In the setting of negative standard evaluations, ductography localized 76% of otherwise occult malignant/high-risk lesions and 91% of benign lesions [39]. When the standard evaluation is positive, ductography facilitated preoperative localization of the causative lesion in 78% of cases [39]. For detection of cancer in patients with pathologic nipple discharge, 2 studies showed the sensitivity, specificity, PPV, and NPV of ductography to be 75% to 100%, 6% to 49%, 16% to 18%, and 93% to 100%, respectively [16,23]. For detection of high-risk lesions, Adepoju et al [16] reported the sensitivity, specificity, PPV, and NPV of ductography to be 75%, 53%, 22%, and 92%, respectively. Ductography is more sensitive than mammography and US but has a lower specificity than both modalities. A negative ductogram does not reliably exclude an underlying cancer or high-risk lesion, with the false-negative rate reported to be as high as 20% to 30% [44]. As such, the primary value of ductography is to localize intraductal lesions and assist in surgery [45]. A study found that patients who underwent ductography-guided operations or any other surgical procedure with image guidance of the lesion were significantly more likely to have a specific underlying lesion identified than patients who underwent central duct excision alone [23,42]. At this time, there is no relevant literature available for use of ductography for evaluation of a male patient with nipple discharge. Contrast-enhanced breast MRI has a high sensitivity for detecting benign papillary lesions as well as in situ and invasive carcinoma [3]. Furthermore, MRI allows for the identification of index lesions in peripheral ducts that are beyond the area normally encompassed by terminal duct excision, ductography, or targeted US [44].
Evaluation of Nipple Discharge. In the setting of negative standard evaluations, ductography localized 76% of otherwise occult malignant/high-risk lesions and 91% of benign lesions [39]. When the standard evaluation is positive, ductography facilitated preoperative localization of the causative lesion in 78% of cases [39]. For detection of cancer in patients with pathologic nipple discharge, 2 studies showed the sensitivity, specificity, PPV, and NPV of ductography to be 75% to 100%, 6% to 49%, 16% to 18%, and 93% to 100%, respectively [16,23]. For detection of high-risk lesions, Adepoju et al [16] reported the sensitivity, specificity, PPV, and NPV of ductography to be 75%, 53%, 22%, and 92%, respectively. Ductography is more sensitive than mammography and US but has a lower specificity than both modalities. A negative ductogram does not reliably exclude an underlying cancer or high-risk lesion, with the false-negative rate reported to be as high as 20% to 30% [44]. As such, the primary value of ductography is to localize intraductal lesions and assist in surgery [45]. A study found that patients who underwent ductography-guided operations or any other surgical procedure with image guidance of the lesion were significantly more likely to have a specific underlying lesion identified than patients who underwent central duct excision alone [23,42]. At this time, there is no relevant literature available for use of ductography for evaluation of a male patient with nipple discharge. Contrast-enhanced breast MRI has a high sensitivity for detecting benign papillary lesions as well as in situ and invasive carcinoma [3]. Furthermore, MRI allows for the identification of index lesions in peripheral ducts that are beyond the area normally encompassed by terminal duct excision, ductography, or targeted US [44].