Because papillomas diagnosed on CNB are often excised, excisional biopsy instead of CNB may be useful when a papillary lesion is anticipated based on imaging findings. 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 pathologic 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 pathologic nipple discharge. Sestamibi MBI There is no relevant literature to support the use of molecular breast imaging (MBI) in the evaluation of a male or female patient with pathologic nipple discharge. Mammography Diagnostic 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]. Either mammography or US may be used as the initial imaging modality, on the basis of institutional preference and case-by-case consideration.
Evaluation of Nipple Discharge. Because papillomas diagnosed on CNB are often excised, excisional biopsy instead of CNB may be useful when a papillary lesion is anticipated based on imaging findings. 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 pathologic 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 pathologic nipple discharge. Sestamibi MBI There is no relevant literature to support the use of molecular breast imaging (MBI) in the evaluation of a male or female patient with pathologic nipple discharge. Mammography Diagnostic 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]. Either mammography or US may be used as the initial imaging modality, on the basis of institutional preference and case-by-case consideration.