Bookmarks
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Pathologic nipple discharge (PND) requires imaging work-up and usually tissue diagnosis
- Unilateral, uniductal, single orificial
- Suspicious (any of following)
- Bloody: Requires further evaluation
- Spontaneous serosanguineous or serous
- Watery (clear)
- Discharge of any color in association with palpable lump, skin retraction, nipple retraction
- Nonbloody discharge only with stimulation, or incidental during mammogram, is usually of no significance
- Physiologic nipple discharge
- Usually bilateral, multiductal, spontaneous or stimulated
- White, green, or cloudy yellow
- Galactorrhea: Discharge of milk from breast
- Physiologic: Associated with pregnancy, breastfeeding, induced by stimulation
- Nonphysiologic: Due to underlying abnormality (hypothyroidism, pituitary adenoma) or exposure to some drugs (e.g., antihypertensive, antiemetic, histamine-2 receptor antagonists)
- Pathologic nipple discharge (PND) requires imaging work-up and usually tissue diagnosis
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Ductography
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Treatment
Alternative Procedures
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Grimm LJ et al: Concordant, non-atypical breast papillomas do not require surgical excision: a 10-year multi-institution study and review of the literature. Clin Imaging. 51:180-185, 2018
- Li GZ et al: Evaluating the risk of underlying malignancy in patients with pathologic nipple discharge. Breast J. 24(4):624-627, 2018
- Patel BK et al: Nipple discharge: imaging variability among U.S. radiologists. AJR Am J Roentgenol. 211(4):920-925, 2018
- Bahl M et al: Journal club: diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge. AJR Am J Roentgenol. 209(6):1404-1410, 2017
- Berger N et al: Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: a systematic review and meta-analysis. AJR Am J Roentgenol. 209(2):465-471, 2017
- Castellano I et al: The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients. PLoS One. 12(8):e0182073, 2017
- Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria® evaluation of nipple discharge. J Am Coll Radiol. 14(5S):S138-S153, 2017
- Lesetedi C et al: Indicators of breast cancer in patients undergoing microdochectomy for a pathological nipple discharge in a middle-income country. J Surg Res. 220:336-340, 2017
- Bahl M et al: Diagnostic value of ultrasound in female patients with nipple discharge. AJR Am J Roentgenol. 205(1):203-8, 2015
- Manganaro L et al: Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography. Biomed Res Int. 2015:806368, 2015
- Patel BK et al: Management of nipple discharge and the associated imaging findings. Am J Med. 128(4):353-60, 2015
- Albrecht C et al: Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests. Onkologie. 36(1-2):12-6, 2013
- Kaplan R et al: Cytological evaluation of bloody nipple discharge fluid. Diagn Cytopathol. 41(2):183-5, 2013
- Chen L et al: Bloody nipple discharge is a predictor of breast cancer risk: a meta-analysis. Breast Cancer Res Treat. 132(1):9-14, 2012
- Ferris-James DM et al: Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics. 32(4):1009-30, 2012
- Kalu ON et al: The diagnostic value of nipple discharge cytology: breast imaging complements predictive value of nipple discharge cytology. J Surg Oncol. 106(4):381-5, 2012
- Kamali S et al: Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer. 21(2):154-61, 2012
- Sabel MS et al: Is duct excision still necessary for all cases of suspicious nipple discharge? Breast J. 18(2):157-62, 2012
- Lorenzon M et al: Magnetic resonance imaging in patients with nipple discharge: should we recommend it? Eur Radiol. 21(5):899-907, 2011
- Seow JH et al: Nipple discharge in a screening programme: imaging findings with pathological correlation. J Med Imaging Radiat Oncol. 55(6):577-86, 2011
- Dolan RT et al: Nipple discharge and the efficacy of duct cytology in evaluating breast cancer risk. Surgeon. 8(5):252-8, 2010
- Morrogh M et al: Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg. 200:73-80, 2010
- Sarica O et al: Evaluation of nipple-areola complex with ultrasonography and magnetic resonance imaging. J Comput Assist Tomogr. 34(4):575-86, 2010
- Zervoudis S et al: Nipple discharge screening. Womens Health (Lond Engl). 6(1):135-51, 2010
- Chang JM et al: Does ultrasound-guided directional vacuum-assisted removal help eliminate abnormal nipple discharge in patients with benign intraductal single mass? Korean J Radiol. 10(6):575-80, 2009
- Kim SH et al: Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis. Arch Gynecol Obstet. 280(2):217-22, 2009
- Maxwell AJ: Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 64(8):801-6, 2009
- Nicholson BT et al: Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 29(2):509-23, 2009
- Tokuda Y et al: Evaluation of suspicious nipple discharge by magnetic resonance mammography based on breast imaging reporting and data system magnetic resonance imaging descriptors. J Comput Assist Tomogr. 33(1):58-62, 2009
- Da Costa D et al: Common and unusual diseases of the nipple-areolar complex. Radiographics. 27 Suppl 1():S65-77, 2007
- Hirose M et al: MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics. 27 Suppl 1:S183-96, 2007
- Morrogh M et al: The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 14(12):3369-77, 2007
- Rissanen T et al: Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. J Ultrasound Med. 26(8):1031-9, 2007
- Escobar PF et al: The clinical applications of mammary ductoscopy. Am J Surg. 191(2):211-5, 2006
- Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
- Daniel BL et al: Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging. 21(8):887-92, 2003
- Dennis MA et al: Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. AJR Am J Roentgenol. 174(5):1263-8, 2000
- Orel SG et al: MR imaging in patients with nipple discharge: initial experience. Radiology. 216(1):248-54, 2000
- Sickles EA: Galactography and other imaging investigations of nipple discharge. Lancet. 356(9242):1622-3, 2000
- Hild F et al: Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev. 7 Suppl 1:S57-62, 1998
- Cardenosa G et al: Ductography of the breast: technique and findings. AJR Am J Roentgenol. 162(5):1081-7, 1994
- Tabár L et al: Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 149(1):31-8, 1983
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Pathologic nipple discharge (PND) requires imaging work-up and usually tissue diagnosis
- Unilateral, uniductal, single orificial
- Suspicious (any of following)
- Bloody: Requires further evaluation
- Spontaneous serosanguineous or serous
- Watery (clear)
- Discharge of any color in association with palpable lump, skin retraction, nipple retraction
- Nonbloody discharge only with stimulation, or incidental during mammogram, is usually of no significance
- Physiologic nipple discharge
- Usually bilateral, multiductal, spontaneous or stimulated
- White, green, or cloudy yellow
- Galactorrhea: Discharge of milk from breast
- Physiologic: Associated with pregnancy, breastfeeding, induced by stimulation
- Nonphysiologic: Due to underlying abnormality (hypothyroidism, pituitary adenoma) or exposure to some drugs (e.g., antihypertensive, antiemetic, histamine-2 receptor antagonists)
- Pathologic nipple discharge (PND) requires imaging work-up and usually tissue diagnosis
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Ductography
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Treatment
Alternative Procedures
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Grimm LJ et al: Concordant, non-atypical breast papillomas do not require surgical excision: a 10-year multi-institution study and review of the literature. Clin Imaging. 51:180-185, 2018
- Li GZ et al: Evaluating the risk of underlying malignancy in patients with pathologic nipple discharge. Breast J. 24(4):624-627, 2018
- Patel BK et al: Nipple discharge: imaging variability among U.S. radiologists. AJR Am J Roentgenol. 211(4):920-925, 2018
- Bahl M et al: Journal club: diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge. AJR Am J Roentgenol. 209(6):1404-1410, 2017
- Berger N et al: Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: a systematic review and meta-analysis. AJR Am J Roentgenol. 209(2):465-471, 2017
- Castellano I et al: The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients. PLoS One. 12(8):e0182073, 2017
- Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria® evaluation of nipple discharge. J Am Coll Radiol. 14(5S):S138-S153, 2017
- Lesetedi C et al: Indicators of breast cancer in patients undergoing microdochectomy for a pathological nipple discharge in a middle-income country. J Surg Res. 220:336-340, 2017
- Bahl M et al: Diagnostic value of ultrasound in female patients with nipple discharge. AJR Am J Roentgenol. 205(1):203-8, 2015
- Manganaro L et al: Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography. Biomed Res Int. 2015:806368, 2015
- Patel BK et al: Management of nipple discharge and the associated imaging findings. Am J Med. 128(4):353-60, 2015
- Albrecht C et al: Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests. Onkologie. 36(1-2):12-6, 2013
- Kaplan R et al: Cytological evaluation of bloody nipple discharge fluid. Diagn Cytopathol. 41(2):183-5, 2013
- Chen L et al: Bloody nipple discharge is a predictor of breast cancer risk: a meta-analysis. Breast Cancer Res Treat. 132(1):9-14, 2012
- Ferris-James DM et al: Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics. 32(4):1009-30, 2012
- Kalu ON et al: The diagnostic value of nipple discharge cytology: breast imaging complements predictive value of nipple discharge cytology. J Surg Oncol. 106(4):381-5, 2012
- Kamali S et al: Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer. 21(2):154-61, 2012
- Sabel MS et al: Is duct excision still necessary for all cases of suspicious nipple discharge? Breast J. 18(2):157-62, 2012
- Lorenzon M et al: Magnetic resonance imaging in patients with nipple discharge: should we recommend it? Eur Radiol. 21(5):899-907, 2011
- Seow JH et al: Nipple discharge in a screening programme: imaging findings with pathological correlation. J Med Imaging Radiat Oncol. 55(6):577-86, 2011
- Dolan RT et al: Nipple discharge and the efficacy of duct cytology in evaluating breast cancer risk. Surgeon. 8(5):252-8, 2010
- Morrogh M et al: Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg. 200:73-80, 2010
- Sarica O et al: Evaluation of nipple-areola complex with ultrasonography and magnetic resonance imaging. J Comput Assist Tomogr. 34(4):575-86, 2010
- Zervoudis S et al: Nipple discharge screening. Womens Health (Lond Engl). 6(1):135-51, 2010
- Chang JM et al: Does ultrasound-guided directional vacuum-assisted removal help eliminate abnormal nipple discharge in patients with benign intraductal single mass? Korean J Radiol. 10(6):575-80, 2009
- Kim SH et al: Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis. Arch Gynecol Obstet. 280(2):217-22, 2009
- Maxwell AJ: Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 64(8):801-6, 2009
- Nicholson BT et al: Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 29(2):509-23, 2009
- Tokuda Y et al: Evaluation of suspicious nipple discharge by magnetic resonance mammography based on breast imaging reporting and data system magnetic resonance imaging descriptors. J Comput Assist Tomogr. 33(1):58-62, 2009
- Da Costa D et al: Common and unusual diseases of the nipple-areolar complex. Radiographics. 27 Suppl 1():S65-77, 2007
- Hirose M et al: MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics. 27 Suppl 1:S183-96, 2007
- Morrogh M et al: The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 14(12):3369-77, 2007
- Rissanen T et al: Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. J Ultrasound Med. 26(8):1031-9, 2007
- Escobar PF et al: The clinical applications of mammary ductoscopy. Am J Surg. 191(2):211-5, 2006
- Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
- Daniel BL et al: Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging. 21(8):887-92, 2003
- Dennis MA et al: Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. AJR Am J Roentgenol. 174(5):1263-8, 2000
- Orel SG et al: MR imaging in patients with nipple discharge: initial experience. Radiology. 216(1):248-54, 2000
- Sickles EA: Galactography and other imaging investigations of nipple discharge. Lancet. 356(9242):1622-3, 2000
- Hild F et al: Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev. 7 Suppl 1:S57-62, 1998
- Cardenosa G et al: Ductography of the breast: technique and findings. AJR Am J Roentgenol. 162(5):1081-7, 1994
- Tabár L et al: Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 149(1):31-8, 1983
