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Cancer Epidemiol Biomarkers Prev 2021 Mar;30(3):429-431

Division of Cancer Prevention, NCI, Rockville, Maryland.

Intraductal assessment of the breast holds the potential to provide useful information regarding breast cancer risk assessment, early diagnosis, and/or response to therapy. Intraductal assessment can be through imaging (ductography), direct visualization (mammary ductoscopy), or evaluation of the intraductal fluid collected. The most common nonradiologic approaches to intraductal assessment that provide intraductal fluid for evaluation include breast nipple aspiration fluid (NAF), spontaneous nipple discharge (SND), mammary ductoscopy, and ductal lavage. Read More

Br J Radiol 2021 Apr 5;94(1120):20201013. Epub 2021 Feb 5.

New York University, Grossman School of Medicine, New York, NY, USA.

Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Read More

J Family Community Med 2020 Sep-Dec;27(3):216-218. Epub 2020 Sep 25.

Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Male breast cancer is itself a very rare condition and represents 0.5%-1% of all breast cancers diagnosed. Atypical ductal hyperplasia (ADH), intraductal papilloma (IP), and ductal carcinoma are also very rare in a male breast. Read More

AJR Am J Roentgenol 2021 02 9;216(2):330-339. Epub 2020 Dec 9.

Lynn Sage Comprehensive Breast Center, Prentice Hospital, Northwestern Medicine, 250 E Superior St, Chicago, IL 60611.

Nipple discharge is a common complaint that is first evaluated with clinical assessment. Physiologic discharge does not require imaging other than routine screening mammography. Initial evaluation of pathologic nipple discharge involves mammography and ultrasound. Read More

Cureus 2020 Sep 23;12(9):e10612. Epub 2020 Sep 23.

Radiology, University of Texas Medical Branch, Galveston, USA.

Breast complaints in the emergency department (ED) include trauma, infection, pain, masses, and nipple discharge. Breast cancer mimics other inflammatory conditions such as mastitis and abscess. Differentiating infectious processes versus cancer can become problematic when no imaging is used. Read More

J Med Case Rep 2020 Sep 24;14(1):164. Epub 2020 Sep 24.

Division of Surgical Oncology, University of New Mexico, Albuquerque, NM, USA.

Background: Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparing mastectomy is a rare event, it has been described in the literature. Read More

FP Essent 2020 Sep;496:16-20

University of Maryland School of Medicine - Department of Surgery, 655 W. Baltimore St, Baltimore, MD 21201.

Benign breast conditions are heterogenous, with varying clinical presentations. These conditions commonly include nipple discharge, breast pain, palpable masses, common breast lesions, and high-risk breast lesions. Signs and symptoms of these conditions range from pain and abnormal physical examination findings to asymptomatic abnormalities detected on breast imaging. Read More

AJR Am J Roentgenol 2021 06 5;216(6):1462-1475. Epub 2020 Aug 5.

Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, PO Box 670761, Cincinnati, OH 45267-0761.

During pregnancy and lactation, the breast undergoes unique changes that manifest as varied clinical and imaging findings. Understanding the expected physiologic changes of the breast as well as recognizing the best imaging modalities for a given clinical scenario can help the radiologist identify the abnormalities arising during this time. Discussion with the patient about the safety of breast imaging can reassure patients and improve management. Read More

Medicine (Baltimore) 2020 Jul;99(27):e21063

Department of Interventional Radiology, First Affiliated Hospital of Jiamusi University, Jiamusi, China.

Background: Overflow breast disease (OBD), also known as breast nipple discharge, refers fluid or liquid that comes out of nipple. Many patients with breast cancer experience such condition. However, it is not easy to detect it at early stage, especially for pathological OBD. Read More

Br J Radiol 2020 May 28;93(1109):20191039. Epub 2020 Feb 28.

Department of Radiology, Mayo Clinic, Rochester, Minnesota.

Objective: The purpose of this study is to assess the outcomes of symptomatic and asymptomatic solitary dilated ducts detected on mammography, ultrasound, and MRI.

Methods: All cases of isolated solitary dilated ducts between January 1, 2009 and December 31, 2016 in non-lactating females were reviewed. Clinical data, including patient's age, breast cancer history, and pathology results were collected. Read More

Breast Cancer 2020 Jul 1;27(4):607-612. Epub 2020 Feb 1.

Division of Breast Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.

Background: Microdochectomy is the gold-standard for definitive diagnosis for pathological nipple discharge (PND); however, problem of over-treating exists since majority of PND are self-limiting and due to benign causes. Ductoscopy may assist diagnosis, and triage patients for intervention or expectant management. This study aimed to evaluate if ductoscopy could reduce unnecessary microdochectomy but not compromising the diagnosis of malignancy. Read More

Eur J Radiol 2020 Jan 20;122:108754. Epub 2019 Nov 20.

Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.

Purpose: To evaluate magnetic resonance imaging (MRI) features including tumor-nipple enhancement for predicting nipple-areolar-complex (NAC) involvement in breast cancer.

Methods: A total of 249 breast cancer cases with available preoperative MRI data were studied. On MRI, tumor-nipple enhancement was evaluated 2 min (early) and 6 min (delayed) after contrast injection. Read More

Ir J Med Sci 2020 May 21;189(2):451-460. Epub 2019 Oct 21.

Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey.

Background: The most common cause of pathological nipple discharge (PND) is single papilloma, which is a benign intraductal lesion (BIL). However, underlying malign (MIL) or high-risk intraductal lesions (HIL) should be considered during examination.

Aim: To reveal the value of conventional imaging methods (CIM), discharge characteristics, and cytology in lack of intraductal imaging methods to detect intraductal lesions (IL) and MIL that cause PND. Read More

Breast J 2020 02 11;26(2):139-143. Epub 2019 Sep 11.

Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.

Nipple discharge is the third breast complaint after pain and lumps. The modern high-resolution ultrasound techniques are becoming more sensitive for the visualization of intraductal changes especially focal ductal dilatation (FDD), hypothesized as a radiographic manifestation of the lesion itself and that ultrasound-guided wire localization of this finding would enable identification and excision of the causative lesion. The aim of this study was to evaluate the safety, feasibility, efficiency and outcome of ultrasound-guided wire localization of FDD as possible cause of pathological nipple discharge (PND). Read More

Breast Cancer Res Treat 2019 Nov 27;178(1):115-120. Epub 2019 Jul 27.

Breast Unit, Charring Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London, W6 8RF, UK.

Introduction: The aim of this study was to determine the ability of MRI to identify and assess the extent of disease in patients with pathological nipple discharge (PND) with an occult malignancy not evident on standard pre-operative evaluation with mammography and ultrasound.

Methods: Patients presenting to the breast unit of Imperial College Healthcare NHS Trust between December 2009 and December 2018 with PND and normal imaging were enrolled in the study. Pre-operative bilateral breast MRI was performed in all patients as part of our protocol and all patients were offered diagnostic microdochectomy. Read More

Breast J 2019 07 13;25(4):654-662. Epub 2019 May 13.

Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.

Objective: To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple-modality evaluation.

Materials And Methods: We retrospectively reviewed the medical records of patients who had presented with pathologic nipple discharge and had undergone mammography and/or ultrasound and ductography between January 1, 2005, and October 31, 2010. We tested the diagnostic sensitivity, specificity and accuracy of combined triple-modality evaluation as well as of MRI performed in addition to these imaging techniques. Read More

Am Fam Physician 2019 04;99(8):505-514

Thomas Jefferson University, Philadelphia, PA, USA.

Palpable breast masses, mastalgia, and nipple discharge are commonly encountered symptoms in outpatient practice, causing significant patient anxiety and precipitating medical consultation. The initial workup includes a detailed clinical history and physical examination. Women presenting with a breast mass will require imaging and further assessment to exclude cancer. Read More

Breast Cancer Res Treat 2019 Apr 3;174(3):703-709. Epub 2019 Jan 3.

University of British Columbia, Vancouver, Canada.

Purpose: Patients with spontaneous nipple discharge (SND) who have neither clinically palpable masses nor evidence of disease on imaging with mammogram and/or ultrasound are traditionally investigated with galactogram and duct excision. As breast imaging improves, it has raised the question whether galactography and microductectomy are necessary to diagnose breast cancer. The purpose of this study was to determine the incidence of malignancy in patients presenting with SND who underwent microductectomy and to evaluate the utility of duct excision and galactography in patients whose initial clinical and radiological evaluation were negative. Read More

Cancer Rep (Hoboken) 2018 12 24;1(4):e1136. Epub 2018 Sep 24.

Radiology Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.

Background: With the increasing use of image-guided biopsy, more breast intraductal papillomas are found than ever. Most intraductal papillomas are small, ranging from several milimeters to 2 cm.

Case: We described a case of giant intraductal papilloma of breast in a 19-year-old girl with nipple bloody discharge and rapid growth. Read More

J Am Coll Radiol 2018 Nov;15(11S):S276-S282

Panel Chair, Emory University Hospital, Atlanta, Georgia.

Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). Read More

J Am Coll Radiol 2018 Nov;15(11S):S263-S275

Panel Chair, Emory University Hospital, Atlanta, Georgia.

Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Read More

PLoS One 2018 8;13(10):e0204326. Epub 2018 Oct 8.

Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland.

Purpose: To evaluate the malignancy rate and diagnostic performance of galactography in patients with pathological nipple discharge (PND) after negative clinical breast examination, mammography and ultrasound.

Materials And Methods: We retrospectively evaluated all galactograms obtained between January 2006 and December 2014 in women with PND. Galactographic findings were classified into 6 groups according to a modified Galactogram Image Classification system (GICS) to comply with the breast imaging reporting and data system classification. Read More

AJR Am J Roentgenol 2018 10 14;211(4):920-925. Epub 2018 Aug 14.

5 Department of Surgery, Mayo Clinic, Phoenix, AZ.

Objective: The purpose of this study was to assess radiologists' choice of imaging modality for the evaluation of clinical symptoms of physiologic nipple discharge (e.g., bilateral discharge, multiple-duct orifices, and yellow, green, or white color) and pathologic nipple discharge (e. Read More

Radiology 2018 08;288(2):624-629

From the Department of Radiology, Mount Sinai Beth Israel, 10 Nathan D Perlman Place, New York, NY 10003.

History A 57-year-old woman presented with right breast swelling and enlargement and a palpable mass in the right lower inner breast. There was no history of fever, trauma, skin redness, or nipple discharge. The patient had a history of breast augmentation, with retropectoral silicone implants placed 2. Read More

Geburtshilfe Frauenheilkd 2018 May 4;78(5):493-498. Epub 2018 Jun 4.

Klinik für Radiologie - Klinikum Frankfurt Hoechst, DKG-zertifiziertes Brustzentrum, Frankfurt am Main, Germany.

Introduction: For decades, conventional galactography was the only imaging technique capable of showing the mammary ducts. Today, diagnosis is based on a multimodal concept which combines high-resolution ultrasound with magnetic resonance (MR) mammography and ductoscopy/galactoscopy and has a sensitivity and specificity of up to 95%. This study used tomosynthesis in galactography for the first time and compared the synthetic digital 2D full-field mammograms generated with this technique with the images created using the established method of ductal sonography. Read More

Curr Probl Diagn Radiol 2019 Mar - Apr;48(2):117-120. Epub 2018 Jan 9.

Department of Radiology, Columba University Medical Center, New York, NY.

Purpose: To evaluate whether in the setting of negative diagnostic mammogram for breast pain additional ultrasound is necessary.

Methods: Retrospective IRB-approved review of our database identified 8085 women who underwent ultrasound evaluation for breast pain from 1/1/2013-12/31/2013. Of 8085 women, 559 women had mammogram evaluation preceding the ultrasound and these women comprise the basis of this study. Read More

Radiol Bras 2017 Nov-Dec;50(6):383-388

Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at Conrad Diagnóstico por Imagem, Belo Horizonte, MG, Brazil.

Nipple discharge is a common symptom in clinical practice, representing the third leading breast complaint, after pain and lumps. It is usually limited and has a benign etiology. The risk of malignancy is higher when the discharge is uniductal, unilateral, spontaneous, persistent, bloody, or serous, as well as when it is accompanied by a breast mass. Read More

J Am Osteopath Assoc 2017 Dec;117(12):755-760

Breast masses and nipple discharge are common symptoms that lead women to seek medical care. Many of the findings on subsequent examination are benign. When evaluating a patient who presents with breast masses or nipple discharge, it is useful to take a holistic approach to evaluating the patient, including a detailed history, structural and directed physical examination, and, if indicated, laboratory studies, diagnostic imaging, and biopsy. Read More

Breast J 2018 05 24;24(3):356-359. Epub 2017 Oct 24.

Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Patients presenting with pathologic nipple discharge (PND) often pose a diagnostic and therapeutic challenge. We used ultrasound to identify focal ductal dilatation-hypothesized to be a radiographic manifestation of the causative lesion-in patients with PND and no relevant clinical or radiographic findings. Twenty-two excisions guided by ultrasound wire localization of focal duct dilation were performed. Read More

AJR Am J Roentgenol 2017 Dec 12;209(6):1404-1410. Epub 2017 Sep 12.

1 Department of Radiology, Division of Breast Imaging, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114.

Objective: The purpose of this study is to determine the diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge.

Materials And Methods: We conducted a retrospective review of breast MRI examinations from January 1, 2006, through December 31, 2015, that were performed after negative or inconclusive mammography for the evaluation of nipple discharge. Clinical notes, imaging findings, and pathology outcomes were reviewed. Read More