What is the role of MRI in nipple discharge evaluation?

Updated: Aug 08, 2018
  • Author: Edward Azavedo, MD, PhD; Chief Editor: Eugene C Lin, MD  more...
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MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge when conventional imaging is negative. A retrospective study of 118 women who underwent MRI for evaluation of nipple discharge reported that in women with negative or inconclusive mammography findings, the risk of malignancy is low, at 5.7%. With negative MRI findings, the risk of malignancy is less than 4%. A negative MRI in this symptomatic population may obviate the need for duct exploration and excision. [8, 9]  

The most common abnormality seen with a pathologic nipple discharge is enhancement without a mass (EWM) for malignant, atypical, or papillary lesions. In decreasing order of frequency, these are ductal EWM, focal regions, and segmentally or regionally distributed EWM. [10, 11] A ductal or segmental EWM can be seen in both papillomas and papillomatoses. In this situation, the segmental spatial distribution and micronodular or annular nature of the lesion are the EWM features, which have the greatest positive predictive value for malignancy. [3]

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