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Nipple discharge: The state of the art
Over 80% of females experience nipple discharge during their life. Differently from lactational (milk production) and physiological (white, green, or yellow), which are usually bilateral and involving multiple ducts, pathologic nipple discharge (PND) is a spontaneous commonly single-duct and unilate...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The British Institute of Radiology.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592406/ https://www.ncbi.nlm.nih.gov/pubmed/33178912 http://dx.doi.org/10.1259/bjro.20180016 |
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author | Panzironi, Giovanna Pediconi, Federica Sardanelli, Francesco |
author_facet | Panzironi, Giovanna Pediconi, Federica Sardanelli, Francesco |
author_sort | Panzironi, Giovanna |
collection | PubMed |
description | Over 80% of females experience nipple discharge during their life. Differently from lactational (milk production) and physiological (white, green, or yellow), which are usually bilateral and involving multiple ducts, pathologic nipple discharge (PND) is a spontaneous commonly single-duct and unilateral, clear, serous, or bloody secretion. Mostly caused by intraductal papilloma(s) or ductal ectasia, in 5-33% of cases is due to an underlying malignancy. After clinical history and physical examination, mammography is the first step after 39, but its sensitivity is low (7–26%). Ultrasound shows higher sensitivity (63–100%). Nipple discharge cytology is limited by a false negative rate over 50%. Galactography is an invasive technique that may cause discomfort and pain; it can be performed only when the duct discharge is demonstrated at the time of the study, with incomplete/failed examination rate up to 15% and a difficult differentiation between malignant and benign lesions. Ductoscopy, performed under local anesthesia in outpatients, provides a direct visualization of intraductal lesions, allowing for directed excision and facilitating a targeted surgery. Its sensitivity reaches 94%; however, it is available in only few centers and most clinicians are unfamiliar with its use. PND has recently emerged as a new indication for contrast-enhanced breast MRI, showing sensitivity superior to galactography, with an overall sensitivity up to 96%, also allowing tailored surgery. Surgery no longer can be considered the standard approach to PND. We propose a state-of-the art flowchart for the management of nipple discharge, including ductoscopy and breast MRI as best options. |
format | Online Article Text |
id | pubmed-7592406 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | The British Institute of Radiology. |
record_format | MEDLINE/PubMed |
spelling | pubmed-75924062020-11-10 Nipple discharge: The state of the art Panzironi, Giovanna Pediconi, Federica Sardanelli, Francesco BJR Open Review Article Over 80% of females experience nipple discharge during their life. Differently from lactational (milk production) and physiological (white, green, or yellow), which are usually bilateral and involving multiple ducts, pathologic nipple discharge (PND) is a spontaneous commonly single-duct and unilateral, clear, serous, or bloody secretion. Mostly caused by intraductal papilloma(s) or ductal ectasia, in 5-33% of cases is due to an underlying malignancy. After clinical history and physical examination, mammography is the first step after 39, but its sensitivity is low (7–26%). Ultrasound shows higher sensitivity (63–100%). Nipple discharge cytology is limited by a false negative rate over 50%. Galactography is an invasive technique that may cause discomfort and pain; it can be performed only when the duct discharge is demonstrated at the time of the study, with incomplete/failed examination rate up to 15% and a difficult differentiation between malignant and benign lesions. Ductoscopy, performed under local anesthesia in outpatients, provides a direct visualization of intraductal lesions, allowing for directed excision and facilitating a targeted surgery. Its sensitivity reaches 94%; however, it is available in only few centers and most clinicians are unfamiliar with its use. PND has recently emerged as a new indication for contrast-enhanced breast MRI, showing sensitivity superior to galactography, with an overall sensitivity up to 96%, also allowing tailored surgery. Surgery no longer can be considered the standard approach to PND. We propose a state-of-the art flowchart for the management of nipple discharge, including ductoscopy and breast MRI as best options. The British Institute of Radiology. 2018-11-07 /pmc/articles/PMC7592406/ /pubmed/33178912 http://dx.doi.org/10.1259/bjro.20180016 Text en © 2018 The Authors. Published by the British Institute of Radiology This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reprhttp://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted non-commercial reuse, provided the original author and source are credited. |
spellingShingle | Review Article Panzironi, Giovanna Pediconi, Federica Sardanelli, Francesco Nipple discharge: The state of the art |
title | Nipple discharge: The state of the art |
title_full | Nipple discharge: The state of the art |
title_fullStr | Nipple discharge: The state of the art |
title_full_unstemmed | Nipple discharge: The state of the art |
title_short | Nipple discharge: The state of the art |
title_sort | nipple discharge: the state of the art |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592406/ https://www.ncbi.nlm.nih.gov/pubmed/33178912 http://dx.doi.org/10.1259/bjro.20180016 |
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