647 research outputs found
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 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
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