A recent study suggests that patients with nonbloody pathologic nipple discharge, a benign CNB, or normal imaging (cancer risk <2%) may be considered for nonoperative management if they do not have risk factors such as prior ipsilateral breast cancer, BRCA mutation, or atypia on CNB [61]. In addition, US does not reliably distinguish between benign and malignant small intraductal lesions [9]. Therefore, the decision to perform percutaneous biopsy versus major duct excision should involve the patient and their health care provider. Image-guided CNB is equally useful in male patients for obtaining tissue diagnosis and assisting in patient management [40]. Image-guided CNB is not indicated as the initial examination to evaluate pathological nipple discharge. Image-Guided Fine Needle Aspiration Breast Once a suspicious lesion that is likely responsible for the pathologic nipple discharge is identified on imaging, image-guided FNA or CNB can be performed for histological diagnosis. Although some institutions demonstrate good results using FNA, larger series have shown that core biopsy is superior to FNA in terms of sensitivity, specificity, and correct histological grading of a lesion [54,55]. Image-guided FNA is not indicated as the initial examination to evaluate pathological nipple discharge. Sestamibi MBI There is no relevant literature to support the use of MBI in the evaluation of a male or female patient with pathologic 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 in assessing the symptomatic breast [35,36]. Ductography There is no relevant literature to support the use of ductography for the evaluation of male patients with nipple discharge.
Evaluation of Nipple Discharge. A recent study suggests that patients with nonbloody pathologic nipple discharge, a benign CNB, or normal imaging (cancer risk <2%) may be considered for nonoperative management if they do not have risk factors such as prior ipsilateral breast cancer, BRCA mutation, or atypia on CNB [61]. In addition, US does not reliably distinguish between benign and malignant small intraductal lesions [9]. Therefore, the decision to perform percutaneous biopsy versus major duct excision should involve the patient and their health care provider. Image-guided CNB is equally useful in male patients for obtaining tissue diagnosis and assisting in patient management [40]. Image-guided CNB is not indicated as the initial examination to evaluate pathological nipple discharge. Image-Guided Fine Needle Aspiration Breast Once a suspicious lesion that is likely responsible for the pathologic nipple discharge is identified on imaging, image-guided FNA or CNB can be performed for histological diagnosis. Although some institutions demonstrate good results using FNA, larger series have shown that core biopsy is superior to FNA in terms of sensitivity, specificity, and correct histological grading of a lesion [54,55]. Image-guided FNA is not indicated as the initial examination to evaluate pathological nipple discharge. Sestamibi MBI There is no relevant literature to support the use of MBI in the evaluation of a male or female patient with pathologic 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 in assessing the symptomatic breast [35,36]. Ductography There is no relevant literature to support the use of ductography for the evaluation of male patients with nipple discharge.