What are the limitations of breast imaging for nipple discharge evaluation?

Updated: Aug 08, 2018
  • Author: Edward Azavedo, MD, PhD; Chief Editor: Eugene C Lin, MD  more...
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Ductography (galactography) is not indicated unless the nipple discharge is spontaneous, unilateral, and expressed from a single pore. Ductography is occasionally technically impossible because of failed catheterization of the pore because of the need to reproduce the discharge on the day of the investigation. It is invasive, with a risk of extravasation and complications due to allergy to the iodinated contrast medium, or mastitis. [3]   Ductoscopy detects about 94% of all underlying malignancies in patients with PND, but it oes not permit reliable discrimination between malignant and benign findings. [6]

The major disadvantage of  MRI is that it often detects additional images or false positives, which result in MRI monitoring or biopsies being taken that are unrelated to the pathologic nipple discharge. It appears to be more difficult with this technique to characterize an endoductal lesion and therefore guide the diagnosis toward a benign or malignant lesion, which then necessitates repeat ultrasound. [3]

High-resolution ultrasonography is not available at all breast-imaging centers. In addition, it is operator dependent and requires expertise for the identification of small intraductal structures.

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