 Special Imaging Considerations In 2018, Schulz-Wendtland et al [25] first described a technique combining digital breast tomosynthesis (DBT) and ductography and evaluated 5 women with pathologic nipple discharge. They found that DBT-ductography performed comparably to high-resolution ultrasound (US) in identifying suspicious imaging lesions. In 2020 Moschetta et al [26] used this nascent technique on 49 consecutive patients with spontaneous, unilateral, single- pore discharge and inconclusive conventional digital mammography and US. In this series, they compared DBT- Reprint requests to: publications@acr.org Evaluation of Nipple Discharge ductography with conventional full-field galactography and found improved sensitivity (95% versus 77%) and accuracy (96% versus 80%) with identical specificity (80%). OR Discussion of Procedures by Variant Variant 1: Adult female or male or transfeminine (male-to-female) or transmasculine (female-to-male). Physiologic nipple discharge. Initial imaging. Physiologic nipple discharge is defined as bilateral, originating from multiple ducts, white/green/yellow in color, or milky in appearance [27]. It tends to occur only when provoked [8]. Many studies have shown physiologic nipple discharge to be benign, with no association within situ or invasive carcinoma [9,28,29]. Mammography Diagnostic If patient history and physical examination demonstrate physiologic nipple discharge and routine screening mammography is up to date, no further radiologic investigation is needed [28,29]. Digital Breast Tomosynthesis Diagnostic If patient history and physical examination demonstrate physiologic nipple discharge and routine screening mammography is up to date, no further radiologic investigation is needed [28,29]. US Breast If patient history and physical examination demonstrate physiologic nipple discharge and routine screening mammography is up to date, no further radiologic investigation is needed [28,29].
Evaluation of Nipple Discharge.  Special Imaging Considerations In 2018, Schulz-Wendtland et al [25] first described a technique combining digital breast tomosynthesis (DBT) and ductography and evaluated 5 women with pathologic nipple discharge. They found that DBT-ductography performed comparably to high-resolution ultrasound (US) in identifying suspicious imaging lesions. In 2020 Moschetta et al [26] used this nascent technique on 49 consecutive patients with spontaneous, unilateral, single- pore discharge and inconclusive conventional digital mammography and US. In this series, they compared DBT- Reprint requests to: publications@acr.org Evaluation of Nipple Discharge ductography with conventional full-field galactography and found improved sensitivity (95% versus 77%) and accuracy (96% versus 80%) with identical specificity (80%). OR Discussion of Procedures by Variant Variant 1: Adult female or male or transfeminine (male-to-female) or transmasculine (female-to-male). Physiologic nipple discharge. Initial imaging. Physiologic nipple discharge is defined as bilateral, originating from multiple ducts, white/green/yellow in color, or milky in appearance [27]. It tends to occur only when provoked [8]. Many studies have shown physiologic nipple discharge to be benign, with no association within situ or invasive carcinoma [9,28,29]. Mammography Diagnostic If patient history and physical examination demonstrate physiologic nipple discharge and routine screening mammography is up to date, no further radiologic investigation is needed [28,29]. Digital Breast Tomosynthesis Diagnostic If patient history and physical examination demonstrate physiologic nipple discharge and routine screening mammography is up to date, no further radiologic investigation is needed [28,29]. US Breast If patient history and physical examination demonstrate physiologic nipple discharge and routine screening mammography is up to date, no further radiologic investigation is needed [28,29].