Rationale and Objective
To determine the diagnostic yield of various imaging tests used to evaluate nipple
discharge.
Materials and Methods
A single institution, IRB-approved, retrospective study was performed of 320 consecutive
patients presenting with nipple discharge. Imaging and pathology were reviewed to
determine the yield for malignancy, atypical high-risk lesions (HRLs), and intraductal
papillomas (IDPs).
Results
Of the 320 patients, pathology or follow up confirmed 40 breast malignancies (40/320,
12.5%),14 atypical HRLs (14/320, 4.4%), 71 IDPs (71/320, 22.2%), 48 other benign pathologies
(48/320,15.0%), and 147 unknown but benign cases (147/320, 45.9%). Physiologic discharge
characteristics were observed in a minority of malignant cases: nonspontaneous (4/40,
10.0%); neither bloody nor clear (4/40, 10.0%); bilateral (3/40, 7.5%). Malignancy
was associated with older age (p < 0.001) and bloody discharge (odds ratio 6.5, p < 0.0001).
The combination of digital mammography and ultrasound had a 93% sensitivity and a
98% NPV, while contrast enhanced MRI (CE-MRI) had a 100% sensitivity and a 100% NPV
for malignancy. Only three galactography examinations were performed among the malignant
cohort, with minimal contribution (1 of 3) to the diagnostic evaluation. In this case,
galactography findings helped determine imaging-pathology discordance, prompting a
recommendation for surgical excision and subsequently a malignant diagnosis.
Conclusion
The combination of mammography and ultrasonography detected 93% of breast malignancies
associated with nipple discharge and had a 98% NPV for malignancy. The value of CE-MRI
is its ability to detect the remaining malignancies, not detected on mammography or
ultrasound, and its ability to obviate the need for surgical duct excision.
Key Words
Abbreviations:
IDP (intraductal papilloma), DCIS (ductal carcinoma in situ), ACR (American College of Radiology), CE-MRI (contrast enhanced-magnetic resonance imaging), BI-RADS (Breast Imaging Reporting and Data System), US (ultrasound), FNA (fine needle aspiration), HRL (High Risk Lesion), CI (confidence interval), TP (true positive), FP (false positive), TN (true negative), FN (false negative), PPV (positive predictive value), NPV (negative predictive value), ADH (atypical ductal hyperplasia), ALH (atypical lobular hyperplasia), LCIS (lobular carcinoma in situ)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 24, 2022
Accepted:
May 22,
2022
Received in revised form:
May 20,
2022
Received:
April 11,
2022
Identification
Copyright
Published by Elsevier Inc. on behalf of The Association of University Radiologists.
