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 US is useful in identifying invasive cancer and assessing extent of disease but has a diminished sensitivity for detecting DCIS [9,12,37,38]. In patients with pathologic nipple discharge, US identifies lesions not visible on mammography 63% to 69% of the time [30,39]. US adds specificity for some lesions when compared with mammography if it identifies the mammographic finding as a simple cyst or duct ectasia. US expands on ductography in its ability to visualize and detect abnormalities in multiple rather than single ducts [24]. Although more sensitive than mammography, US suffers from lower specificity in differentiating benign versus malignant lesions [9]. False-positive US results may be due to volume averaging with the ductal wall in a tortuous duct, intraductal and periductal fibrosis, adherent blood clots, or inspissated debris [31]. Previous studies have also reported mammography and US to be unreliable in predicting histology in patients with pathologic nipple discharge, which underscores the necessity of histological diagnosis [17,23]. In male and female patients, US is useful in identifying and assessing lesions and for biopsy guidance [40]. 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 Evaluation of Nipple Discharge the day of ductography so that a cannula can be placed in the appropriate duct.
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 US is useful in identifying invasive cancer and assessing extent of disease but has a diminished sensitivity for detecting DCIS [9,12,37,38]. In patients with pathologic nipple discharge, US identifies lesions not visible on mammography 63% to 69% of the time [30,39]. US adds specificity for some lesions when compared with mammography if it identifies the mammographic finding as a simple cyst or duct ectasia. US expands on ductography in its ability to visualize and detect abnormalities in multiple rather than single ducts [24]. Although more sensitive than mammography, US suffers from lower specificity in differentiating benign versus malignant lesions [9]. False-positive US results may be due to volume averaging with the ductal wall in a tortuous duct, intraductal and periductal fibrosis, adherent blood clots, or inspissated debris [31]. Previous studies have also reported mammography and US to be unreliable in predicting histology in patients with pathologic nipple discharge, which underscores the necessity of histological diagnosis [17,23]. In male and female patients, US is useful in identifying and assessing lesions and for biopsy guidance [40]. 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 Evaluation of Nipple Discharge the day of ductography so that a cannula can be placed in the appropriate duct.