Index or synchronous lesions found on MRI alone can be percutaneously biopsied with MRI guidance to allow for single- stage definitive surgical management (if malignant) or potentially to avoid unnecessary surgical excision for some benign lesions. In general, MRI should be considered in cases in which mammography and US have failed to identify an underlying cause of pathologic nipple discharge [3,44,48-50]. The sensitivities of breast MRI for detecting the cause of the pathologic nipple discharge are 86% to 100% for invasive cancer and 40% to 100% for noninvasive disease [3,12,44,49,51,52]. Bahl et al [52] reported the sensitivity, specificity, PPV, and NPV of MRI for detecting malignancy in patients with pathologic nipple discharge to be 100%, 68%, 37%, and 100%, respectively. Several Evaluation of Nipple Discharge studies have shown that MRI has a higher sensitivity and specificity than US and ductography for lesion detection and may be an alternative to ductography [12,32,48,49]. However, a study by van Gelder et al [51] asserted that MRI has limited added value in patients with unilateral bloody nipple discharge who showed no signs of a malignancy on conventional diagnostic examinations, because malignancy was demonstrated in <2% of their cases. At this time, there is no relevant literature available for use of MRI for evaluation of a male patient with nipple discharge. FDG-PET Breast Dedicated High-resolution cameras specifically designed for breast imaging have improved detection of small and noninvasive carcinomas. However, specific research evaluating women with nipple discharge is lacking [41,53]. Currently, there is no relevant literature for the use of FDG-PET in the evaluation of a male or female patient with pathologic nipple discharge.
Evaluation of Nipple Discharge. Index or synchronous lesions found on MRI alone can be percutaneously biopsied with MRI guidance to allow for single- stage definitive surgical management (if malignant) or potentially to avoid unnecessary surgical excision for some benign lesions. In general, MRI should be considered in cases in which mammography and US have failed to identify an underlying cause of pathologic nipple discharge [3,44,48-50]. The sensitivities of breast MRI for detecting the cause of the pathologic nipple discharge are 86% to 100% for invasive cancer and 40% to 100% for noninvasive disease [3,12,44,49,51,52]. Bahl et al [52] reported the sensitivity, specificity, PPV, and NPV of MRI for detecting malignancy in patients with pathologic nipple discharge to be 100%, 68%, 37%, and 100%, respectively. Several Evaluation of Nipple Discharge studies have shown that MRI has a higher sensitivity and specificity than US and ductography for lesion detection and may be an alternative to ductography [12,32,48,49]. However, a study by van Gelder et al [51] asserted that MRI has limited added value in patients with unilateral bloody nipple discharge who showed no signs of a malignancy on conventional diagnostic examinations, because malignancy was demonstrated in <2% of their cases. At this time, there is no relevant literature available for use of MRI for evaluation of a male patient with nipple discharge. FDG-PET Breast Dedicated High-resolution cameras specifically designed for breast imaging have improved detection of small and noninvasive carcinomas. However, specific research evaluating women with nipple discharge is lacking [41,53]. Currently, there is no relevant literature for the use of FDG-PET in the evaluation of a male or female patient with pathologic nipple discharge.