Currently, there is no relevant literature for the use of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET in the evaluation of a male or female patient with pathologic nipple discharge. Image-Guided Core Biopsy Breast Previous studies showed that mammography, US, and ductography are unreliable in predicting histology in patients with pathologic nipple discharge [17,23,44], which underscores the importance of histological diagnosis of lesions identified on imaging. The biopsy procedures may be guided by stereotactic mammography, US, ductography, or MRI, depending on the imaging modality that best depicts the lesion. CNB is preferred over FNA because the larger gauge needle improves sampling [54,55]. Placement of a tissue marker at the end of the biopsy allows for needle Evaluation of Nipple Discharge localization and excision if the biopsied lesion yields malignant or high-risk histology. Vacuum-assisted CNB is particularly useful in assuring complete sampling of small intraductal papillary lesions [24]. Although biopsy is a diagnostic procedure, the process of removing enough of the intraductal papillary lesion during vacuum-assisted core biopsy may be therapeutic and will lead to permanent cessation of nipple discharge in 90% to 97.2% of patients [24,56]. However, Reiner et al [57] cautioned that ductography-guided 11-gauge vacuum-assisted stereotactic biopsy should not be used as a substitute for surgical duct excision in cases of pathologic nipple discharge with abnormalities on ductography because of the high underestimation rate (50%) for high-risk lesions and DCIS, false- negative rate (7%), and histopathological detection of lesion remnants in every case. Papillomas are historically considered high-risk lesions, with reported rates of upgrade to malignancy between 3% and 14% [58,59]. The management of papillomas diagnosed on CNB is controversial and varies by institution [60].
Evaluation of Nipple Discharge. Currently, there is no relevant literature for the use of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET in the evaluation of a male or female patient with pathologic nipple discharge. Image-Guided Core Biopsy Breast Previous studies showed that mammography, US, and ductography are unreliable in predicting histology in patients with pathologic nipple discharge [17,23,44], which underscores the importance of histological diagnosis of lesions identified on imaging. The biopsy procedures may be guided by stereotactic mammography, US, ductography, or MRI, depending on the imaging modality that best depicts the lesion. CNB is preferred over FNA because the larger gauge needle improves sampling [54,55]. Placement of a tissue marker at the end of the biopsy allows for needle Evaluation of Nipple Discharge localization and excision if the biopsied lesion yields malignant or high-risk histology. Vacuum-assisted CNB is particularly useful in assuring complete sampling of small intraductal papillary lesions [24]. Although biopsy is a diagnostic procedure, the process of removing enough of the intraductal papillary lesion during vacuum-assisted core biopsy may be therapeutic and will lead to permanent cessation of nipple discharge in 90% to 97.2% of patients [24,56]. However, Reiner et al [57] cautioned that ductography-guided 11-gauge vacuum-assisted stereotactic biopsy should not be used as a substitute for surgical duct excision in cases of pathologic nipple discharge with abnormalities on ductography because of the high underestimation rate (50%) for high-risk lesions and DCIS, false- negative rate (7%), and histopathological detection of lesion remnants in every case. Papillomas are historically considered high-risk lesions, with reported rates of upgrade to malignancy between 3% and 14% [58,59]. The management of papillomas diagnosed on CNB is controversial and varies by institution [60].