,延期乳房再造3例.结果 16例假体置入乳房再造术后外观评价均为良,未出现术后并发症.10例TRAM瓣乳房再造术后发生皮瓣部分坏死2例,腹壁疝1例,术后外观评价7例为良.2例为较好,1例为差.4例背阔肌肌皮瓣再造术后外观评价为良.结论 乳房再造术是乳腺癌综合治疗不可忽视一部分,对于有强烈的保乳愿望,而又不符合保乳条件的患者,乳房再造术是一种较好的选择.即刻乳房再造优于延迟乳房再造.乳房再造的方法选择要因人而异.局部晚期乳腺癌患者可以选择性进行即刻乳房再造术.     

乳腺癌术后肌皮瓣重建术44例分析

目的:探讨乳腺癌术后一期乳房重建不同术式的疗效对比。方法:回顾分析本院2005年1月至2007年12月乳腺癌术后一期乳房再造44例。其中一期行背阔肌肌皮瓣移植者27例,横向腹直肌肌皮瓣移植者17例。结果:中位随访时间22.5个月,两种重建方式在客观效果评价、术后并发症和复发率方面均无统计学差异,但腹直肌肌皮瓣组的主观效果评价优于背阔肌肌皮瓣组(P=0.0462)。结论:背阔肌肌皮瓣和腹直肌肌皮瓣移植仍是目前乳房重建的常用术式。而腹直肌肌皮瓣重建与背阔肌皮瓣相比具有一定的优势。     

乳房再造术的临床研究

目的 回顾总结了乳癌根治术后应用单纯假体植入、Becker可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣(TRAM)移植、扩大的背阔肌肌皮瓣(ELDF)移植乳房再造术的经验,探讨手术的适应征、方法和效果.方法 16例行保留皮肤的乳癌根治术一期假体植入乳房再造;13例行Becker可扩张假体植入一期乳房再造;4例行单蒂下腹部横形腹直肌肌皮瓣(TRAM)移植乳房再造手术,其中2例为一期再造,另2例为二期再造.应用Becker可扩张假体行二期乳房再造1例.扩大背阔肌肌皮瓣(ELDF)移植二期乳房再造1例.结果 手术效果满意,优良率超过90%.3例病人出现轻微并发症,其中1例皮瓣局灶坏死,一例出现保留的乳头乳晕部分坏死,1例出现血清肿.结论 单纯假体植入适用于瘦小病人,对侧乳房小且没有明显下垂.优点是不增加额外瘢痕,术后恢复快;可扩张假体植入乳房再造适用于乳房大或改良乳癌根治术的患者,此法结合了单纯假体植入法和组织扩张术乳房再造术的优点;TRAM和ELDF皮瓣移植乳房再造的优点是自体组织移植,安全、手术效果好.     

保留乳房外形的乳腺手术的临床应用研究

目的:探讨利用背阔肌皮瓣、腹直肌肌皮瓣(r ect us abdomi ni s myocut aneous f l ap,TRAM),假体或者联合使用开展保留乳房外形的乳腺手术的手术适应证,方式选择,手术并发症。方法:2007年5月至2009年2月行背阔肌皮瓣,腹直肌皮瓣,假体,以及联合使用的保留乳房外形的乳腺手术21例。观察指标包括手术方式的选择,手术时间,术后并发症以及美学效果。结果:背阔肌皮瓣改良保乳术12例,平均时间289mi n;腹直肌皮瓣改良保乳术4例,平均时间393 mi n。利用腹直肌和背阔肌皮瓣修复乳癌术后胸壁巨大缺损1例。Paget病利用腹直肌和背阔肌皮瓣行乳房再造术1例。乳癌术后行游离腹直肌皮瓣乳房再造术1例。保留皮肤乳头乳晕全切术后背阔肌乳房再造术1例。乳房全切后乳房即刻再造术1例。再造乳房有2例失败,其余乳房存活良好,手术并发症少。结论:利用自体组织或者假体行改良保乳术或者乳房再造术,操作时间不长,术后并发症少,美学效果好,基本不影响患者的后期治疗。     

几种乳房再造术的临床应用体会

目的：探讨乳腺癌根治术后应用单纯假体植入、可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造的适应证、手术方法、手术效果。方法：本组共24例病例。14例乳腺癌患者行保留皮肤的乳腺癌根治术，Ⅰ期行假体植入乳房再造；6例采用改良乳腺癌根治可扩张假体植入Ⅰ期乳房再造；4例接受单蒂下腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造手术，其中2例为Ⅰ期再造，另2例为Ⅱ期乳房再造。结果：手术效果较满意，2例出现轻微并发症，其中1例皮瓣局灶坏死，另1例出现乳头乳晕部分坏死。结论：单纯假体植入适用于乳房小，没有明显下垂的瘦小病人。优点是不增加额外瘢痕，术后恢复快；可扩张假体植入乳房再造适用于乳房大或改良乳腺癌根治术的患者，此法结合了单纯假体植入法和组织扩张的优点：TRAM皮瓣移植乳房再造的优点是自体组织移植，安全、手术效果好。     

早中期乳腺癌保留乳头乳晕改良根治术后离断背阔肌止点扩大肌皮瓣I期乳房再造术的临床效果

目的探讨早中期乳腺癌行保留乳头乳晕改良根治术后使用扩大背阔肌肌皮瓣I期乳房再造治疗的应用价值及临床效果。方法我院2009年11月至2012年10月期间收治的60例经临床穿刺活检病理明确诊断为早中期的乳腺癌患者按术式分为2组：乳房再造组（30例）,即保留乳头乳晕乳腺癌改良根治术后离断背阔肌止点扩大肌皮瓣I期乳房再造术;对照组（30例）,即行传统乳腺癌改良根治术。比较2组患者的术后并发症,近远期疗效,生活质量,复发转移情况。结果①对照组完全患侧乳房缺失;乳房再造组乳房再造术均获得成功,再造乳房美容效果评价优22例,良7例,一般1例。②2组患者术后皮下积液、皮瓣坏死及患肢活动受限情况比较差异无统计学意义（P〉0．05）;术后切口拆线时间、术区引流时间、住院时间及术后化疗开始时间差异均无统计学意义（P〉0．05）。③乳房再造组心理压力出现率及对第二性征不满意率明显低于对照组（P〈0．001）,乳房再造组社会交往适应率明显高于对照组（P〈0．001）。④2组患者随访12～38个月（平均25个月）,其中对照组有1例死亡,其余59例患者均未发现有局部复发和远处转移。结论从本组有限的数据初步看,乳腺癌根治术后离断背阔肌止点扩大肌皮瓣I期乳房再造术,可在根治肿瘤的基础上获得满意的乳房美容效果,使患者的生活质量明显提高,该术式术后并发症较少,不影响乳腺癌的术后辅助放化疗和近远期疗效。     

可扩张乳房假体加背阔肌肌皮瓣的乳房再造术

目的：报告应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体（BECKER）置入,修复乳腺癌根治术后的胸壁畸形,同时再造乳房的手术方法。方法：根据乳腺癌病灶清除术后患者胸部的畸形状况,设计患侧带蒂背阔肌肌皮瓣的肌瓣长度、体积以及皮瓣的面积和形状,切取肌皮瓣后经腋部皮下隧道转移至胸前。用肌瓣修复胸前软组织缺损,皮瓣则用于弥补胸部皮肤的不足。肌瓣与胸壁间置入可扩张的乳房假体。术后经注射壶注水,逐步扩张至额定值。6个月后,可抽除注射壶并重建乳头,完成治疗。结果：自1999年以来,对各种乳腺癌术后患者行乳房再造术共26例,获得了满意效果。结论：应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体置入,不仅可修复乳腺癌病灶清除术后的胸部软组织的缺损、锁骨下的凹陷畸形而且可重建乳房。该法具有创伤小、恢复快、再造乳房的外形及质感逼真等特点。     

Breast conserving therapy with accelerated partial breast versus external beam whole breast irradiation: comparison of imaging sequela and complications in a matched population

Our purpose was to evaluate and compare the imaging sequela and complications of accelerated partial breast irradiation (APBI) with those occurring in patients treated with standard external beam therapy. Patient selection included those who met the criteria for possible ABPI: age 45 or older; cancer stage T1N0M0 or ductal carcinoma in situ 3 cm or less, and negative surgical margins. One hundred and ninety seven had complete records and films available for review. Ninety-seven (49%) were treated with APBI (MammoSite) and 100(51%) were treated with external beam. Image findings for APBI versus external beam were: distortion 90(93%) versus 83(83%), seroma 67(69%) versus 7(7%), skin edema 52(54%) versus 47(47%), increased stroma 75(77%) versus 66(66%), calcifications 10(10%) versus 6(6%), and fat necrosis 12(12%) versus 6(6%). For APBI, skin and stromal edema was more commonly focal. At imaging, the seroma rate was statistically and significantly different between the two treatment modes (p < 0.0001). For patients treated with APBI, seroma formation was not related to balloon size and only weakly related to lumpectomy cavity size. The complication rate was significantly higher for those treated with APBI (36 versus 20%) and the types and treatment of complications differed. There were three recurrences among the APBI group and none among those treated with external beam radiation.     

Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging

The incidence of synchronous bilateral breast cancers has been reported to be between 3.4% and 7.4%, as detected on mammography, physical examination, or both. We undertook a study to determine how often magnetic resonance (MR) imaging detects a contralateral abnormality in patients with known breast carcinoma. As part of an institutional review board (IRB) -approved research protocol, 17 patients with pathologically proven invasive carcinoma underwent preoperative MR imaging of both breasts using a T1-weighted, high-resolution gradient echo sequence (precontrast and postcontrast), an echo-planar sequence during administration of gadolinium, and a T2-weighted, fast-spin echo sequence. The morphology and dynamic enhancement of lesions in both breasts were assessed. Biopsy was recommended for any lesion meeting set criteria. MR imaging identified all 17 known invasive cancers in the breast of concern on mammography or physical examination. Five of 17 patients (29%) had 10 contralateral lesions identified on MR, for which biopsy was recommended. One of these lesions proved to represent a fibroadenoma. The other 9 lesions proved to represent a malignancy (6 invasive lobular, 2 infiltrating ductal, and 1 tubular). Four of the 17 patients (24%) with invasive cancer had contralateral synchronous cancers occult to physical examination, mammography, and ultrasonography. In this series, breast MR imaging of the breasts was more sensitive than mammography or physical examination in the detection of early breast cancer. Breast MR imaging of the contralateral breast may be of value as a routine screen in those patients with a known or suspected malignancy.     

Elevating your breast program to the next level

This paper describes a series of steps taken to elevate the Hoag Breast Program to the next level. The hope is that some of our ideas will be useful to you and your breast program.     

PATHOLOGICAL ASPECTS OF THE UK BREAST SCREENING PROJECT WITH SPECIAL REFERENCE TO MINIMAL AND ‘BORDERLINE’ LESIONS

Because of the logistical and financial implications of large scale screening for the early detection of breast cancer, the Department of Health and Social Security in the UK has established a study to compare two methods, mammography and breast self-examination. Screening is under evaluation in women aged 45–64 years, over a seven year period. Mammography is carried out in health districts based on Edinburgh and Guildford and self-examination related to a programme of education in Huddersfield and Nottingham. Four other health districts, Bristol, Dundee, Oxford and Stoke, act as control areas. A Pathology Review Panel composed of pathologists from each participating centre has been established to verify the accuracy of the histopathological data. In particular, all lesions in the borderline between benign and malignant disease are reviewed together with all minimal carcinomas. The Pathology Panel has carried out four consistency surveys to improve diagnostic criteria and accuracy, and 83% agreement is now achieved with no errors across the benign/malignant border. Review of ‘borderline’ cases from the study is now in progress.     

Developmental breast asymmetry

Developmental breast asymmetry (DBA) can affect psychosocial well-being in the young female. Correction of breast asymmetry may present a reconstructive challenge, especially in tuberous breasts. Fifty-two cases of DBA treated between January 2002 and January 2006 were reviewed. Preoperative clinical assessment of the specific anatomical deformity, subsequent surgical treatment modalities, esthetic outcome, and patient's satisfaction were evaluated. Surgical modalities used in our series include augmentation mammaplasty with or without tissue expansion, parenchymal scoring, nipple areola complex reduction, glanduloplasty techniques, mastopexy and reduction mammaplasty. The mean age of DBA presentation was 21 years; 69% (36/52) patients had tuberous breasts, of which 67% (24/36) were unilateral and 33% (12/36) were bilateral deformities. Patients with tuberous breast deformity presented consistently under the age of 25 years. Esthetic outcome was rated "good" in 75% (39/52), and symmetry rated as "good" in 58% (30/52) by professional evaluation. Surgical treatment is tailored to the affected esthetic units of the individual breast. In our experience, symmetry is the hardest parameter to achieve, particularly in tuberous breasts. Operative treatment is of great value to the psychosocial well-being of the patient. A conceptual approach in the assessment and treatment of DBA is emphasized by this series.     

Evaluation of Malignant Breast Lesions in the Diagnostic Setting with Cone Beam Breast Computed Tomography (Breast CT): Feasibility Study

To investigate the feasibility of noncontrast and contrast‐enhanced cone beam breast Computed Tomography (CT) in demonstrating malignant breast lesions in the diagnostic setting. This Institutional Review Board approved, Health Information Portability and Accountability Act compliant, prospective study enrolled BI‐RADS four and five patients from 2008 to 2010. Eighty‐seven subjects had noncontrast breast CT, 42 had contrast‐enhanced breast CT (CE‐breast CT) with 70 pathologically confirmed cancer diagnoses. All 70 comprise the study cohort for noncontrast breast CT, and 23 who had CE‐breast CT comprise the cohort for CE‐breast CT. All had diagnostic work‐up. Patient age, breast density, lesion size and characteristics, biopsy method, and core pathology were recorded. A Fisher's exact test was used to detect a difference in detectability. For agreement in size measurement between the imaging modalities, a paired t‐test was employed. Reported p‐values were based on 2‐sided tests. Two one‐sided tests were calculated to determine equivalence within ±0.3 cm at a 90% significance level. Noncontrast breast CT identified 67 of 70 malignant lesions, detected by diagnostic work‐up. CE‐breast CT identified 23 of 23 index malignant lesions and in addition, found three malignant lesions in three cases not previously detected. Noncontrast breast CT demonstrated the index lesion in 67 of 70 cases and CE‐breast CT demonstrated the index lesion in all 23 cases. An additional three new malignant lesions not seen with conventional diagnostic work‐up were detected. In this preliminary study, breast CT with or without contrast was shown to be accurate at identifying malignant breast lesions in the diagnostic setting.     

Incidence and outcomes of incidental breast lesions detected on cross‐sectional imaging examinations

The aim of this study was to determine the frequency and outcomes of incidental breast lesions detected on nonbreast specific cross‐sectional imaging examinations. A retrospective review of the medical records was performed to identify all patients without a known history of breast cancer, who had an incidentally discovered breast lesion detected on a nonbreast imaging examination performed at our institution between September 2008 and August 2012 for this IRB‐approved, HIPAA compliant study. Outcomes of the incidental lesions were determined by follow‐up with dedicated breast imaging (mammography, breast ultrasound, and/or breast MRI) or results of biopsy, if performed. Imaging modality of detection, imaging features, patient age, patient location at the time of the nonbreast imaging examination, type of follow‐up, and final outcome were recorded. Rates of malignancy were also calculated, and comparison was made across the different cross‐sectional imaging modalities. Kruskal‐Wallis and Fisher's exact tests were used to identify factors associated with an increased rate of malignancy. Logistic regression was used to model the risk of malignancy as a function of continuous predictors (such as patient age or lesion size); odds ratios and 95% confidence intervals were obtained. A total of 292 patients with incidental breast lesions were identified, 242 of whom had incidental lesions were noted on computed tomography (CT) studies, 25 on magnetic resonance imaging (MRI), and 25 on positron emission tomography (PET). Although most of the incidental breast lesions were detected on CT examinations, PET studies had the highest rate of detection of incidental breast lesions per number of studies performed (rate of incidental breast lesion detection on PET studies was 0.29%, compared to 0.10% for CT and 0.01% for MRI). Of the 121 of 292 (41%) patients who received dedicated breast imaging work‐up at our institution, 40 of 121 (33%) underwent biopsy and 25 of 121 (21%) had malignancy. There was a significantly increased rate of malignancy in older patients (odds ratio: 1.05, 95% CI: 1.02‐1.093; P = .006). Additionally, patients with PET‐detected incidental breast lesions had a significantly higher rate of malignancy (55%), compared to patients with CT‐detected (35%) and MRI‐detected (8%) incidental breast lesions (P = .038). The rate of malignancy upon follow‐up of incidental breast lesions detected on nonbreast imaging examinations in this retrospective study was 21%, supporting the importance of emphasizing further work‐up of all incidentally detected breast lesions with dedicated breast imaging. Additionally, we found that PET examinations had the highest rate of detection of incidental breast lesions and the highest rate of malignancy, which suggests that PET examinations may be more specific for predicting the likelihood of malignancy of incidental breast lesions, compared to CT and MRI.     

PARAFFINOMAS OF THE BREAST: AN ORIENTAL CURIOSITY

Background: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30–40 years ago. Patients may present many years later with complications of this treatment. Methods: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3–41 years (median 17) previously. Results: Patients presented with hard masses in the breast 4–18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes. Conclusions: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually requires total mastectomy.     

Benign breast papilloma: Is surgical excision necessary?

In many centers internationally, current standard of care is to excise all papillomas of the breast, despite recently reported low rates of upgrade to malignancy on final excision. The objective of this study was to determine the upgrade rate to malignancy in patients with papilloma without atypia. A retrospective review of a prospectively maintained database of all cases of benign intraductal papilloma in a tertiary referral symptomatic breast unit between July 2008 and July 2018 was performed. Patients with evidence of malignancy or atypia on core biopsy and those with a history of breast cancer or genetic mutations predisposing to breast cancer were excluded. One hundred and seventy‐three cases of benign papilloma diagnosed on core biopsy were identified. Following exclusions, the final cohort comprised of 138 patients. Mean age at presentation was 51. Mean follow‐up time was 9.6 months. The most common symptom was a lump (40%). Of the 124 patients who underwent excision, three had ductal carcinoma in situ and there were no cases of invasive disease, giving an upgrade rate to malignancy of 2.4%. Upgrade to other high‐risk lesions (atypical lobular and ductal hyperplasia and lobular carcinoma in situ) was demonstrated in 15 cases (12.1%). Benign papilloma was confirmed in 100 cases (81.5%), and 6 (4.8%) had no residual papilloma found on final excision. Twelve patients (8.7%) were managed conservatively. Of those, one later went on to develop malignancy. Patients with a diagnosis of benign papilloma without atypia on core biopsy have a low risk of upgrade to malignancy on final pathology, suggesting that observation may be a safe alternative to surgical excision. Further research is warranted to determine which patients can be safely managed conservatively.     

Contribution of diffusion‐weighted imaging to dynamic contrast‐enhanced MRI in the characterization of papillary breast lesions

Papillary lesions have a broad spectrum of appearances on magnetic resonance imaging (MRI ). The purpose of this study was to evaluate whether apparent diffusion coefficient (ADC ) values of papillary lesions can be used to characterize lesion as benign or malignant. This retrospective study included 29 papillary lesions. Diagnostic values of dynamic contrast‐enhanced MRI (DCE‐MRI), DWI ‐ADC , and DCE ‐MRI plus DWI ‐ADC were separately calculated. The malignant papillary lesions (0.744×10^?3 mm²/s) exhibited significantly lower mean ADC values than the benign lesions (1.339×10^?3 mm²/s). Addition of DWI to standard DCE ‐MRI provided 100% sensitivity. We hypothesized that this combination may prevent unnecessary excisional biopsies.