Breast imaging in patients with nipple discharge

Area of Science:

• Radiology
• Oncology
• Breast Imaging

Background:

• Nipple discharge is a frequent clinical complaint, often benign but can indicate malignancy.
• Risk factors for malignancy include uniductal, unilateral, spontaneous, persistent, bloody, or serous discharge, especially with a breast mass.

Purpose of the Study:

• To review the diagnostic approaches for nipple discharge.
• To highlight the role of imaging in differentiating benign from malignant causes.

Main Methods:

• Clinical examination is crucial for initial evaluation.
• Mammography and ultrasound are first-line imaging modalities.
• Magnetic resonance imaging (MRI) is recommended for suspicious cases with normal mammography/ultrasound.

Main Results:

• Common causes of pathologic discharge are papilloma and ductal ectasia; malignancy risk is 5%, primarily ductal carcinoma in situ.
• Mammography has limited sensitivity for nipple discharge due to small, retroareolar lesions.
• Ultrasound requires specific techniques for retroareolar intraductal lesions; MRI's common finding is non-mass enhancement.

Conclusions:

• While clinical evaluation guides diagnosis, advanced imaging like MRI is essential for equivocal cases.
• Short-term follow-up may be a safe alternative to surgery for suspicious nipple discharge.