Katie M. Davis, DO; Robin N. Sobolewski, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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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)
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
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Related Differential Diagnoses
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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)
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
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