However, mammography has its value in detecting suspicious microcalcifications, given the high incidence of patients with DCIS presenting with nipple discharge. Evaluation of Nipple Discharge Digital Breast Tomosynthesis Diagnostic Although there is no relevant literature to support the use of DBT alone in assessing nipple discharge, mammography is useful for evaluating pathologic nipple discharge in male and female patients in this age group [30]. Early studies with DBT demonstrate promise is assessing the symptomatic breast [35,36]. US Breast The sensitivity of US for palpable or nonpalpable breast cancer is higher than that of mammography (95.7% versus 60.9%) for women 30 to 39 years of age [63,64]. Hence, US may be useful as the initial imaging modality, with mammography added when necessary. Ductography Ductography may demonstrate small lesions and localize the duct responsible for the nipple discharge. Ductography is minimally invasive, may be uncomfortable, and can be time-consuming. The procedure is technically challenging with 10% to 15% of cases resulting in inadequate or incomplete results [41,42]. The discharge must be present on the day of ductography so that a cannula can be placed in the appropriate duct. Failure to cannulate the discharging duct may lead to a false negative [43]. Ductography is not recommended in lactating women or patients with active mastitis. Known hypersensitivity to iodinated contrast agents is a relative contraindication. Findings on ductography suggestive of malignant or papillary lesions include intraductal filling defect, partial or complete obstruction of a duct, duct expansion or distortion, and duct wall irregularity [1]. In patients with pathologic nipple discharge and a negative mammogram and US, Morrogh et al [44] reported the PPV and NPV of ductography for the detection of cancer and high-risk lesions to be 19% and 63%, respectively.
Evaluation of Nipple Discharge. However, mammography has its value in detecting suspicious microcalcifications, given the high incidence of patients with DCIS presenting with nipple discharge. Evaluation of Nipple Discharge Digital Breast Tomosynthesis Diagnostic Although there is no relevant literature to support the use of DBT alone in assessing nipple discharge, mammography is useful for evaluating pathologic nipple discharge in male and female patients in this age group [30]. Early studies with DBT demonstrate promise is assessing the symptomatic breast [35,36]. US Breast The sensitivity of US for palpable or nonpalpable breast cancer is higher than that of mammography (95.7% versus 60.9%) for women 30 to 39 years of age [63,64]. Hence, US may be useful as the initial imaging modality, with mammography added when necessary. Ductography Ductography may demonstrate small lesions and localize the duct responsible for the nipple discharge. Ductography is minimally invasive, may be uncomfortable, and can be time-consuming. The procedure is technically challenging with 10% to 15% of cases resulting in inadequate or incomplete results [41,42]. The discharge must be present on the day of ductography so that a cannula can be placed in the appropriate duct. Failure to cannulate the discharging duct may lead to a false negative [43]. Ductography is not recommended in lactating women or patients with active mastitis. Known hypersensitivity to iodinated contrast agents is a relative contraindication. Findings on ductography suggestive of malignant or papillary lesions include intraductal filling defect, partial or complete obstruction of a duct, duct expansion or distortion, and duct wall irregularity [1]. In patients with pathologic nipple discharge and a negative mammogram and US, Morrogh et al [44] reported the PPV and NPV of ductography for the detection of cancer and high-risk lesions to be 19% and 63%, respectively.