Nipple Discharge: Current Clinical and Imaging Evaluation.

Area of Science:

• Radiology
• Oncology
• Breast Imaging

Background:

• Nipple discharge is a frequent clinical concern.
• Physiologic discharge requires only routine screening mammography.
• Pathologic nipple discharge necessitates further diagnostic imaging.

Purpose of the Study:

• To outline the evolving algorithm for evaluating suspicious nipple discharge.
• To compare the efficacy of different imaging modalities.
• To assess the role of MRI in diagnosing breast malignancy.

Main Methods:

• Clinical assessment and mammography are initial steps.
• Ultrasound is used for further evaluation of pathologic discharge.
• Magnetic resonance imaging (MRI) is increasingly utilized, often replacing ductography.

Main Results:

• MRI demonstrates high sensitivity and specificity in detecting breast malignancy.
• MRI offers biopsy capability, aiding in diagnosis.
• When initial diagnostic imaging is negative, clinical suspicion guides management.

Conclusions:

• The diagnostic approach to nipple discharge is dynamic.
• MRI is the preferred advanced imaging modality for suspicious nipple discharge due to superior accuracy and patient comfort.
• Surveillance may be a viable alternative to central duct excision for malignancy evaluation, supported by MRI's high negative predictive value.